Ciprofloxacin hemolytic anemia

Allergic reactions (e.g., rashes, urticaria, and eosino-philia) have been observed. These drugs have occasionally been associated with cholestatic jaundice, blood dyscrasias, hemolytic anemia, hypoglycemia, and nephrotoxicity. Recently the use of ciprofloxacin for prophylaxis protection against anthrax infection has been associated with damage to muscle ligaments. 

Angioimmunoblastic lymphadenopathy is a rare disorder characterized by generalized lymphadenopathy, fever, hepatosplenomegaly, immune hemolytic anemia, and polyclonal hypergammaglobulinemia. Biopsy-proven angioimmunoblastic lymphadenopathy has been reported in a 79-year-old man who had received ciprofloxacin (60). 

In over 33 000 patients treated with ciprofloxacin, norfloxacin, or ofloxacin, no case of hemolytic anemia was discovered by prescription event monitoring (19). However, ciprofloxacin has been associated with hemolysis in combination with a severe skin reaction in a young adult (41). 

The first quinolone, nalidixic acid, was isolated as a byproduct of the synthesis of chloroquine. It has been available for the treatment of urinary tract infections for many years. The introduction of fluorinated 4-quinolones, such as ciprofloxacin (Cipro), moxifloxacin (Avelox), and gatifloxacin (Tequin) represents a particularly important therapeutic advance because these agents have broad antimicrobial activity and are effective after oral administration for the treatment of a wide variety of infectious diseases. Relatively few side effects appear to accompany the use of these fluoroquinolones, and microbial resistance to their action does not develop rapidly. Rare and potentially fatal side effects, however, have resulted in the withdrawal from the market of temafloxacin (immune hemolytic anemia), trovafloxacin... 

Hematologic An 88-year-old woman with glucose-6-phosphate dehydrogenase (G6PD) deflciency developed an acute hemolytic anemia soon after the use of intravenous ciprofloxacin 500mg/day for fever and diarrhea after chemotherapy for colon cancer [25 ]. She had shortness of breath, cyanosis, and a fall in hemoglobin from 11.1 to 6.4 g/dl. 

Hematologic A 30-year-old man took oral ciprofloxacin 1 g/day for 3 days for a suspected urinary tract infection and developed a rapidly fatal hemolytic anemia and severe thrombocytopenia [38 ]. The authors attributed the hemolysis and thrombocytopenia to ciprofloxacin, but a non-drug cause could not be ruled, since hematuria preceded exposure to ciprofloxacin. 

A 53-year-old white man was given chemotherapy for acute lymphoblastic leukemia and after 4 weeks recovered his blood cell count but developed a fever and was given oral ciprofloxacin 500 mg bd. After four doses he developed the typical features of hemolytic-uremic syndrome with microangiopathic hemoljdic anemia. The ciprofloxacin was withdrawn, and he received five sessions of plasma exchange. He recovered completely. 

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