Unusual serological findings associated with ceftriaxone‐induced immune hemolytic anemia in a child with disseminated low‐grade glioma

Pecker, Lydia H.; Timsar, Ali Kazerouni; Pary, Philippe; Denomme, Gregory A.; Criss, V. R.; Luban, Naomi L.C.; Hwang, Eui-Hyoung; Wong, Edward C.C.

doi:10.1002/pbc.26101

Cited by 3 publications

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References 10 publications

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“…Concerning drug-dependent antibodies, a further distinction can be made considering the binding mechanism of the drug to the erythrocyte: a covalent binding will result in a so-called “ drug-adsorption mechanism ” or “ penicillin-type ” reaction, while a rather loose binding will result in a so-called “ immune complex-type ” reaction, the latter being associated with a worse outcome due to formation of IgM-antibodies, complement activation and intravascular hemolysis (reviewed in [ 1 , 3 , 11 ]). Ceftriaxone-induced IHA is characterized by “ immune complex-type ” reactions and in a recent case of ceftriaxone-induced IHA antibodies with Rh specificity were described, that persisted 8 months after the drug reaction [ 15 ]. DIIHA by NIPA does not depend on any drug-induced antibody.…”

Section: Discussionmentioning

confidence: 99%

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

Leicht

Weinig

Mayer

et al. 2018

BMC Pharmacol Toxicol

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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.

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Section: Discussionmentioning

confidence: 99%

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

Leicht

Weinig

Mayer

et al. 2018

BMC Pharmacol Toxicol

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Ceftriaxone

2016

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Ceftriaxone-induced severe hemolytic anemia, renal calculi, and cholecystolithiasis in a 3-year-old child: a case report and literature review

Tao,

Zhou,

Zheng

et al. 2024

Front. Pharmacol.

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Ceftriaxone is widely used in pediatric outpatient care for its efficacy against respiratory and digestive system infections, yet its increasing association with severe immune hemolytic reactions requires heightened vigilance from pediatricians. This report details a rare and severe case of ceftriaxone-induced severe immune hemolytic anemia (IHA), hemolytic crisis, myocardial injury, liver injury, renal calculi, and cholecystolithiasis in a previously healthy 3-year-old child. The child, treated for bronchitis, experienced sudden pallor, limb stiffness, and altered consciousness following the fifth day of ceftriaxone infusion, with hemoglobin (Hb) levels precipitously dropping to 21 g/L. Immediate cessation of ceftriaxone and the administration of oxygen therapy, blood transfusion, intravenous immunoglobulin (IVIG), and corticosteroids led to a gradual recovery. Despite initial improvements, the patient’s condition necessitated extensive hospital care due to complications including myocardial injury, liver injury, renal calculi, and cholecystolithiasis. After a 12-day hospital stay and a 3-month follow-up, the child showed complete normalization of Hb and liver function and resolution of calculi. In children, ceftriaxone infusion may trigger severe, potentially fatal, hemolytic reactions. Pediatricians must promptly recognize symptoms such as pallor, limb stiffness, and unresponsiveness, indicative of ceftriaxone-induced severe IHA, and immediately discontinue the drug. Effective management includes timely blood transfusion, respiratory support, IVIG administration, and corticosteroids when necessary, along with rigorous vital signs monitoring. Continued vigilance is imperative, even after cessation of ceftriaxone, to promptly address any residual adverse effects.

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Unusual serological findings associated with ceftriaxone‐induced immune hemolytic anemia in a child with disseminated low‐grade glioma

Cited by 3 publications

References 10 publications

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

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

Ceftriaxone

Ceftriaxone-induced severe hemolytic anemia, renal calculi, and cholecystolithiasis in a 3-year-old child: a case report and literature review

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