Abstract
BackgroundDrug induced immune hemolytic anemia (DIIHA) is a rare complication and often underdiagnosed. DIIHA is frequently associated with a bad outcome, including organ failure and even death. For the last decades, ceftriaxone has been one of the most common drugs causing DIIHA, and ceftriaxone-induced immune hemolytic anemia (IHA) has especially been reported to cause severe complications and fatal outcomes.Case presentationA 76-year-old male patient was treated with ceftriaxone for cholangitis. Short time after antibiotic exposure the patient was referred to intensive care unit due to cardiopulmonary instability. Hemolysis was observed on laboratory testing and the patient developed severe renal failure with a need for hemodialysis for 2 weeks. Medical history revealed that the patient had been previously exposed to ceftriaxone less than 3 weeks before with subsequent hemolytic reaction. Further causes for hemolytic anemia were excluded and drug-induced immune hemolytic (DIIHA) anemia to ceftriaxone could be confirmed.ConclusionsThe case demonstrates the severity of ceftriaxone-induced immune hemolytic anemia, a rare, but immediately life-threatening condition of a frequently used antibiotic in clinical practice. Early and correct diagnosis of DIIHA is crucial, as immediate withdrawal of the causative drug is essential for the patient prognosis. Thus, awareness for this complication must be raised among treating physicians.
Highlights
Drug induced immune hemolytic anemia (DIIHA) is a rare complication and often underdiagnosed
drug-induced immune hemolytic anemia (DIIHA) can be mediated through drug-induced antibodies or through a mechanism called nonimmunologic protein adsorption (NIPA), which is not triggered by antibodies [1, 11, 13]
Drug-independent antibodies can bind erythrocytes in absence of the causative drugs and are true autoantibodies that can serologically not be distinguished from autoantibodies mediating warm autoimmune hemolytic anemia (WAIHA), so diagnosis relies on clinical response to cessation of the causative drug [1, 5, 6, 11, 13, 14]
Summary
Our case demonstrates the severity of ceftriaxone-induced immune hemolytic anemia, a rare, but immediately life-threatening condition of a frequently used antibiotic in clinical practice. Ceftriaxone has been one of the most common drugs responsible for DIIHA and has been associated with severe outcome. In cases of unclear hemolysis, treating physicians should be aware of DIIHA and check the patient’s medication carefully. Suspected drugs have to be stopped immediately in order to prevent severe complications and fatal outcomes
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