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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
Summary
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.
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