Drug‐induced immune haemolytic anaemia caused by cefamandole sodium: Complete serologic studies and clinical follow‐up

Background and Objectives There is limited knowledge regarding cefamandole‐related drug‐induced immune haemolytic anaemia (DIIHA). We conducted a comprehensive serological and clinical follow‐up study of a case of cefamandole‐induced DIIHA to improve understanding of this condition. Materials and Methods A patient with advanced hepatocellular carcinoma developed severe haemolytic anaemia along with significant worsening of hepatic and renal function after intravenous cefamandole was administered for a urinary tract infection. Serological testing included the direct antiglobulin tests (DATs), irregular red blood cell (RBC) antibody screening and detection of cefamandole‐dependent antibodies using two standard methods for drug‐dependent antibodies: ‘testing in the presence of soluble drug’ and ‘testing drug‐treated RBCs’, which were performed after cefamandole discontinuation. Clinical follow‐up was conducted for 41 days after drug cessation. Results The results of DAT for anti‐IgG and anti‐C3d were strongly positive, while irregular RBC antibody screening was negative. Plasma samples collected at different points from 13 to 38 days after cefamandole discontinuation were incubated with cefamandole‐coated RBCs at 37°C, revealing both IgM and IgG cefamandole‐dependent antibodies, with a maximum titre of 16. Following treatment with blood transfusion, intravenous immunoglobulin (IVIG), and methylprednisolone, anaemia and organ dysfunction showed marked improvement. Therefore, the patient was diagnosed with cefamandole‐induced DIIHA. Conclusions This study may be the second serological analysis and the first comprehensive clinical follow‐up of cefamandole‐induced DIIHA. It demonstrates that cefamandole‐dependent antibodies can activate complement, leading to severe haemolytic anaemia and hepatic and renal impairment. The ‘testing drug‐treated RBCs’ method is suitable for detecting cefamandole‐dependent antibodies.