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<p>Hospitalized individuals undergoing intravenous iron treatment and antibiotics may test positive for direct antiglobulin (DAT). However, hemolysis that is clinically important is not always indicated by DAT positive. In addition to determining if laboratory evidence of hemolysis was present, this study analyzed the relationship between DAT positive and specific drugs. At Chettinad Hospital and Research Institute, 97 individuals with positive DAT findings participated in retrospective cohort research. The research examined data from January to August of 2024, concentrating on infection status, underlying diseases, prescription regimens, and demographics. Either (1) auto-control positive during crossmatch, (2) an inexplicable drop in hemoglobin (&gt; 1.5&#xa0;g/dL within 48–72&#xa0;h), or (3) a clinical suspicion of hemolysis prompted DAT testing. Lactate dehydrogenase (LDH), indirect bilirubin, reticulocyte count, and peripheral smear results were examined as laboratory indicators of hemolysis.DAT analysis was done using the gel micro column method (Liss/Coomb’s ID-CARD from BIO-RAD). Positive (+), Positive (++), and Positive (+++) elution levels were classified, and chi-square analysis and descriptive statistics were used to look for correlations with drug type and illness history. Among 97 DAT-positive patients, 89 (91.7%) had active infections and were receiving antibiotics. Laboratory evidence of hemolysis was seen in 18 patients (18.6%), which included falling hemoglobin trends, elevated LDH, increased indirect bilirubin, and/or reticulocytosis. However, 79 patients (81.4%) were DAT-positive without significant biochemical hemolysis. Strong elution positivity (+++) was clearly linked to infection status (<i>p</i> = 0.009). Antibiotics, especially piperacillin-tazobactam and ceftriaxone, were most often found in patients with DAT positivity. Eight patients receiving intravenous iron therapy (iron sucrose or ferric carboxymaltose) showed strong DAT positivity; however, only two had mild signs of hemolysis in lab results. DAT positive in hospitalized patients is strongly correlated with antibiotics and intravenous iron treatment. The majority of individuals, however, did not exhibit hemolysis that was clinically relevant, underscoring the need of distinguishing between drug-induced red cell sensitization and actual immune hemolytic anemia. Before identifying drug-induced hemolytic anemia, a thorough clinical and laboratory correlation is necessary.</p>

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Direct Antiglobulin Test (DAT) Positivity Associated with Antibiotic and Intravenous Iron Therapy: A Retrospective Study from a Tertiary Care Center

  • 期刊论文

  • 发表日期：

    2026年4月4日

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  • I. Azeem

摘要

Hospitalized individuals undergoing intravenous iron treatment and antibiotics may test positive for direct antiglobulin (DAT). However, hemolysis that is clinically important is not always indicated by DAT positive. In addition to determining if laboratory evidence of hemolysis was present, this study analyzed the relationship between DAT positive and specific drugs. At Chettinad Hospital and Research Institute, 97 individuals with positive DAT findings participated in retrospective cohort research. The research examined data from January to August of 2024, concentrating on infection status, underlying diseases, prescription regimens, and demographics. Either (1) auto-control positive during crossmatch, (2) an inexplicable drop in hemoglobin (> 1.5 g/dL within 48–72 h), or (3) a clinical suspicion of hemolysis prompted DAT testing. Lactate dehydrogenase (LDH), indirect bilirubin, reticulocyte count, and peripheral smear results were examined as laboratory indicators of hemolysis.DAT analysis was done using the gel micro column method (Liss/Coomb’s ID-CARD from BIO-RAD). Positive (+), Positive (++), and Positive (+++) elution levels were classified, and chi-square analysis and descriptive statistics were used to look for correlations with drug type and illness history. Among 97 DAT-positive patients, 89 (91.7%) had active infections and were receiving antibiotics. Laboratory evidence of hemolysis was seen in 18 patients (18.6%), which included falling hemoglobin trends, elevated LDH, increased indirect bilirubin, and/or reticulocytosis. However, 79 patients (81.4%) were DAT-positive without significant biochemical hemolysis. Strong elution positivity (+++) was clearly linked to infection status (p = 0.009). Antibiotics, especially piperacillin-tazobactam and ceftriaxone, were most often found in patients with DAT positivity. Eight patients receiving intravenous iron therapy (iron sucrose or ferric carboxymaltose) showed strong DAT positivity; however, only two had mild signs of hemolysis in lab results. DAT positive in hospitalized patients is strongly correlated with antibiotics and intravenous iron treatment. The majority of individuals, however, did not exhibit hemolysis that was clinically relevant, underscoring the need of distinguishing between drug-induced red cell sensitization and actual immune hemolytic anemia. Before identifying drug-induced hemolytic anemia, a thorough clinical and laboratory correlation is necessary.