Piperacillin-tazobactam induced immune hemolytic anemia led to increased renal impairment and eventual death from multiple organ failure in a patient with hypertensive nephropathy: case report and literature review

BMC Nephrology

Case Report

Jiajun Zeng¹  Ganping Guo¹  Yuanjun Wu²  Yong Wu³  Yueqin Wu³  Yan Liu³ 

[1] Department of Blood Transfusion, Dongguan Maternal and Child Health Hospital, Dongguan, China;Department of Blood Transfusion, Dongguan Maternal and Child Health Hospital, Dongguan, China;Department of Laboratory Medicine, Dongguan Maternal and Child Health Hospital, Dongguan Key Clinical Specialist, Dongguan, China;Department of Blood Transfusion, Dongguan Tungwah Hospital, Dongguan, China;

关键词: Piperacillin;    Drug-dependent antibody;    Antiglobulin test;    Drug-induced immune hemolytic anemia (DIIHA);    Renal dysfunction after administration;   

DOI  :  10.1186/s12882-023-03235-w

 received in 2022-06-15, accepted in 2023-06-06,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundPiperacillin is one of the most common drugs that cause drug-induced immune hemolytic anemia, but a complete description of the serological features and course of the disease is rare. This study completely describes the serological characteristics and course of a patient with hypertensive nephropathy who developed drug-induced immune hemolytic anemia and worsened renal function during repeated administration of piperacillin-tazobactam.Case presentationA 79-year-old male patient with hypertensive nephropathy who developed severe hemolytic anemia and worsened renal function during intravenous piperacillin-tazobactam anti-infective treatment due to lung infection. Serological tests showed that the result of the direct antiglobulin test for anti-IgG was positive (4 +) and anti-C3d was negative, and the irregular red blood cell antibody screening test was negative. Plasma samples collected at different times from 2 days before to 12 days after the discontinuation of piperacillin-tazobactam administration were incubated with piperacillin solution and red blood cells of O-type healthy blood donors at 37 °C, IgG piperacillin-dependent antibodies were detected, and the highest titer was 128. However, no tazobactam-dependent antibody was detected in any plasma samples. Therefore, the patient was diagnosed with piperacillin-induced immune hemolytic anemia. Although blood transfusion and continuous renal replacement therapy were given, the patient died of multiple organ failure 15 days after the administration of piperacillin-tazobactam was stopped.ConclusionThis is the first complete description of the disease course and serological changes of piperacillin-induced immune hemolytic anemia, which is bound to help deepen the understanding of drug-induced immune hemolytic anemia and draw profound lessons from it.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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