Ceftriaxone-Induced Hemolytic Anemia in a Jehovah’s Witness

Tasch, James; Gonzalez-Zayaz, Pedro

doi:10.12659/ajcr.903507

Cited by 5 publications

(3 citation statements)

References 13 publications

(24 reference statements)

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“…The etiology of the symptoms was suspected to be a hemolytic anemia directly related to her ceftriaxone infusions. [ 7 ] De Wilde et al . reported life-threatening ceftriaxone-induced immune hemolytic anemia with an acute kidney injury in a 76-year-old woman,[ 8 ] while Mulkens et al .…”

Section: Discussionmentioning

confidence: 99%

Severe drug-induced immune hemolysis due to ceftriaxone

Dara

Sharma

Bhardwaj

2020

Asian J Transfus Sci

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Drug-induced immune hemolytic anemia (DIIHA) is a rare condition that results primarily due to drug-induced antibodies, either drug dependent or drug independent. For its diagnosis, specialized immunohematology laboratory is often required for performing complex serological tests. The exact incidence of DIIHA is not known, but as per data published by Garratty, the incidence of DIIHA is estimated to be one in million population. [1] There are many drugs which are implicated in causing DIIHA ranging from antimicrobials, antineoplastics to anti-inflammatory drugs. Among antimicrobials, cephalosporins are commonly reported to cause hemolytic anemia. [2] In this report, we present a life-threatening hemolytic reaction to cephalosporin (ceftriaxone) in a 15-year-old child, which was diagnosed and managed in a timely manner. Our patient was suddenly deteriorated after two doses of intravenous ceftriaxone, with increase in pallor, fatigue, and frank hematuria. Repeat laboratory investigations showed signs of hemolysis, presence of schistocytes, raised lactic dehydrogenase, and indirect bilirubin. Reticulocyte count was 3.4%. Direct antiglobulin test was strong positive (4+) with IgG and C3d positive. Testing for drug-dependent antibody confirmed the presence of ceftriaxone-dependent antibody. Drug was stopped immediately. There was a rapid improvement in patient's general condition after discontinuation of drug. Laboratory parameters were improved after 48 h, and the patient was stable with no further drop in hemoglobin and hemolytic episodes. We suggest the need for proper immunohematological services to diagnose and solve such complex cases promptly.

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Section: Discussionmentioning

confidence: 99%

Severe drug-induced immune hemolysis due to ceftriaxone

Dara

Sharma

Bhardwaj

2020

Asian J Transfus Sci

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“…Recently, a case of ceftriaxone-induced IHA was reported with a patient refusing transfusions for religious reasons (Jehova’s witness). In this case the patient could be stabilized with daily application of erythropoietin, ferrous sulfate, folic acid and vitamin B12 [ 26 ]. In many cases, patients are given steroids.…”

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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“…Besides, recent study reported ceftriaxone-induced neurotoxicity in patients with end-stage renal disease resulting from the delayed clearance of the drug (Inoue and others 2017). In rare cases, ceftriaxone can cause drug-induced hemolytic anemia (Tasch & Gonzalez-Zayaz 2017).…”

Section: Ceftriaxone: β-Lactam Antibioticmentioning

confidence: 99%

Drug Repurposing in Neurological Disorders: Implications for Neurotherapy in Traumatic Brain Injury

et al. 2020

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Traumatic brain injury (TBI) remains a significant leading cause of death and disability among adults and children globally. To date, there are no Food and Drug Administration–approved drugs that can substantially attenuate the sequelae of TBI. The innumerable challenges faced by the conventional de novo discovery of new pharmacological agents led to the emergence of alternative paradigm, which is drug repurposing. Repurposing of existing drugs with well-characterized mechanisms of action and human safety profiles is believed to be a promising strategy for novel drug use. Compared to the conventional discovery pathways, drug repurposing is less costly, relatively rapid, and poses minimal risk of the adverse outcomes to study on participants. In recent years, drug repurposing has covered a wide range of neurodegenerative diseases and neurological disorders including brain injury. This review highlights the advances in drug repurposing and presents some of the promising candidate drugs for potential TBI treatment along with their possible mechanisms of neuroprotection. Edaravone, glyburide, ceftriaxone, levetiracetam, and progesterone have been selected due to their potential role as putative TBI neurotherapeutic agents. These drugs are Food and Drug Administration–approved for purposes other than brain injuries; however, preclinical and clinical studies have shown their efficacy in ameliorating the various detrimental outcomes of TBI.

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Ceftriaxone-Induced Hemolytic Anemia in a Jehovah’s Witness

Cited by 5 publications

References 13 publications

Severe drug-induced immune hemolysis due to ceftriaxone

Severe drug-induced immune hemolysis due to ceftriaxone

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

Drug Repurposing in Neurological Disorders: Implications for Neurotherapy in Traumatic Brain Injury

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