Drug-induced immune haemolytic anaemia caused by cefamandole sodium: Complete serologic studies and clinical follow-up.

[BACKGROUND AND OBJECTIVES] There is limited knowledge regarding cefamandole-related drug-induced immune haemolytic anaemia (DIIHA). We conducted a comprehensive serological and clinical follow-up study of a case of cefamandole-induced DIIHA to improve understanding of this condition.

[MATERIALS AND METHODS] A patient with advanced hepatocellular carcinoma developed severe haemolytic anaemia along with significant worsening of hepatic and renal function after intravenous cefamandole was administered for a urinary tract infection. Serological testing included the direct antiglobulin tests (DATs), irregular red blood cell (RBC) antibody screening and detection of cefamandole-dependent antibodies using two standard methods for drug-dependent antibodies: 'testing in the presence of soluble drug' and 'testing drug-treated RBCs', which were performed after cefamandole discontinuation. Clinical follow-up was conducted for 41 days after drug cessation.

[RESULTS] The results of DAT for anti-IgG and anti-C3d were strongly positive, while irregular RBC antibody screening was negative. Plasma samples collected at different points from 13 to 38 days after cefamandole discontinuation were incubated with cefamandole-coated RBCs at 37°C, revealing both IgM and IgG cefamandole-dependent antibodies, with a maximum titre of 16. Following treatment with blood transfusion, intravenous immunoglobulin (IVIG), and methylprednisolone, anaemia and organ dysfunction showed marked improvement. Therefore, the patient was diagnosed with cefamandole-induced DIIHA.

[CONCLUSIONS] This study may be the second serological analysis and the first comprehensive clinical follow-up of cefamandole-induced DIIHA. It demonstrates that cefamandole-dependent antibodies can activate complement, leading to severe haemolytic anaemia and hepatic and renal impairment. The 'testing drug-treated RBCs' method is suitable for detecting cefamandole-dependent antibodies.