Coombs' Positive Reactions Associated With Sodium Cephalothin Therapy

Sodium cephalothin (Keflin) has been extensively used in the therapy of gram-negative and gram-positive infections with but few untoward reactions. In a few cases hematological side effects, ie, transient neutropenia—associated in one case with the bone marrow manifestation of maturation arrest, have been reported. Cessation of cephalothin therapy was associated with a prompt recovery from the neutropenia.1 Our interest in cephalothin began with the case of a 16-year-old boy with anemia and uremia due to congenital absence of one kidney and hypoplasia of the other. He had a positive direct Coombs' (antiglobulin) test without evidence of any blood-cell antibodies in his serum. No antibody could be eluted from his erythrocytes. He was receiving cephalothin intravenously, and the possibility of a serologic abnormality associated with a specific antibody to this drug or cross-reacting anti-peni-cillin antibody was considered. To investigate this possibility, we studied the sera and red blood cells (RBCs)