一例头孢唑肟钠诱发免疫性溶血性贫血的病例报告及文献学习

doi:10.3969/j.issn.1671-2587.2025.04.016

临床输血与检验 ›› 2025, Vol. 27 ›› Issue (4): 540-546.DOI: 10.3969/j.issn.1671-2587.2025.04.016

一例头孢唑肟钠诱发免疫性溶血性贫血的病例报告及文献学习

高明¹, 曾群娟², 杨贺才³, 沈伟⁴

¹奉贤区中心医院,上海 201400;
²达州市中心医院,四川 635000;
³河南省红十字血液中心,河南 450012;
⁴上海市血液中心,上海 200051

收稿日期:2025-04-16 出版日期:2025-08-20 发布日期:2025-08-22
通讯作者: 沈伟,主要从事血型免疫学研究,（E-mail）danielsam@qq.com。
作者简介:高明,主要从事临床输血及血型免疫学研究,（E-mail）2538702092@qq.com。并列第一作者：曾群娟,主要从事临床输血及血型免疫学研究,（E-mail）379573270@qq.com。

Ceftizoxime Sodium-induced Immune Hemolytic Anemia: A Case Report and Literature Review

GAO Ming¹, ZENG Qunjuan², YANG Hecai³, SHEN Wei⁴

¹Fengxian Central Hospital, Shanghai 201400;
²Dazhou Central Hospital, Sichuan 635000;
³Henan Red Cross Blood Center, Henan 450012;
⁴Shanghai Blood Center, Shanghai 200051

Received:2025-04-16 Online:2025-08-20 Published:2025-08-22

摘要/Abstract

摘要： 目的探讨头孢唑肟钠诱发免疫性溶血性贫血患者的血清学特征及临床诊断。方法选取2024年4月我院1例使用头孢唑肟钠药物后诱发免疫性溶血性贫血的患者为研究对象。采用直接抗球蛋白试验（direct antiglobulin test, DAT）、血清抗体筛查、药物依赖性抗体检测及体外溶血试验等血清学技术鉴定药物抗体。结果患者DAT显示抗-IgG和抗-C3d阳性,血清抗体筛查呈宽反应性,放散试验阴性,药物抗体检测证实存在头孢唑肟钠依赖性IgM（效价32）及IgG（效价16）抗体。体外实验表明,该药物抗体在钙离子与补体共同参与下可导致红细胞溶血。结论头孢唑肟钠可通过免疫复合物机制激活补体导致急性血管内溶血。快速识别药物诱导的免疫性溶血性贫血（drug-induced immune hemolytic anemia, DIIHA）,建立合适的实验室各种药物抗体检测的流程和方法,及时停用致敏药物是治疗关键。

关键词: 头孢唑肟钠, 免疫溶血性贫血, 血清学技术, 药物依赖性抗体

Abstract: Objective To investigate immune hemolytic anemia induced by ceftizoxime sodium, focusing on its serological characteristics and clinical diagnostic approaches. Methods A patient who developed immune hemolytic anemia following ceftizoxime sodium administration in April 2024 was enrolled. Serological tests, including the direct antiglobulin test (DAT), serum antibody screening, elution testing, drug-dependent antibody detection, and in vitro hemolysis assays, were done to identify drug-specific antibodies. Results The patient's DAT results were positive for anti-IgG and anti-C3d. Serum antibody screening showed pan-reactivity, while elution tests were negative. Drug-dependent IgM (titer 32) and IgG (titer 16) antibodies specific to ceftizoxime sodium were confirmed. In vitro experiments revealed that these antibodies induced erythrocyte hemolysis in the presence of calcium ions and complement. Conclusion Ceftizoxime sodium activates complement through an immune complex mechanism, leading to acute intravascular hemolysis. Rapid recognition of drug-induced immune hemolytic anemia (DIIHA), establishment of standardized laboratory protocols for detecting drug-dependent antibodies, and immediate discontinuation of the sensitizing drug are critical for effective clinical management.

Key words: Ceftizoxime sodium, Immune hemolytic anemia, Serological techniques, Drug dependent antibodies

中图分类号:

高明, 曾群娟, 杨贺才, 沈伟. 一例头孢唑肟钠诱发免疫性溶血性贫血的病例报告及文献学习[J]. 临床输血与检验, 2025, 27(4): 540-546.

GAO Ming, ZENG Qunjuan, YANG Hecai, SHEN Wei. Ceftizoxime Sodium-induced Immune Hemolytic Anemia: A Case Report and Literature Review[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2025, 27(4): 540-546.

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一例头孢唑肟钠诱发免疫性溶血性贫血的病例报告及文献学习

Ceftizoxime Sodium-induced Immune Hemolytic Anemia: A Case Report and Literature Review

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