Immune-mediated hemolytic anemia induced by penicillin in horses

Three horses developed severe, immune-mediated hemolytic anemia after treatment with penicillin. The horses had positive direct antiglobulin (Coombs) tests and high titers of IgG antibody that agglutinated penicillin-coated equine red cells. Two of the horses were tested for antibodies to autologous red cell antigens; autoantibodies were not present. Titers of antipenicillin antibody decreased after penicillin was discontinued but IgG antibody was detectable months after recovery. One of the horses was challenged with penicillin; antibody titer increased slightly, but anemia did not develop. Antipenicillin antibody of the IgM class was present in low titer in 23 (77%) of 30 non-anemic horses tested. Apparently, the horse is similar to man in that penicillin-induced anemia is rare but the percentage of individuals with antipenicillin antibody is high.