Hemolysis ceftriaxone

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). 

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 14-year-old girl, perinatally infected with HIV, had a medical history of recurrent infections that had been treated with several antibiotics, including ceftriaxone. She was given ceftriaxone (60 mg/kg intravenously) for pneumonia and 30 minutes later complained of severe back pain, became nauseated, vomited, and collapsed. Despite intensive medical care she died within a few hours with massive intravascular hemolysis and disseminated intravascular coagulopathy. Autopsy was refused. 

Of 10 patients with hemolysis due to ceftriaxone, seven died, six of them children (48,57,60-62). 

In a case of hemolysis associated with ceftriaxone the causative antibodies appeared to be stimulated solely by a degradation product of ceftriaxone (62). 

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Moallem HJ, Garratty G, Wakeham M, Dial S, Oligario A, Gondi A, Rao SP, Fikrig S. Ceftriaxone-related fatal hemolysis in an adolescent with perinatally acquired human immunodeficiency virus infection. J Pediatr 1998 133(2) 279-81. 

Punar M, Ozsut H, Eraksoy H, Calangu S, Dilmener M. An adult case of fatal hemolysis induced by ceftriaxone. Clin Microbiol Infect 1999 5(9) 585-6. 

Maraspin V, Lotric-Furlan S, Strle F. Ceftriaxone associated hemolysis. Wien Khn Wochenschr 1999 lll(9) 368-70. 

Bernini JC, Mustafa MM, Sutor LJ, Buchanan GR. Fatal hemolysis induced by ceftriaxone in a child with sickle cell anemia. J Pediatr 1995 126(5 Pt 1) 813-15. 

Scimeca PG, Weinblatt ME, Boxer R. Hemolysis after treatment tvith ceftriaxone. J Pediatr 1996 128(1) 163. 

Borgna-Pignatti C, Bezzi TM, Reverberi R. Fatal ceftriaxone-induced hemolysis in a child with acquired immunodeficiency syndrome. Pediatr Infect Dis J 1995 14(12) 1116-17. 

Schuettpelz LG, Behrens D, Goldsmith MI, Druley TE. Severe ceftriaxone-induced hemolysis complicated by diffuse cerebral ischemia in a child with sickle cell disease. J Pediatr Hematol Oncol 2009 31(11) 870-2. 

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