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Cefazolin-induced hemolytic anemia: a case report and systematic review of literature
Elizabeth Mause1, Mohammad Selim2, Manasa Velagapudi3
1Creighton University School of Medicine, Omaha, NE, USA. eam19739@creighton.edu.
Background:
Cefazolin is a first-generation cephalosporin commonly used for skin and soft tissue infections, abdominal and orthopedic surgery prophylaxis, and methicillin-sensitive staph aureus. Cephalosporins as a whole are known potential inducers of hemolytic anemia; however, mechanism of action is primarily autoimmune, and compared to other drugs, cefazolin is the least common.
Methods:
A rare case report of cefazolin-induced hemolytic anemia "CIHA" and a systematic review of CIHA articles in English literature. Two authors performed review of publications and articles were selected based on inclusion and exclusion criteria. A systematic search of the literature yielded 768 entries with five case reports on cefazolin-induced hemolytic anemia.
Case Presentation/Results:
An 80-year-old female with methicillin-sensitive Staphylococcus aureus "MSSA" endocarditis. The patient was started on intravenous "IV" cefazolin that that resulted in hemolytic anemia and eosinophilia. Switching to vancomycin improved hemoglobin level and resolved eosinophilia. Four cefazolin-induced hemolytic anemia case reports and one population-based article with a case reported were analyzed with respect to direct antiglobulin test "DAT" (also known as the direct Coombs test) results, prior penicillin sensitivity, and acute anemia causes exclusion.
Conclusions:
CIHA is a rare cause of clinically significant anemia. The diagnosis of drug-induced anemia is one of exclusion. It is important to consider DAT results and prior penicillin sensitivity when evaluating a patient for cefazolin-induced hemolytic anemia. However, the frequency of cefazolin use and resultant anemia necessitates early recognition of hemolytic anemia and prompt discontinuation of cefazolin, especially with long-term use.
Insights
Cefazolin-induced hemolytic anemia (CIHA) is rare but requires prompt recognition. Early diagnosis and cefazolin discontinuation are crucial, especially with long-term use, to manage this drug-induced anemia.
Area of Science:
- Pharmacology
- Hematology
- Immunology
Background:
- Cefazolin, a first-generation cephalosporin, is widely used for infections and surgical prophylaxis.
- Cephalosporins can induce hemolytic anemia, typically autoimmune, with cefazolin being a less common cause.
- Methicillin-sensitive Staphylococcus aureus (MSSA) infections are a common indication for cefazolin therapy.
Observation:
- A rare case of cefazolin-induced hemolytic anemia (CIHA) and eosinophilia occurred in an elderly female with MSSA endocarditis.
- Hemoglobin levels improved and eosinophilia resolved after switching from intravenous cefazolin to vancomycin.
- Analysis of five case reports focused on direct antiglobulin test (DAT) results, penicillin sensitivity, and exclusion of other anemia causes.
Findings:
- Cefazolin-induced hemolytic anemia (CIHA) is a rare but clinically significant condition.
- Diagnosis of drug-induced anemia is achieved through exclusion.
- Direct antiglobulin test (DAT) results and prior penicillin sensitivity are important considerations in diagnosing CIHA.
Implications:
- Prompt recognition and cefazolin discontinuation are vital for managing CIHA, particularly in long-term treatment scenarios.
- Clinicians should consider CIHA in patients developing anemia during cefazolin therapy.
- Understanding the diagnostic factors, including DAT and penicillin sensitivity, aids in identifying cefazolin-induced anemia.
