HEMOLYSIS IN A RECENTLY HOSPITALIZED PATIENT. L. Chang 1 ; 1 UCLA/San Fernando Valley Program, Sepulveda, CA LEARNING OBJECTIVES: 1) To recognize drug-induced hemolysis as a common cause of hemolytic anemia 2) To recognize that 2nd and 3rd generation cephalosporins are the most common cause of drug-induced hemolytic anemia 3) To recognize that cephalosporin-induced hemolytic anemia is often serious, and can be fatal. CASE INFORMATION: A 62-year-old female discharged 7 days ago after being treated for Streptococcus pharyngitis presents to a follow-up clinic complaining of a 5-day history of nausea, nonbilious and nonbloody vomiting, and anorexia. She also complains of a generalized headache and subjective fevers. In her previous hospitalization, she presented to the emergency room complaining of fever, sore throat, and epigastric pain. At that time, she was found to have a WBC of 16 with 89%neutrophils, a Hct of 44, and a clean urinalysis. A CT abdomen was done revealing diverticulosis only. Her temperature was 38.4. She was given one dose of Cefotetan in the ER and admitted for further workup. On the medicine wards, further evaluation revealed an exudative tonsillitis with anterior cervical lymphadenopathy. She admitted to a history of recurrent pharyngitis. She was treated with penicillin VK, improved clinically, and sent home on penicillin. She had no known drug allergies. Physical examination: Temp 38.5, BP 141/70, pulse 97. She was moderately ill appearing. Eyes were icteric. Oropharynx revealed tonsillar swelling, but was significantly improved from her previous hospitalization exam. Neck was supple. Heart and lung exams were normal. Abdomen revealed mild epigastric tenderness without peritoneal signs. Neurological exam was normal. Laboratory studies: WBC 18.2, Hgb 11, Hct 30.6, Plt 300, MCV 89. Total bilirubin 13.2, direct bilirubin 0.5, AST 34, ALT 28, alkaline phosphatase 93. PTT 23, INR 1.04. LDH 1578, corrected reticulocyte count 1.8, haptoglobin < 50. Direct Coombs was markedly positive. DISCUSSION: The positive direct Coombs test was further investigated by the blood bank that, along with assistance from the Red Cross, determined that this patient had developed a Cefotetan-induced autoimmune hemolytic anemia (HA). It should be recognized that 1stgeneration cephalosporins rarely cause HA, but 2nd and 3rd generation cephalosporins are the most common cause of drug-induced HA. Most cases of cephalosporin-induced HA revealed moderate-to-severe hemolysis with fatalities reported. Most patients required treatment with blood transfusion and steroids. Because of the common use of 2nd and 3rd generation cephalosporins by physicians, and the severity of the hemolysis that can be induced by them, recognition of this entity is of significant importance to the practicing clinician.