Ceftriaxone hemolytic anemia

Autoimmune hemolytic anemia has rarely been reported with the older cephalosporins, including cefalexin (40), cefalotin (41,42), cefazolin (43), and cefaloridine (44). The main laboratory findings correspond to the drug adsorption mechanism classically found in benzylpenicil-lin-induced immune hemolysis. Antibodies cross-reacting with cefalotin and benzylpenicillin were found in both benzylpenicillin-induced and cefalotin-induced hemolysis (43,45) Cases have also been reported with cefamandole (46), cefalexin (47), ceftriaxone (48), cefotaxime (49,50), cefotetan (51,52) and ceftazidime (53). 

Cefotetan-induced hemolytic anemia has been discussed in a review of 35 cases, eight of which were discussed in greater detail (54). All eight cases were associated with the prophylactic use of cefotetan in gynecological or obstetric procedures. The patients had received -A doses of cefotetan, and they left hospital in good shape, but all were re-admitted with hemolytic anemia within 2 weeks after the last dose. All needed several blood transfusions and two underwent plasmapheresis twice. They all survived, but the authors underlined the seriousness of this adverse effect. Of 43 cases of drug-induced hemolytic anemia that had been referred to their laboratory in the previous 8 years, 35 had been caused by cefotetan and three by ceftriaxone 11 had a fatal outcome, eight and three caused by cefotetan and ceftriaxone respectively. 

Ceftriaxone has been associated with autoimmune hemolytic anemia, erythroblastocytopenia, and acute hepatitis (56). The ceftriaxone in this case was given intravenously and not orally, as erroneously published (written communication from the authors). Other cases of hemolysis have been reported after ceftriaxone (57). 

A 38-year-old man with no known disease rapidly developed disturbed consciousness 4 days after having taken co-amoxiclav for sinusitis (58). On admission, he was given intravenous ceftriaxone 2 g bd for purulent meningitis. On the 10th day of therapy, he developed icterus and hemolytic anemia. Despite vigorous resuscitative efforts, he died with evidence of multiple organ failure on day 5. 

A 48-year-old woman who had been given ceftriaxone 2 g/day intravenously for 7 days for Lyme disease developed severe hemolytic anemia (59). She had previously been given ceftriaxone twice without any adverse effects. An immune complex mechanism was suggested. 

Garratty G, Postoway N, Schwellenbach J, McMahill PC. A fatal case of ceftriaxone (Rocephin)-induced hemolytic anemia associated with intravascular immune hemolysis. Transfusion 1991 31(2) 176-9. 

Longo F, Hastier P, Buckley MJ, Chichmanian RM, Delmont JP. Acute hepatitis, autoimmune hemolytic anemia, and erythroblastocytopenia induced by ceftriaxone. Am J Gastroenterol 1998 93(5) 836-7. 

Lo G, Higginbottom P. Ceftriaxone induced hemolytic anemia. Transfusion 1993 33(Suppl) 25S. 

Hemolytic anemia occurred in a 7-year-old Caribbean-American boy with hemophago-cytic lymphohistiocytosis shortly after he took amikacin and ceftriaxone and resolved after withdrawal of ceftriaxone there were IgM ceftriaxone-dependent antibodies 1 32, falling to zero after 5 days [16 ]. 

Tobian AA, Shirey RS, Savage WJ. Transfusion med illustrated ceftriaxone-induced acute hemolytic anemia. Transfusion 2010 50(8) 1647-8. 

Hematologic Further cases of hemolytic anemia have been attributed to ceftriaxone [63 ]. In a 6-year-old girl with sickle cell disease it resulted in a hemoglobin concentration of 0.4 g/dl and extensive... 

Kim S, Song KS, Kim HO, Lee HM. Ceftriaxone-induced immune hemolytic anemia detection of drug-dependent antibody by ex-vivo antigen in urine. Yonsei Med J 2002 43(3) 391. ... 

Imam SN, Wright K, Bhoopalam N, Choudhury A. Hemolytic anemia from ceftriaxone in an elderly patient a case report. J Am Med Dir Assoc 2008 9(8) ... 

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