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Tazobactam‐induced haemolytic anaemia, possibly caused by non‐immunological adsorption of IgG onto patient's red cells
Author(s) -
Broadberry R. E.,
Farren T. W.,
Bevin S. V.,
Kohler J. A.,
Yates S.,
Skidmore I.,
Poole J.,
Garratty G.
Publication year - 2004
Publication title -
transfusion medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.471
H-Index - 59
eISSN - 1365-3148
pISSN - 0958-7578
DOI - 10.1111/j.0958-7578.2004.00481.x
Subject(s) - antibody , haemolysis , chemistry , medicine , hemolysis , immunology , bilirubin , immunoglobulin g
Summary. A patient with pneumonia was treated with Tazocin (piperacillin/tazobactam). However, the expected haemoglobin (Hb) increment after transfusion was not achieved. Plasma bilirubin and lactate dehydrogenase were raised. The direct antiglobulin test (DAT) was positive (4+) for immunoglobulin G (IgG) only, but no RBC antibodies were demonstrable in the plasma or an eluate from the patient's RBCs. Drug‐induced haemolysis was suspected. After discontinuing Tazocin administration, Hb and bilirubin levels returned to expected values. The patient's plasma gave a positive (3+) indirect antiglobulin reaction only with RBCs pretreated with tazobactam. However, random patient plasmas also gave weak (± to 1+) reactions, indicating non‐immunological adsorption of IgG onto RBCs rather than specific anti‐tazobactam antibodies. Subsequently, plasma samples with varying IgG levels (0·8–89·7 g L −1 ) were tested against RBCs pretreated with tazobactam. The amount of plasma IgG non‐immunologically adsorbed onto the drug‐coated RBCs was found to correlate directly with the plasma IgG level. The patient had a high plasma IgG level (41·6 g L −1 ) which explains why the antiglobulin test was stronger with the patient's plasma than with random plasma samples. Previous reports (Garratty & Arndt, (1998) British Journal of Haematology , 100 , 777–783; Arndt & Garratty (2000) Transfusion , 40 , 29S) suggested that non‐immunological coating of RBCs with IgG may affect RBC survival; our results would support that suggestion. This is the first reported case of haemolytic anaemia associated with tazobactam.