title: Ceftriaxone-induced hemolytic anemia in a child successfully managed with intravenous immunoglobulin.
abstract: Drug-induced hemolytic anemia is an immune-mediated phenomenon that leads to the destruction of red blood cells. Here, we present a case of life-threatening ceftriaxone-induced hemolytic anemia (CIHA) in a previously healthy 3-year-old girl. We also reviewed the literature to summarize the clinical features and treatment of hemolytic anemia. Acute hemolysis is a rare side effect of ceftriaxone therapy associated with high mortality. Our patient had a sudden loss of consciousness with macroscopic hematuria and her hemoglobin dropped from 10.2 to 2.2 g/dl over 4 hours, indicating that the patient had life-threatening hemolysis after an intravascular dose of ceftriaxone who had previously been treated with ceftriaxone in intramuscular form for six days. CIHA is associated with a positive direct antiglobulin test, revealing the presence of IgG in all cases and C3d in most cases. Our patient's direct antiglobulin test was positive for IgG (3+) and for C3d (4+). The case was managed successfully with supportive measures and intravenous immunoglobulin therapy. Ceftriaxone is used very frequently in children; an early diagnosis and proper treatment of hemolytic anemia are essential to improve the patient outcome. The pathophysiological mechanism is the same as for non-drug autoimmune hemolytic anemia. However, there is still no consensus treatment for CIHA. Intravenous immunoglobulin can be used in clinical emergencies, such as our case, or in refractory cases.
authors.affiliation: Department of Pediatrics, Bezmialem Vakıf University Faculty of Medicine, Istanbul, Turkey.
authors.forename: Aysel
authors.initials: A
authors.lastname: Vehapoğlu
authors.affiliation: Department of Pediatrics, Bezmialem Vakıf University Faculty of Medicine, Istanbul, Turkey.
authors.forename: Nilüfer
authors.initials: N
authors.lastname: Göknar
authors.affiliation: Department of Pediatrics, Bezmialem Vakıf University Faculty of Medicine, Istanbul, Turkey.
authors.forename: Rümeysa
authors.initials: R
authors.lastname: Tuna
authors.affiliation: Division of Pediatric Hematology-Oncology, Bezmialem Vakıf University Faculty of Medicine, Istanbul, Turkey.
authors.forename: Fatma Betül
authors.initials: FB
authors.lastname: Çakır
mesh_terms: D000744:Anemia, Hemolytic, Autoimmune / Q000139:chemically induced* / Q000188:drug therapy; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D002443:Ceftriaxone / Q000009:adverse effects*; D002675:Child, Preschool; D064420:Drug-Related Side Effects and Adverse Reactions; D004912:Erythrocytes / Q000276:immunology; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D016756:Immunoglobulins, Intravenous; D002443:Ceftriaxone
keywords: IVIG; ceftriaxone; children; immune hemolytic anemia