哌拉西林钠他唑巴坦钠诱导免疫性溶血性贫血一例

A Case of Immune Hemolytic Anemia Induced by Piperacillin Sodium and Tazobactam Sodium

摘要: 目的：探讨哌拉西林钠他唑巴坦钠诱导免疫性溶血性贫血(drug-induced immune hemolytic anemia, DIIHA)的临床特征、血清学诊断方法及诊疗要点，提高临床对该类药物不良反应的识别与处置能力。方法：回顾性分析1例83岁男性患者因肺部感染使用哌拉西林钠他唑巴坦钠后发生免疫性溶血性贫血的临床资料，包括病史、症状体征、实验室指标动态变化及治疗转归。同时采用经典抗人球蛋白法进行体外药物抗体试验，验证药物依赖性抗体的存在及其免疫球蛋白类型。结果：患者于首次使用哌拉西林钠他唑巴坦钠后第8天出现急性溶血，停药并予糖皮质激素治疗后溶血缓解。后因临床需要再次使用该药，第4天溶血迅速复发。体外药物抗体试验证实患者血浆中存在哌拉西林钠他唑巴坦钠依赖性的IgM及IgG型抗红细胞抗体。结论：哌拉西林钠他唑巴坦钠可诱发免疫性溶血性贫血，其诊断需结合用药时间链、血清学动态监测及体外药物抗体试验综合判断。临床使用该药期间应加强血液学监测，一旦疑诊应立即停药并避免再次暴露。输血科在DIIHA的血清学诊断及输血时机决策中具有关键作用，体外药物抗体试验是明确致敏药物的重要手段。

Abstract: Objective: To investigate the clinical characteristics, serological diagnostic methods, and key management points of drug-induced immune hemolytic anemia (DIIHA) induced by piperacillin sodium and tazobactam sodium, thereby enhancing clinical recognition and management of this adverse drug reaction. Methods: A retrospective analysis was conducted on the clinical data of an 83-year-old male patient who developed immune hemolytic anemia after receiving piperacillin sodium and tazobactam sodium for pulmonary infection, including medical history, symptoms and signs, dynamic changes in laboratory parameters, and treatment outcomes. Additionally, a classical anti-human immunoglobulin assay was performed to confirm the presence of drug-dependent antibodies and their immunoglobulin types. Results: The patient developed acute hemolysis on day 8 following initial administration of piperacillin sodium and tazobactam sodium; hemolysis resolved after discontinuation of the medication and glucocorticoid therapy. However, the drug was re-administered due to clinical necessity, leading to rapid hemolytic recurrence on day 4. In vitro antibody testing confirmed the presence of piperacillin sodium and tazobactam sodium-dependent IgM-and IgG-type anti-red blood cell antibodies in the plasma. Conclusion: Piperacillin sodium and tazobactam sodium can induce immune hemolytic anemia, and diagnosis requires comprehensive evaluation of the medication timeline, serological monitoring, and in vitro antibody testing. Hematologic surveillance should be intensified during clinical use; immediate discontinuation and avoidance of re-exposure are warranted upon suspected diagnosis. The transfusion department plays a critical role in serological diagnosis and transfusion decision-making for DIIHA, with in vitro antibody testing serving as a pivotal tool for identifying sensitizing agents.