Piperacillin antibody-induced immune hemolytic anemia is not rare in adults, and there have been reports of anti-HLA antibody-induced newborn platelet transfusion refractoriness. However, there has been no report of piperacillin-accompanied anti-HLA antibody-induced newborn pancytopenia.
We herein present the case of a newborn with pancytopenia from a mother who carried anti-HLA-B55, anti-HLA-DR11, and piperacillin antibodies. The newborn HLA genotypes were HLA*B55:02 and HLA*DRB1*11:01. IgG antibodies can be transferred to the newborn via the placenta and induce the destruction of the platelet and white blood cells, which carry the corresponding antigens. Piperacillin antibodies coupling with newborn red blood cells (RBCs) led to the destruction of the RBCs and hemolytic anemia.
The direct anti-globulin test was positive for RBCs in the newborn, and piperacillin antibodies were positive in both the newborn and his mother. Anti-HLA antibodies were positive in the maternal serum, whereas homologous antigens were positive in the newborn. The direct anti-globulin test of platelet was weekly positive in the newborn.
Piperacillin and anti-HLA antibodies can pass through the placenta, induce incompatible blood cell destruction, and cause a series of clinical syndromes in newborns.
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- Piperacillin-induced immune hemolysis presenting with tachycardia and cardiac arrest.Case Rep Med. 2011; 2011816497
- Marked thrombocytopenia in a neonate is associated with anti-HPA-5b, anti-HLA-A31, and anti-HLA-B55 antibodies.Pediatr Blood Cancer. 2019; 66e27555
- Foetal and neonatal alloimmune thrombocytopenia.Best Pract Res Clin Obstet Gynaecol. 2019; 58: 15-27
- Piperacillin-tazobactam-induced adverse drug events in pediatric patients on outpatient parenteral antimicrobial therapy.Pediatr Infect Dis J. 2017; 36: 50-52
- Drug-induced immune hemolytic anemia.Hematol Am Soc Hematol Educ Program. 2009; : 73-79
- HLA antibodies and fetomaternal alloimmune thrombocytopenia: myth or meaningful?.Transfus Med Rev. 2000; 14: 275-280
- Neonatal alloimmune thrombocytopenia: a report of four cases.Kobe J Med Sci. 2019; 64: E197-e199
- Feotal and neonatal alloimmune thrombocytopenia.Best Pract Res Clin Obstet Gynaecol. 2019; 58: 15-27
Published online: November 23, 2021
Accepted: November 20, 2021
Received in revised form: November 16, 2021
Received: April 9, 2021
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