Perinatology.  2016 Sep;27(3):190-193. 10.14734/PN.2016.27.3.190.

Ampicillin/Sulbactam-induced Hemolytic Anemia Manifested as Hyperbilirubinemia in a Preterm Infant

• Roh JH
• Yun HS
• Park HK
• Lee HJ
• Kim CR
• Han TH

• KMID: 2355580
• DOI: http://doi.org/10.14734/PN.2016.27.3.190

Abstract

A female was born at 36⁺⁵ weeks of gestation with a birth weight of 2,120 g. Apgar score was 7 at 1 minute and 9 at 5 minutes. Shortly after birth, tachypnea, chest retraction, and a severe build-up of oral secretions were noted. Her blood type was A⁺ and initial hemoglobin was 17.5 g/dl. Her mother was A⁺ blood type. Ampicillin/Sulbactam and gentamicin were started empirically. At 8th day of admission, laboratory results showed hemolytic anemia. Exchange transfusion was performed along with intravenous immunoglobulin and hydrocortisone. After 2 days, the patient's clinical and laboratory conditions improved. Column hemagglutination assay revealed that the patient's hemolysis was due to ampicillin/sulbactam.

Keyword

Ampicillin-sulbactam; Hemolytic anemia; Preterm infant

MeSH Terms

Anemia, Hemolytic*
Apgar Score
Birth Weight
Female
Gentamicins
Hemagglutination
Hemolysis
Humans
Hydrocortisone
Hyperbilirubinemia*
Immunoglobulins
Infant, Newborn
Infant, Premature*
Mothers
Parturition
Pregnancy
Tachypnea
Thorax
Gentamicins
Hydrocortisone
Immunoglobulins

Figure

• 

  Fig. 1 The pattern of hemoglobin and bilirubin levels according to antibiotics and other treatments. Abbreviations: Amp, ampicillin; Hb, hemoglobin (g/dL); TB, total bilirubin (mg/dL); DB, direct bilirubin (mg/dL); Reti, reticulocyte (%); IVIG, intravenous immunoglobulin; RBC, packed red blood cell transfusion; ExTF, exchange transfusion.

• 

  Fig. 2 The detection of RBC antibody in patient's serum. The patient's serum was obtained on the 15th day of age and the patient's RBC on the 50th day of age respectively. The serum was reactive with the patient's RBC coated with ampicillin/sulbactam. A(negative)=patient's RBC+patient's serum+ampicillin/sulbactam; B (negative)=type O blood donor 1's RBC+patient's serum+ampicillin/sulbactam; C (negative)=type O blood donor 2's RBC+patient's serum+ampicillin/sulbactam; D (4+ positive) =ampicillin/sulbactam-coated patient's RBC+patient's serum; E (negative)=ampicillin/sulbactam-coated type O blood donor 1's RBC+patient's serum; F (negative)=Ampicillin/sulbactam-coated type O blood donor 2's RBC+patient's serum.

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