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Ceftriaxone-induced immune hemolytic anemia

Gal Neuman1, Sabrina Boodhan1, Ilana Wurman2

  • 1University of Toronto, Toronto, ON, Canada The Hospital for Sick Children, Toronto, ON, Canada.

The Annals of Pharmacotherapy
|August 29, 2014
PubMed

Insights

Ceftriaxone-induced immune hemolytic anemia (CIIHA) is a rare but fatal condition, particularly in children with sickle cell disease (SCD). Early diagnosis through history of ceftriaxone exposure and monitoring for hemoglobinuria is crucial.

Area of Science:

  • Hematology
  • Pharmacovigilance
  • Pediatrics

Background:

  • Ceftriaxone is a widely used antibiotic with potential for serious adverse effects.
  • Immune hemolytic anemia is a rare complication of antibiotic therapy.
  • Sickle cell disease (SCD) is a common underlying condition in pediatric patients presenting with anemia.

Observation:

  • A case of ceftriaxone-induced immune hemolytic anemia (CIIHA) in a child with SCD is presented.
  • A systematic literature review identified 37 eligible reports of CIIHA, with 70% of cases occurring in children.
  • The majority of patients (70%) had underlying conditions, most commonly SCD.

Findings:

  • Mortality rates were high, reaching 30% overall and 64% in children.
  • Common clinical and laboratory findings included elevated lactate dehydrogenase, hemoglobinuria, acute renal failure, and positive direct antibody testing.
  • A significant proportion of patients (65%) had prior ceftriaxone exposure, and 32% experienced a preceding unrecognized hemolytic episode.

Implications:

  • Clinicians must be aware of CIIHA, as it is often diagnosed late.
  • Screening for prior ceftriaxone exposure and monitoring for new-onset hemoglobinuria during therapy can aid early diagnosis.
  • Prompt recognition and management of CIIHA are essential to improve patient outcomes, especially in high-risk populations like those with SCD.
Abstract

Keywords:
adverse drug reactionsceftriaxoneceftriaxone-induced immune hemolytic anemiacephalosporinsdrug-induced immune hemolytic anemiasickle cell disease

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