Drug-Induced Immune Hemolytic Anemia due to Amoxicillin-Clavulanate: A Case Report and Review

Abstract

Drug-induced immune hemolytic anemia (DIIHA) is a rare cause of anemia. It is often difficult to distinguish from other causes of hemolytic anemia, thereby delaying diagnosis and treatment. Antibiotics, including penicillins and cephalosporins, are the drugs most often implicated in the development of DIIHA. Discontinuation of the offending agent is often sufficient for treatment. Here, we review the case of a 25-year-old Caucasian female who presented with jaundice and generalized weakness in the setting of outpatient treatment with amoxicillin-clavulanate due to sinus infection. Laboratory testing revealed transaminitis and hemolytic anemia. Direct antiglobulin test (DAT) revealed negative IgG and positive anti-C3. Cold agglutinin titer and Donath-Landsteiner test were negative. The patient was diagnosed with DIIHA most likely due to amoxicillin. She improved with drug cessation and a short course of glucocorticoids. Mechanism of DIIHA, workup, and management are subsequently reviewed.

Consumo de Antibióticos y su Relación con el Desarrollo de Anemia Hemolítica Autoinmune

“…Un reporte de caso informa de una mujer de 25 años que recibió amoxicilina-clavulanato para el tratamiento de una infección de los senos nasales. Las pruebas de laboratorio revelaron anemia con niveles bajos de hemoglobina 6.8 g/dl (HB 14 inicial del paciente) y hematocrito 19.2% (HB 14 inicial del paciente) (23). Otros casos reportados, es el de una mujer diagnosticada clínicamente de neumonía adquirida en la comunidad, que desarrolla anemia hemolítica secundaria a ceftriaxona y el de un hombre un anciano que desarrolló DIIHA secundaria a piperacilina-tazobactam y comenzó a controlar la infección del sitio de la gastrostomía.…”

Contrast Media-Induced Immune Hemolytic Anemia

“…Drug-induced immune hemolysis (drug-dependent type) is the most likely explanation of the hemolysis in our case, evidenced by the abrupt severe hemolysis after the administration of iohexol (omnipaque), the positive DAT (IgG class), and the absence of other factors explaining the sever onset hemolysis. Cessation of the culprit drug and blood products transfusion are the main aspects in the management of drug-induced hemolytic anemia [ 9 ]. Steroids, intravenous immunoglobulins (IVIG), plasmapheresis, or immunosuppressants may be tried in refractory cases [ 10 , 11 ].…”