Ceftriaxone-induced Hemolytic Anemia Research Articles

Sometimes Treatment Kills: Ceftriaxone-induced Hemolytic Anemia in a Case of Pyogenic Meningitis

ABSTRACT Drug-induced immune hemolytic anemia (DIIHA) is a rare condition that is often misdiagnosed or not diagnosed promptly, even at specialized medical facilities. The leading causes of DIIHA are antibiotics, particularly second and third-generation cephalosporins, and platinum-based chemotherapy. While identifying the responsible drug and discontinuing it typically resolves the issue, fatalities may still occur in cases of progressive immune-mediated hemolysis and underlying medical conditions. This case involves an 80-year-old man receiving injectable broad-spectrum antibiotics, including ceftriaxone, for pyogenic meningitis, who experienced severe hemolytic anemia that ultimately led to intracranial hemorrhage and death.

Ceftriaxone-induced hemolytic anemia with severe renal failure: a case report and review of literature

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.

A Fatal Case Report of Ceftriaxone-induced Hemolytic Anemia and Literature Review in Pediatrics

A Fatal Case Report of Ceftriaxone-induced Hemolytic Anemia and Literature Review in Pediatrics

Ceftriaxone-Induced Hemolysis in Pediatric Patients with Sickle Cell Disease

OBJECTIVE: To provide a review on the case reports of ceftriaxone-induced hemolytic anemia in pediatric patients with sickle cell disease, present a proposed mechanism of the reaction, and provide an alternative antimicrobial regimen for these patients. DATA SOURCES: Literature retrieval was accessed through PUBMED (1985-present) using the terms pediatric, sickle cell disease, ceftriaxone, hemolytic anemia, and hemolysis. In addition, reference citations identified from these publications were reviewed. STUDY SELECTION AND DATA EXTRACTION: All articles in English identified from the data sources were evaluated. All case reports and studies were included in the review. DATA SYNTHESIS: Ceftriaxone, a third-generation cephalosporin that is frequently used for the empiric treatment of suspected infections in pediatric patients with sickle cell disease, has been linked to cases of hemolytic anemia. Ceftriaxone has many favorable attributes to promote its use: broad-spectrum anti-microbial activity, long half-life, and no requirement for dose adjustment in patients with renal dysfunction. Hemolytic anemia is a very serious condition and can be fatal. Children with sickle cell disease have a reduced number of red blood cells, and therefore, hemolytic anemia can potentially be detrimental in these children. Five case reports of ceftriaxone-induced hemolytic anemia are presented, in which the typical onset was three to seven days into therapy and all patients had received ceftriaxone courses during prior hospitalizations. There have been several proposed mechanisms of drug-induced hemolytic anemia and ceftriaxone appears to be inducing hemolysis through an immune reaction involving immunoglobulin M and complement found on the surfaces of red blood cells. The hemolysis can be managed by immediately stopping the offending agent, giving packed red blood cell transfusions, and there is possibly a role for intravenous corticosteroids, plasmapheresis, and intravenous immunoglobulin. Cefotaxime is a safe and effective alternative antibiotic in this patient population. CONCLUSIONS: Although rare, ceftriaxone appears to induce hemolytic anemia in pediatric patients with sickle cell disease. Cefotaxime provides a safe and effective alternative in this population.

Severe Ceftriaxone-induced Hemolysis Complicated by Diffuse Cerebral Ischemia in a Child With Sickle Cell Disease

Ceftriaxone-induced hemolytic anemia is a rare and often fatal phenomenon. We report here the case of a 6-year-old female with sickle cell disease who survived a brisk and profound hemolytic reaction, resulting in hemoglobin of 0.4 g/dL, after ceftriaxone infusion. Ongoing hemolysis was abrogated with aggressive supportive care, but the patient suffered extensive neurologic sequelae as a result of the event. Serologic testing confirmed the presence of ceftriaxone antibodies.

Ceftriaxone induced hemolysis complicated by acute renal failure

Over the last decade, second and third generation cephalosporins have been the most common drugs causing hemolytic anemia (HA). Of these cases, 20% have been attributed to ceftriaxone. The clinical presentation of ceftriaxone-induced HA is usually abrupt with sudden onset of pallor, tachypnea, cardio-respiratory arrest and shock. Acute renal failure (ARF) has been reported in 41% of such cases with a high fatality rate. We report a pediatric patient with ARF complicating ceftriaxone-induced HA who survived. Ceftriaxone is a commonly used drug, and early recognition of HA and institution of supportive care, including dialysis is likely to improve the outcome.

Ceftriaxone-induced hemolytic anemia and hepatitis in an adolescent with hemoglobin SC disease

To describe a case of a ceftriaxone-induced hemolytic anemia and hepatitis leading to multiple organ failure and death in an adolescent with hemoglobin SC disease and to review the previous cases of this rare and potentially fatal disorder in children. Case report and literature review. Intensive care unit. Adolescent with hemoglobin SC. Emergency treatment. After 4 days of ceftriaxone therapy, the adolescent experienced an acute hemolytic reaction (hemoglobin decreased to 5 g/dL with hemoglobinuria) and severe hepatitis (all enzymes increasing dramatically including aminoaspartate transferase >20,000 IU/L). Renal failure and ultimately multiple organ failure ensued, and the patient died on hospital day 19. Direct antiglobulin tests on red cells obtained from the patient on hospital day 2 showed microscopic agglutination with polyspecific and anticomplement (C3) antiglobulin reagents. Plasma samples showed macroscopic agglutination reactions when incubated in the presence of ceftriaxone, many days after cessation of ceftriaxone, indicating the continued presence of ceftriaxone-dependent antibodies. Drug reactions leading to hemolysis are relatively uncommon, and a total of ten cases of ceftriaxone-induced hemolytic anemia have been reported in children. The present case describes an adolescent who ultimately died on hospital day 19 from multiple organ failure, although the presentation of this case seems atypical in several respects. Children with clinical syndromes that place them at risk for hemolysis and children who frequently require broad spectrum antibiotics present unique diagnostic challenges, and the possibility that hemolytic syndromes may be due to ceftriaxone must be considered.