Cefotetan‐induced hemolytic anemia causing severe hypophosphatemia

Abstract

Phosphorus is a major component of proteins, phospholipids, and nucleotides. The increased uptake of phosphorus by cells during erythropoiesis can result in severe hypophosphatemia. A case of severe hypophosphatemia due to accelerated erythropoiesis in response to Cefotetan-induced hemolytic anemia is described. The hypophosphatemia seen during hemolysis may be the result, rather than the cause, of the hemolysis.

BLOOD MANAGEMENT: Large‐dose intravenous ferric carboxymaltose injection for iron deficiency anemia in heavy uterine bleeding: a randomized, controlled trial

“…The most common adverse event associated with ferric carboxymaltose administration was transient, asymptomatic hypophosphatemia, The effect of treatment for iron deficiency anemia on serum phosphate has not been previously examined. However, selective hypophosphatemia without other electrolyte disorders has been reported in association with accelerated erythropoiesis at the onset of acute hemolytic anemia, 28 resolution of erythropoietic aplastic crisis in hereditary spherocytosis, 29 and reconstitution of hematopoiesis after allogeneic peripheral blood stem cell transplantation 30 . Urinary phosphate is not increased, confirming the absence of a renal effect 30 .…”

Cardiorenal Syndrome and the Role of the Bone-Mineral Axis and Anemia

“…Data on possible relations between the bone-mineral axis and iron are derived from associations between hypophosphatemia and stimulated erythropoiesis in some hematopoietic disorders 28,29 as well as after intravenous (IV) iron infusion. 30 Iron-induced hypophosphatemia may result from increased cellular uptake of phosphate during erythropoiesis, but renal phosphate wasting appears to be an important mechanism of iron-induced hypophosphatemia.…”

Effect of ferric carboxymaltose on serum phosphate and C-terminal FGF23 levels in non-dialysis chronic kidney disease patients: post-hoc analysis of a prospective study

“…It has been observed after the administration of other IV iron preparations such as iron saccharide [15] or iron polymaltose [16], but not with low molecular weight iron dextran [7], ferric gluconate [17] or iron isomaltoside [18]. Because hypophosphatemia has been reported in association with stimulated erythropoiesis in other haematopoietic disorders [19-21], it has been suggested that iron-induced hypophosphatemia might be the result of an increased cellular uptake of phosphate during erythropoiesis [13]. However, the main mechanism of iron-induced hypophosphatemia seems to be renal phosphate wasting [22].…”