Two Mechanisms of Erythrocyte Destruction in Penicillin-Induced Hemolytic Anemia

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Abstract
Antiglobulin testing revealed IgG, C3, C4 and C5 on the erythrocytes in a case of penicillin-induced, immune hemolytic anemia. When no penicillin was in the patient's serum, the survival times of autologous and of normal erythrocytes, measured concomitantly, were both shortened (half-time of 21 days). Antibody specific for penicillin was eluted from patient erythrocytes. On addition of eluate to a mixture of normal B cells coated with penicillin and O cells in the presence of complement, C3, but not IgG, was bound to the O cells. Addition of eluate and complement to a mixture of O erythrocytes treated with 2-amino-ethylisothiouronium bromide and penicillin-coated B cells resulted in hemolysis of the O cells. Two mechanisms of erythrocyte destruction are possible: the IgG, complement-binding, antipenicillin antibody causes destruction of patient erythrocytes coated in vivo with penicillin; and, in the absence of detectable serum penicillin, normal erythrocytes may be destroyed because they bind activated complement components.