Hemolysis after treatment with ceftriaxone

Ceftriaxone-induced Hemolytic Anemia

“…Eighteen of these patients, including our patient had previous exposure to ceftriaxone. 4,6,7,[16][17][18][19][20][21][22][23]25,[28][29][30][31] There was no information reported in the remaining 5 patients. 3,5,24,26,27 It is unclear whether the underlying disease processes contribute to the development of anticeftriaxone antibodies and hemolysis, or if repeated exposure to the drug is important, or both.…”

“…13 Hemolysis in pediatric patients with CIHA usually occurs within 30 minutes (range, 5 to 120 min) of ceftriaxone administration. [4][5][6][7][16][17][18][19]21,23,28 The hemolysis is often dramatic and the hemoglobin can acutely drop to 2.5 g/dL (range, 0.4 to 8.4 g/dL) ( Table 1). In adults, the fall in hemoglobin is much less and occurs over a period of hours to days.…”

“…Acute renal failure has been reported in at least 40% of pediatric CIHA patients with an associated mortality rate of 55% (Table 1). The acute drop in hemoglobin along with [4][5][6][7] The rapid progression of hemolysis leading to death in a few hours makes early diagnosis difficult. A high index of DIIHA suspicion is required to promptly diagnose CIHA with serological tests.…”

Ceftriaxone-induced immune haemolysis: two case reports and a concise review of the literature

“…More than half of all reported cases of IHA associated with third-generation cephalosporins are related to ceftriaxone (ceftriaxone in 11 cases [7,8,9,10,11,12,13,14], ceftizoxime in three cases [4,5], cefotaxime in two cases [2,24], ceftazidime in one case [25]). In all cases except one [5], fatal haemolysis occurred only in association with ceftriaxone.…”

“…The remainder is secreted in the bile and is ultimately found in the faeces as microbiologically inactive compounds [6]. Ceftriaxone was responsible for several cases of immune-mediated intravascular haemolysis [7,8,9,10,11,12,13,14]. In some of these cases, however, the serological data was either missing or incomplete.…”