Piperacillin-induced immune hemolysis: new cases and a concise review of the literature

In this study, the data of eight new patients in conjunction with previously reported cases with piperacillin-induced immune hemolytic anemia (PIHA) are described.

Five patients with cystic fibrosis and three patients with other disorders developed massive hemolysis after administration of piperacillin. Serologic tests were carried out using standard techniques. Tests for drug-dependent antibodies (ddab) were performed in the presence and absence of piperacillin and its ex vivo antigens (urine of patients treated with piperacillin).

Hemolysis was acute and severe in all eight patients. The direct antiglobulin test was positive in all cases. Sera from four patients reacted with red blood cells (RBCs) in the presence of piperacillin as well as its ex vivo antigens. Sera from three patients showed positive reactivity with untreated RBCs in the presence of piperacillin, and the serum from the remaining patient was reactive only in the presence of piperacillin ex vivo antigens. Other patients with PIHA have been reported in the literature. Three of these patients also had cystic fibrosis.

To date approximately 26 patients with PIHA have been described and at least eight of these patients had cystic fibrosis. It is unclear whether patients with cystic fibrosis might be susceptible in developing PIHA.