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Review
. 2018 Oct 25;19(1):67.
doi: 10.1186/s40360-018-0257-7.

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

Hans Benno Leicht  1 , Elke Weinig  2 , Beate Mayer  3 , Johannes Viebahn  2 , Andreas Geier  1 , Monika Rau  4
Affiliations
Review

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

Hans Benno Leicht et al. BMC Pharmacol Toxicol. .

Abstract

Background: Drug 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 presentation: A 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.

Conclusions: The 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.

Keywords: Ceftriaxone; Drug-induced immune hemolytic anemia; Hemolysis.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Written informed consent from the patient for this case report was obtained.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Representative laboratory parameters during disease course
Fig. 2
Fig. 2
Serological investigation of ceftriaxon-dependent antibody using gel card technique (BioRad, Cressier sur Morat, Switzerland). Results showing strong agglutination (4+) of the patient’s plasma and eluate in the presence of the drug, but negative results without ceftriaxone added. Patient’s eluate (1) or plasma (2), ceftriaxone and untreated RBCs; Negative controls: patient’s elutate (1a) or plasma (2a), saline (instead of ceftriaxone) and untreated RBCs
Fig. 3
Fig. 3
Systematic overview of different types of drug-induced immune hemolytic anemia
See this image and copyright information in PMC

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