Hemolysis Induced by Cefazolin and Cephalothin in a Patient with Penicillin Sensitivity

Abstract

A patient with penicillin sensitivity, who never received a cephalosporin antibiotic previously, developed anemia and spherocytosis following the administration of cefazolin. Hemolysis abated when the drug was discontinued on the 4th day and recurred on day 6 when cephalothin therapy began. Ig[immunoglobulin]G and complement components were present on the patient''s erythrocytes and IgG antibodies in her serum reacted with normal red blood cells which were coated with benzylpenicillin, cefazolin or cephalothin. Antibodies to cephalothin-coated red blood cells were removed partially by incubating her serum with benzylpenicillin or cefazolin. Complement-fixing IgG antibodies which reacted with red blood cells coated by cefazolin, cephalothin and benzylpenicillin were considered to be responsible for hemolysis during the administration of cefazolin and, subsequently, cephalothin. The patient recovered completely following discontinuation of antibiotics, transfusion of red blood cells and treatment with glucocorticoids. Hemolysis may occur during therapy with cefazolin and cephalothin, and may develop rapidly in a patient with penicillin sensitivity.