Abstract
The blood of two patients were investigated for immune hemolytic anemia after administration of the following antibiotic drugs: Aspoxicillin (Asp. Doyle®) in the first case, Sodium Sulbactam/Sodium Cefoperazone (SBT/CPZ, Sulperazon®) in the second case.
Anti-Asp antibodies of the IgG1 subclass were found in the patient's sera and in the eluates of direct antiglobulin test (DAT) positive red blood cells in the first case, therefore we suggested that hemolysis was caused by anti-Asp antibodies reacting by a well-known ‘hapten-type’ drug absorption mechanism.
The other, the autologous red blood cells in the second case was positive by DAT, but only with anti-C3d reagents, and when the patient's serum was incubated (2 hrs at 37°C) with enzyme-treated red blood cells in the presence of the drugs (SBT-CPZ) and complement, hemagglutination was obserbed by indirect antiglobulin test (IAT). It was interesting that, at the time of these findings, the patient's serum reacted weakly with SBT-coated red blood cells but not with CPZ-coated red blood cells by the flow cytometric analysis. These would suggest that so-call ‘immune complex’ mechanism and another mechanism (perhaps drug absorption mechanism) were involved. It is probable that one or both of these mechanisms were responsible for the patient's immune hemolytic anemia in the second case.
