Piperacillin-Induced Immune Hemolysis Presenting with Tachycardia and Cardiac Arrest
A 20-year-old nonverbal patient with profound developmental disabilities was treated with intravenous piperacillin-tazobactam for respiratory infection. After 8 days, he became afebrile with normal pulmonary status, but his pulse remained inexplicably rapid (114/minute). Investigations revealed seve...
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Wiley
2011-01-01
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| Series: | Case Reports in Medicine |
| Online Access: | http://dx.doi.org/10.1155/2011/816497 |
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| author | Ghan-Shyam Lohiya Lilia Tan-Figueroa Vamsi Krishna |
| author_facet | Ghan-Shyam Lohiya Lilia Tan-Figueroa Vamsi Krishna |
| author_sort | Ghan-Shyam Lohiya |
| collection | DOAJ |
| description | A 20-year-old nonverbal patient with profound developmental disabilities was treated with intravenous piperacillin-tazobactam for respiratory infection. After 8 days, he became afebrile with normal pulmonary status, but his pulse remained inexplicably rapid (114/minute). Investigations revealed severe normochromic normocytic hemolytic anemia (hemoglobin: 40 g/L, reticulocytes: 9.4%, nucleated erythrocytes: 5%). While being hospitalized, patient experienced sudden cardiac arrest from which he was successfully resuscitated. He had no blood loss or intrinsic heart disease to explain the acute anemia or cardiac arrest. He had uneventfully received piperacillin-tazobactam on 7 occasions during the preceding 5 years for >50 days. Patient was treated with intravenous crystalloids, methylprednisolone and transfusion of 3 units of packed erythrocytes. Piperacillin-tazobactam was discontinued. A direct antiglobulin test was positive for immunoglobulin G and complement. Antibody to piperacillin was detected in patient's serum by the “immune-complex” method confirming “piperacillin-induced immune hemolytic anemia (PIHA)”. On discharge (day 15), patient's hemoglobin improved to 115 g/L (baseline: 131 g/L). Vigilant clinical and hematological monitoring for anemia is indicated in piperacillin-treated patients, particularly in those unable to verbalize their discomfort. Repeated piperacillin exposure may sensitize and predispose patients to PIHA. |
| format | Article |
| id | doaj-art-de06dc1176a34b938ead457a2622166b |
| institution | Kabale University |
| issn | 1687-9627 1687-9635 |
| language | English |
| publishDate | 2011-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Medicine |
| spelling | doaj-art-de06dc1176a34b938ead457a2622166b2025-02-03T00:59:40ZengWileyCase Reports in Medicine1687-96271687-96352011-01-01201110.1155/2011/816497816497Piperacillin-Induced Immune Hemolysis Presenting with Tachycardia and Cardiac ArrestGhan-Shyam Lohiya0Lilia Tan-Figueroa1Vamsi Krishna2Department of Public Health, Fairview Developmental Center, Costa Mesa, CA 92626, USADepartment of Public Health, Fairview Developmental Center, Costa Mesa, CA 92626, USADepartment of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USAA 20-year-old nonverbal patient with profound developmental disabilities was treated with intravenous piperacillin-tazobactam for respiratory infection. After 8 days, he became afebrile with normal pulmonary status, but his pulse remained inexplicably rapid (114/minute). Investigations revealed severe normochromic normocytic hemolytic anemia (hemoglobin: 40 g/L, reticulocytes: 9.4%, nucleated erythrocytes: 5%). While being hospitalized, patient experienced sudden cardiac arrest from which he was successfully resuscitated. He had no blood loss or intrinsic heart disease to explain the acute anemia or cardiac arrest. He had uneventfully received piperacillin-tazobactam on 7 occasions during the preceding 5 years for >50 days. Patient was treated with intravenous crystalloids, methylprednisolone and transfusion of 3 units of packed erythrocytes. Piperacillin-tazobactam was discontinued. A direct antiglobulin test was positive for immunoglobulin G and complement. Antibody to piperacillin was detected in patient's serum by the “immune-complex” method confirming “piperacillin-induced immune hemolytic anemia (PIHA)”. On discharge (day 15), patient's hemoglobin improved to 115 g/L (baseline: 131 g/L). Vigilant clinical and hematological monitoring for anemia is indicated in piperacillin-treated patients, particularly in those unable to verbalize their discomfort. Repeated piperacillin exposure may sensitize and predispose patients to PIHA.http://dx.doi.org/10.1155/2011/816497 |
| spellingShingle | Ghan-Shyam Lohiya Lilia Tan-Figueroa Vamsi Krishna Piperacillin-Induced Immune Hemolysis Presenting with Tachycardia and Cardiac Arrest Case Reports in Medicine |
| title | Piperacillin-Induced Immune Hemolysis Presenting with Tachycardia and Cardiac Arrest |
| title_full | Piperacillin-Induced Immune Hemolysis Presenting with Tachycardia and Cardiac Arrest |
| title_fullStr | Piperacillin-Induced Immune Hemolysis Presenting with Tachycardia and Cardiac Arrest |
| title_full_unstemmed | Piperacillin-Induced Immune Hemolysis Presenting with Tachycardia and Cardiac Arrest |
| title_short | Piperacillin-Induced Immune Hemolysis Presenting with Tachycardia and Cardiac Arrest |
| title_sort | piperacillin induced immune hemolysis presenting with tachycardia and cardiac arrest |
| url | http://dx.doi.org/10.1155/2011/816497 |
| work_keys_str_mv | AT ghanshyamlohiya piperacillininducedimmunehemolysispresentingwithtachycardiaandcardiacarrest AT liliatanfigueroa piperacillininducedimmunehemolysispresentingwithtachycardiaandcardiacarrest AT vamsikrishna piperacillininducedimmunehemolysispresentingwithtachycardiaandcardiacarrest |