Serologic characteristics of ceftriaxone antibodies in 25 patients with drug‐induced immune hemolytic anemia (CME)

Arndt, Patricia A.; Leger, Regina M.; Garratty, George

doi:10.1111/j.1537-2995.2011.03321.x

Cited by 37 publications

(57 citation statements)

References 44 publications

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“…Normal haptoglobin levels may be present in extravascular hemolysis. In the United States, ceftriaxone appears to be the second most common drug causing DIIHA [6,8]. A positive DAT is the most reliable laboratory finding in DIIHA [2].…”

Section: Discussionmentioning

confidence: 99%

Ceftriaxone-Induced Hemolytic Anemia in a Jehovah’s Witness

Tasch

Gonzalez-Zayaz

2017

Am J Case Rep

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Patient: Female, 65Final Diagnosis: Ceftriaxone induced immune hemolytic anemiaSymptoms: Blindness • fatigueMedication: —Clinical Procedure: —Specialty: HematologyObjective:Unusual clinical courseBackground:Drug-induced immune hemolytic anemia (DIIHA) is a rare condition that may result from the administration of an antibiotic, most notably the cephalosporin class, commonly used in both the adult and pediatric populations. A delay in recognition by a provider may lead to continuation of the offending agent and possibly result in fatal outcomes.Case Report:We report the case of a 65-year-old woman on ceftriaxone infusions after being diagnosed with acute mitral valve endocarditis 3 weeks prior, which presented with severe anemia and bilateral transient vision loss. Being a Jehovah’s Witness, the patient refused blood product transfusions and was managed with alternative therapies. The etiology of the symptoms was suspected to be a hemolytic anemia directly related to her ceftriaxone infusions.Conclusions:This report demonstrates the importance of close vigilance while prescribing drugs known to cause hemolytic anemia. Although rare, drug-induced immune hemolytic anemia caused by ceftriaxone may be a potentially fatal condition, but with early recognition and withdrawal of the offending agent, successful treatment may ensue. Serological tests should be utilized to obtain a definitive diagnosis.

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Section: Discussionmentioning

confidence: 99%

Ceftriaxone-Induced Hemolytic Anemia in a Jehovah’s Witness

Tasch

Gonzalez-Zayaz

2017

Am J Case Rep

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“…CIHA occurs much more commonly in children as compared with adults. 3,32 Children manifesting CIHA commonly have underlying chronic hematologic or immunological disorders or chronic/recurrent infections ( Table 1). Eighteen of these patients, including our patient had previous exposure to ceftriaxone.…”

Section: Discussionmentioning

confidence: 99%

“…In the largest reported series of 25 pediatric and adult DIIHA cases caused by ceftriaxone, DAT detected RBC-bound IgG in half of the cases and the DAT was positive for complement in all the cases suggestive of antibody being predominantly immunoglobulin M (IgM) in nature. 32 In the laboratory, IgM and/or IgG antibodies almost always activate complement and cause in vitro hemolysis, agglutination, and sensitization of test RBCs in the presence of ceftriaxone, and enzyme-treated RBCs react more strongly than untreated RBCs. 8,32 Successful treatment of CIHA as in our patient warrants urgent cardiopulmonary support, correction of severe anemia with blood transfusion, identification of the druginduced hemolysis and most importantly, immediate cessation of ceftriaxone therapy.…”

Section: Discussionmentioning

confidence: 99%

“…32 In the laboratory, IgM and/or IgG antibodies almost always activate complement and cause in vitro hemolysis, agglutination, and sensitization of test RBCs in the presence of ceftriaxone, and enzyme-treated RBCs react more strongly than untreated RBCs. 8,32 Successful treatment of CIHA as in our patient warrants urgent cardiopulmonary support, correction of severe anemia with blood transfusion, identification of the druginduced hemolysis and most importantly, immediate cessation of ceftriaxone therapy. Blood transfusion can usually be safely administered because the antibodies are drug dependent.…”

Section: Discussionmentioning

confidence: 99%

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Ceftriaxone-induced Hemolytic Anemia

Northrop

Agarwal

2015

Journal of Pediatric Hematology/Oncology

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Ceftriaxone is a frequently used empiric antibiotic in children. Acute hemolysis is a rare side effect of ceftriaxone therapy associated with a high mortality rate. A 14-year-old boy suffering from Crohn disease developed bacterial pneumonia that was treated with ceftriaxone. We report successful management of ceftriaxone-induced hemolytic anemia (CIHA) in this patient and review the CIHA literature in pediatric patients. Early recognition of CIHA with prompt discontinuation of ceftriaxone therapy may have a beneficial role in reduction of high mortality seen in these patients.

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“…One might expect that anchoring foreign biological objects (molecules, their fragments and complexes, microorganisms) to the RBC surface would induce immune responses, as evidenced by drug-related autoimmune RBC antibodies. In some cases these antibodies can be neutralized by free drug but frequently they only bind to the drug/membrane complex[112, 113]. Whether induced or preformed, such antibodies can cause severe, life-threatening hemolytic anemia.…”

Section: Effects Of Drugs On Rbcsmentioning

confidence: 99%

Erythrocytes as Carriers for Drug Delivery in Blood Transfusion and Beyond

Villa

Cines

Siegel

et al. 2017

Transfusion Medicine Reviews

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Red blood cells (RBCs) are innate carriers that can also be engineered to improve the pharmacokinetics and pharmacodynamics of many drugs, particularly bio-therapeutics. Successful loading of drugs, both internally and on the external surface of RBCs, has been demonstrated for many drugs including anti-inflammatory, anti-microbial, and anti-thrombotic agents. Methods for internal loading of drugs within RBCs are now entering clinical use. While internal loading can result in membrane disruption that may compromise biocompatibility, surface loading using either affinity or chemical ligands offers a diverse set of approaches for the production of RBC drug carriers. A wide range of surface determinants is potentially available for this approach, although there remains a need to characterize the effects of coupling agents to these surface proteins. Somewhat surprisingly, recent data also suggest that red cell mediated delivery may confer tolerogenic immune effects. Questions remaining before widespread application of these technologies include determining the optimal loading protocol, source of RBCs, and production logistics, as well as addressing regulatory hurdles. RBC drug carriers, after many decades of progress, are now poised to enter the clinic and broaden the potential application of RBCs in blood transfusion.

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Serologic characteristics of ceftriaxone antibodies in 25 patients with drug‐induced immune hemolytic anemia (CME)

Abstract: Ceftriaxone antibodies can cause severe intravascular hemolysis. Complement can usually be detected on the patient's RBCs and IgM antibodies are usually detected in the patient's serum.

Cited by 37 publications

References 44 publications

Ceftriaxone-Induced Hemolytic Anemia in a Jehovah’s Witness

Ceftriaxone-Induced Hemolytic Anemia in a Jehovah’s Witness

Ceftriaxone-induced Hemolytic Anemia

Erythrocytes as Carriers for Drug Delivery in Blood Transfusion and Beyond

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