20-year-old swimmer who has been in excellent health and takes no chronic medications, for new-onset severe fatigue and left upper abdominal pain. She was treated 2 days ago in hospital for presumed typhoid with cefotaxime. She also had past h/o typhoid in 2 yrs back. On physical examination her hea rate of 120 bpm and a palpable spleen. Stool is negative for heme. Lab investigations shows hemoglobin of 5 g/dL with normal TLC and platelets. Peripheral blood smear reveals an excess of spherocytes. All of the following can cause similar type of this condition except:
Patient is having autoimmune hemolytic anemia (AIHA) due to development of warm immunoglobulin G (IgG) antibodies due to cefotaxime exposure Warm antibody hemolytic anemia- most common form of autoimmune hemolytic anemia (AIHA). Autoantibodies generally react at temperatures > 37deg C. Most of the autoantibodies are IgG. Hemolysis occurs primarily in the spleen. The autoantibodies may occur: 1.Spontaneous 2.SLE, lymphoma,CLL 3. Drugs- alpha -methyldopa, high-dose penicillin, cephalosporins
SLE
a - Methyldopa ingestion
Quinidine
Infectious mononucleosis
Sickle Cell Disease, G6PD deficiency and other Hemolytic Anemia