ro13-9904 and Anemia--Hemolytic

To determine the safety of ceftriaxone in paediatric patients and systematically evaluate the categories and incidences of adverse drug reactions (ADRs) of ceftriaxone in paediatric patients.. We performed a systematic search in Medline, PubMed, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, International Pharmaceutical Abstracts and bibliographies of relevant articles up to December 2018 for all types of studies that assessed the safety of ceftriaxone in paediatric patients aged ≤18 years.. 112 studies met the inclusion criteria involving 5717 paediatric patients who received ceftriaxone and reported 1136 ADRs. The most frequent ADRs reported in prospective studies were gastrointestinal (GI) disorders (37.4 %, 292/780), followed by hepatobiliary disorders (24.6%, 192/780). Serious ADRs leading to withdrawal or discontinuation of ceftriaxone were reported in 86 paediatric patients. Immune haemolytic anaemia (34.9%, 30/86) and biliary pseudolithiasis (26.7%, 23/86) were the two major causes. Haemolytic anaemia following intravenous ceftriaxone led to death in 11 children whose primary disease was sickle cell disease. Almost all biliary pseudolithiasis are reversible. However, the incidence was high affecting one in five paediatric patients (20.7%).. GI ADRs are the most common toxicity of ceftriaxone in paediatric patients. Immune haemolytic anaemia and biliary pseudolithiasis are the most serious ADRs and the major reasons for discontinuation of ceftriaxone. Immune haemolytic anaemia is more likely in children with sickle cell disease and may cause death. Ceftriaxone should be used with caution in children with sickle cell disease.. CRD42017055428.

Topics: Anemia, Hemolytic; Anemia, Sickle Cell; Anti-Bacterial Agents; Ceftriaxone; Diarrhea; Digestive System Diseases; Exanthema; Humans; Nephrolithiasis; Pediatrics; Thrombocytosis; Ureteral Calculi; Urination Disorders

Drug induced immune hemolytic anemia (DIIHA) is a rare complication and often underdiagnosed. DIIHA is frequently associated with a bad outcome, including organ failure and even death. For the last decades, ceftriaxone has been one of the most common drugs causing DIIHA, and ceftriaxone-induced immune hemolytic anemia (IHA) has especially been reported to cause severe complications and fatal outcomes.. A 76-year-old male patient was treated with ceftriaxone for cholangitis. Short time after antibiotic exposure the patient was referred to intensive care unit due to cardiopulmonary instability. Hemolysis was observed on laboratory testing and the patient developed severe renal failure with a need for hemodialysis for 2 weeks. Medical history revealed that the patient had been previously exposed to ceftriaxone less than 3 weeks before with subsequent hemolytic reaction. Further causes for hemolytic anemia were excluded and drug-induced immune hemolytic (DIIHA) anemia to ceftriaxone could be confirmed.. The case demonstrates the severity of ceftriaxone-induced immune hemolytic anemia, a rare, but immediately life-threatening condition of a frequently used antibiotic in clinical practice. Early and correct diagnosis of DIIHA is crucial, as immediate withdrawal of the causative drug is essential for the patient prognosis. Thus, awareness for this complication must be raised among treating physicians.

Topics: Aged; Anemia, Hemolytic; Anti-Bacterial Agents; Ceftriaxone; Humans; Male; Renal Insufficiency

Ceftriaxone is a frequently used empiric antibiotic in children. Acute hemolysis is a rare side effect of ceftriaxone therapy associated with a high mortality rate. A 14-year-old boy suffering from Crohn disease developed bacterial pneumonia that was treated with ceftriaxone. We report successful management of ceftriaxone-induced hemolytic anemia (CIHA) in this patient and review the CIHA literature in pediatric patients. Early recognition of CIHA with prompt discontinuation of ceftriaxone therapy may have a beneficial role in reduction of high mortality seen in these patients.

Topics: Adolescent; Anemia, Hemolytic; Anti-Bacterial Agents; Ceftriaxone; Humans; Male

Guidelines for the treatment of Lyme arthritis were published by the Infectious Diseases Society of America in 2006 and recommended oral doxycycline for initial therapy. We report here the case of a young girl treated with intravenous ceftriaxone who subsequently developed drug-induced autoimmune hemolytic anemia and renal failure. Her severe sequelae highlight the importance of antimicrobial stewardship. We review here the goals of antimicrobial stewardship and several strategies for achieving them. In addition, we briefly discuss the rare adverse drug event experienced by our patient.

Topics: Acute Kidney Injury; Anemia, Hemolytic; Anti-Bacterial Agents; Blood Chemical Analysis; Blood Transfusion; Ceftriaxone; Child; Combined Modality Therapy; Female; Follow-Up Studies; Hemolysis; Humans; Kidney Cortex Necrosis; Kidney Function Tests; Lyme Disease; Methylprednisolone; Recovery of Function; Renal Dialysis; Risk Assessment; Severity of Illness Index; Treatment Outcome

Topics: Anemia, Hemolytic; Anemia, Sickle Cell; Bacterial Infections; Ceftriaxone; Cephalosporins; Child; Follow-Up Studies; Humans; Male; Severity of Illness Index

In this report, we will describe the occurrence of intravascular immune haemolytic anaemia (IHA) associated with ceftriaxone and/or its metabolites in two of our patients. Serological examinations were carried out to demonstrate and characterise the causative antibodies. The findings of all previously reported cases will also be discussed.. Direct antiglobulin tests (DAT) and indirect antiglobulin tests were performed according to standard procedures. Tests for drug-dependent antibodies were performed in the presence and absence of the target drugs and their ex vivo antigens (in the urine of patients treated with the drugs).. Ceftriaxone-related haemolysis resulted in the death of one of our patients (patient 2), and caused acute renal failure in the other (patient 1). The DATwas strongly positive for anti-C3d and anti-IgG in one case (patient 2), and for anti-C3d alone in the other (patient 1). The serum of patient 1 reacted with red blood cells only in the presence of ex vivo antigens, while that of patient 2 reacted positively to native ceftriaxone and its ex vivo antigen. In the latter patient, the antibodies appeared to cross-react with native cefotaxime whereas, in the first patient, they weakly cross-reacted only with the ex vivo antigens of cefotaxime and cefpodoxime proxetil.. Ceftriaxone and/or its trace metabolites may induce life-threatening IHA in children and adults. Serological work-up must include tests to determine the cross-reactivity of ceftriaxone-dependent antibodies to avoid immune haemolysis due to administration of structurally related cephalosporins in affected patients.

Topics: Acute Kidney Injury; Aged; Anemia, Hemolytic; Ceftriaxone; Cephalosporins; Fatal Outcome; Female; Humans; Middle Aged; Molecular Structure

We report the case of an 82-year old male patient admitted in our medical intensive care unit for diffuse skin lesions, 3 days after the onset of ceftriaxone for bilateral pneumonia without microbiological documentation. The patient concomitantly exhibited diffuse skin lesions compatible with livedo and neurological and haemodynamic failure. Biological analysis revealed acute haemolytic anaemia. Warming of patient, red blood-cells transfusion and high-doses corticosteroids were initiated and ceftriaxone was stopped. Despite these therapeutics, the patient exhibited multiple organ failure and died. The main suspected triggering factor of this acute and fatal haemolytic anaemia was ceftriaxone administration considering: (i) the delay between cephalosporin administration and symptoms; (ii) the worsening of livedo and acrocyanosis a few hours after meningeal ceftriaxone doses; and (iii) fatal evolution. Cephalosporin-induced autoimmune haemolytic anaemia is a rare and serious cause of livedo that should be suspected in patients exhibiting livedo and acute haemolytic anaemia within hours/days following cephalosporin administration.

Topics: Aged, 80 and over; Anemia, Hemolytic; Anemia, Hemolytic, Autoimmune; Ceftriaxone; Cephalosporins; Hemolysis; Humans; Male

Drug-induced immune hemolytic anemia (DIIHA) is a rare complication of any drug therapy, which if not recognized early can be fatal. It is usually underdiagnosed. Ceftriaxone is a commonly used antibiotic in routine practice and is one of the most common drugs to cause DIIHA.. We report a case of ceftriaxone-induced immune hemolytic anemia in a 62-year-old woman who had a negative result of a direct antiglobulin test.. A review of the literature highlights the salient features of DIIHA and underscores the importance of keeping the suspicion of DIIHA high in the relevant clinical settings because ceftriaxone has been associated with particularly severe outcomes of DIIHA. In cases of unclear hemolysis and despite a negative result of a direct antiglobulin test, the treating physician must keep suspicion of DIIHA high and meticulously look for the possible culprit drugs. Treatment with suspected drugs must be stopped promptly to prevent severe complications and fatal outcomes.

Topics: Anemia, Hemolytic; Anti-Bacterial Agents; Ceftriaxone; Female; Humans; Middle Aged

Topics: Anemia, Hemolytic; Ceftriaxone; Child; Cochlear Implantation; Hearing Loss, Sensorineural; Humans; Male; Vestibular Aqueduct

BACKGROUND Drug-induced immune hemolytic anemia (DIIHA) is a rare condition that may result from the administration of an antibiotic, most notably the cephalosporin class, commonly used in both the adult and pediatric populations. A delay in recognition by a provider may lead to continuation of the offending agent and possibly result in fatal outcomes. CASE REPORT We report the case of a 65-year-old woman on ceftriaxone infusions after being diagnosed with acute mitral valve endocarditis 3 weeks prior, which presented with severe anemia and bilateral transient vision loss. Being a Jehovah's Witness, the patient refused blood product transfusions and was managed with alternative therapies. The etiology of the symptoms was suspected to be a hemolytic anemia directly related to her ceftriaxone infusions. CONCLUSIONS This report demonstrates the importance of close vigilance while prescribing drugs known to cause hemolytic anemia. Although rare, drug-induced immune hemolytic anemia caused by ceftriaxone may be a potentially fatal condition, but with early recognition and withdrawal of the offending agent, successful treatment may ensue. Serological tests should be utilized to obtain a definitive diagnosis.

Topics: Aged; Anemia, Hemolytic; Anti-Bacterial Agents; Ceftriaxone; Endocarditis, Bacterial; Epoetin Alfa; Female; Ferrous Compounds; Folic Acid; Hematinics; Humans; Jehovah's Witnesses; Vitamin B 12

Drug-induced immune haemolytic anaemia (DIIHA) is caused by various drugs or their metabolites. Cephalosporins are associated with haemolytic anaemia but multi-organ failure is rarely described.. We report the case of a 57-year-old female who was diagnosed with neuroborreliosis and treated with ceftriaxone. The patient developed severe DIIHA. Massive intravascular haemolysis led to shock and acute renal failure, necessitating mechanical ventilation and dialysis. Treatment with ceftriaxone was discontinued and glucocorticoids were prescribed. The patient recovered slowly but fully.. Ceftriaxone-induced immune haemolytic anaemia is a rare but potentially fatal condition.

Topics: Anemia, Hemolytic; Anti-Bacterial Agents; Ceftriaxone; Female; Fluid Therapy; Glucocorticoids; Humans; Middle Aged; Multiple Organ Failure

Severe falciparum malaria may be complicated by prolonged haemolysis and recurrent fever after parasite clearance. However, their respective etiologies are unclear and challenging to diagnose. We report the first case of severe falciparum malaria followed by prolonged haemolytic anaemia and rhinomaxillary mucormycosis in a previously healthy adult male.. A 30-year old Bangladeshi man was admitted with severe falciparum malaria complicated by hyperlactataemia and haemoglobinuria. Prior to admission he was treated with intravenous quinine and upon admission received intravenous artesunate and empiric ceftriaxone. Thirty hours later the peripheral parasitaemia cleared with resolution of fever and haemoglobinuria. Despite parasite clearance, on day 3 the patient developed recurrent fever and acute haemolytic anaemia requiring seven blood transfusions over six days with no improvement of his haemoglobin or haemoglobinuria. On day 10, he was treated with high-dose dexamethasone and meropenem with discontinuation of the ceftriaxone. Two days later the haemoglobinuria resolved. Ceftriaxone-induced haemolysis was the suspected final diagnosis. On day 16, the patient had progressively worsening right-sided facial pain and swelling; a necrotic ulceration of the hard palate was observed. Rhinomaxillary mucormycosis was diagnosed supported by microscopy findings. The patient initially responded to treatment with urgent surgical debridement, itraconazole, followed by two weeks of amphotericin B deoxycholate, however was subsequently lost to follow up.. This case highlights the range of potential alternative aetiologies of acute, prolonged haemolysis and recurrent fever following parasite clearance in severe falciparum malaria. It emphasizes the importance of a high degree of suspicion for alternative causes of haemolysis in order to avoid unnecessary treatments, including blood transfusion and steroids. It is critical to consider and identify common invasive bacterial and rare opportunistic co-infections as a cause of fever in severe malaria patients remaining febrile after parasite clearance to promote antimicrobial stewardship and prompt emergency care.

Topics: Adult; Anemia, Hemolytic; Antimalarials; Ceftriaxone; Coinfection; Humans; Malaria, Falciparum; Male; Maxillary Diseases; Mucormycosis; Opportunistic Infections; Parasitemia; Rhinitis; Severity of Illness Index

Topics: Administration, Intravenous; Anemia, Hemolytic; Ceftriaxone; Child, Preschool; Contraindications; Croup; Dexamethasone; Drug-Related Side Effects and Adverse Reactions; Erythrocytes; Female; Hemolysis; Humans; Immunosuppression Therapy; Parainfluenza Virus 2, Human; Steroids

Topics: Anemia, Hemolytic; Anti-Bacterial Agents; Antineoplastic Agents; Cefotetan; Ceftriaxone; Coombs Test; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Piperacillin; Vidarabine

Topics: Anemia, Hemolytic; Anti-Bacterial Agents; Ceftriaxone; Child; Humans; Male

Ceftriaxone-induced hemolytic anemia is a rare and often fatal phenomenon. We report here the case of a 6-year-old female with sickle cell disease who survived a brisk and profound hemolytic reaction, resulting in hemoglobin of 0.4 g/dL, after ceftriaxone infusion. Ongoing hemolysis was abrogated with aggressive supportive care, but the patient suffered extensive neurologic sequelae as a result of the event. Serologic testing confirmed the presence of ceftriaxone antibodies.

Topics: Anemia, Hemolytic; Anemia, Sickle Cell; Anti-Bacterial Agents; Antibodies; Brain Ischemia; Ceftriaxone; Child; Female; Hemolysis; Humans

Drug-induced haemolytic anaemia can be life threatening. We report a case of ceftriaxone-induced severe haemolytic anaemia in a previously healthy 68-year-old woman. The patient had a positive direct antiglobulin test (anti-C3d positive, anti-immunoglobulin G negative). Serological tests showed ceftriaxone-specific antibodies. The patient recovered after cessation of the drug. This complication may cause milder anaemia and thus be poorly recognized.

Topics: Aged; Anemia, Hemolytic; Anti-Bacterial Agents; Antibodies; Ceftriaxone; Endocarditis, Bacterial; Female; Follow-Up Studies; Hemolysis; Humans; Injections, Intravenous

Hemolytic anemia is uncommon in the general population; however, drug-induced hemolysis is not rare in hospitalized patients. We report a case of unrecognized subacute hemolytic anemia due to ceftriaxone in a geriatric patient requiring multiple blood transfusions before a correct diagnosis could be established.

Topics: Aged; Anemia, Hemolytic; Ceftriaxone; Humans; Male; Perioperative Care; Thoracic Surgery

Over the last decade, second and third generation cephalosporins have been the most common drugs causing hemolytic anemia (HA). Of these cases, 20% have been attributed to ceftriaxone. The clinical presentation of ceftriaxone-induced HA is usually abrupt with sudden onset of pallor, tachypnea, cardio-respiratory arrest and shock. Acute renal failure (ARF) has been reported in 41% of such cases with a high fatality rate. We report a pediatric patient with ARF complicating ceftriaxone-induced HA who survived. Ceftriaxone is a commonly used drug, and early recognition of HA and institution of supportive care, including dialysis is likely to improve the outcome.

Topics: Acute Kidney Injury; Anemia, Hemolytic; Anti-Bacterial Agents; Ceftriaxone; Child; Humans; Kidney Tubular Necrosis, Acute; Male

A 5-year-old girl with no underlying immune deficiency or hematologic disease was treated with a combination of ceftriaxone and ampicilline-sulbactam for pneumonia. On the ninth day of the therapy, she developed oliguria, paleness, malaise, immune hemolytic anemia (IHA) and acute renal failure (ARF). Laboratory studies showed the presence of antibodies against ceftriaxone. Acute interstitial nephritis (AIN) was diagnosed by renal biopsy. The patient's renal insufficiency was successfully treated with peritoneal dialysis without any complications. The patient recovered without any treatment using steroids or other immunosuppressive agents.

Topics: Acute Disease; Acute Kidney Injury; Ampicillin; Anemia, Hemolytic; Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Coombs Test; Female; Humans; Immunoglobulin G; Nephritis, Interstitial; Peritoneal Dialysis; Pneumonia; Sulbactam; Treatment Outcome

Hemolysis induced by ceftriaxone is a complication that has been described in sickle cell anemia. Albuterol is known to induce myocardial ischemia. We describe a case of albuterol-induced cardiac dysfunction in a patient with sickle cell anemia who developed severe anemia after administration of ceftriaxone.

Topics: Adrenergic beta-Agonists; Albuterol; Anemia, Hemolytic; Anemia, Sickle Cell; Ceftriaxone; Child; Humans; Male; Myocardial Ischemia

To describe a case of a ceftriaxone-induced hemolytic anemia and hepatitis leading to multiple organ failure and death in an adolescent with hemoglobin SC disease and to review the previous cases of this rare and potentially fatal disorder in children.. Case report and literature review.. Intensive care unit.. Adolescent with hemoglobin SC.. Emergency treatment.. After 4 days of ceftriaxone therapy, the adolescent experienced an acute hemolytic reaction (hemoglobin decreased to 5 g/dL with hemoglobinuria) and severe hepatitis (all enzymes increasing dramatically including aminoaspartate transferase >20,000 IU/L). Renal failure and ultimately multiple organ failure ensued, and the patient died on hospital day 19. Direct antiglobulin tests on red cells obtained from the patient on hospital day 2 showed microscopic agglutination with polyspecific and anticomplement (C3) antiglobulin reagents. Plasma samples showed macroscopic agglutination reactions when incubated in the presence of ceftriaxone, many days after cessation of ceftriaxone, indicating the continued presence of ceftriaxone-dependent antibodies.. Drug reactions leading to hemolysis are relatively uncommon, and a total of ten cases of ceftriaxone-induced hemolytic anemia have been reported in children. The present case describes an adolescent who ultimately died on hospital day 19 from multiple organ failure, although the presentation of this case seems atypical in several respects. Children with clinical syndromes that place them at risk for hemolysis and children who frequently require broad spectrum antibiotics present unique diagnostic challenges, and the possibility that hemolytic syndromes may be due to ceftriaxone must be considered.

Topics: Adolescent; Anemia, Hemolytic; Anti-Bacterial Agents; Ceftriaxone; Chemical and Drug Induced Liver Injury; Fatal Outcome; Female; Hemoglobin SC Disease; Humans; Multiple Organ Failure

Topics: Anemia, Hemolytic; Anti-Bacterial Agents; Catheterization, Central Venous; Ceftriaxone; Child; Crohn Disease; Humans; Male

Ceftriaxone, a third-generation cephalosporin, has been reported to occasionally cause fatal drug-induced immune hemolytic anemia (DIHA). A clinical and serologic analysis of the first two patients with severe drug-induced thrombocytopenia (DITP) due to ceftriaxone and one patient with fatal DIHA is reported.. Sera were assessed by the IAT, EIA, glycoprotein (GP)-specific immunoassay, flow cytometry, and immunoprecipitation using transfectants expressing GPIIb/IIIa and GPIb/IX and with different cephalosporins.. Sera from Patients 1 and 2 reacted strongly with PLTs in the presence of the drug, but not with RBCs. The binding sites of the drug-dependent antibodies (DDAbs) could be localized to GPIIb/IIIa and GPIb/IX, respectively. Inhibition studies indicated that DDAbs recognized epitopes residing on the GPIIb/IIIa complex and on the GPIX subunit, respectively. No cross-reactivity was observed with other cephalosporin derivatives. Serum 3 showed strong agglutination with RBCs of Rh(null) phenotype in the presence of ex-vivo metabolites of ceftriaxone, but no cross-reactivity with PLTs.. The first two cases of severe DITP and a third patient with DIHA are reported. DDAbs from all patients showed individual reaction patterns and clear cell lineage specificity. In addition, the DDAbs were dependent on the substitution at position 3 of the ceftriaxone molecule. Epitopes on GPIIb/IIIa and GPIX were involved on PLTs. The Rh protein was not the only target of DDAbs on RBCs.

Topics: Adolescent; Aged; Anemia, Hemolytic; Animals; Anti-Bacterial Agents; Blood Platelets; Ceftriaxone; Child; CHO Cells; Cricetinae; Erythrocytes; Female; Humans; Male; Platelet Glycoprotein GPIb-IX Complex; Platelet Glycoprotein GPIIb-IIIa Complex; Thrombocytopenia

Topics: Agglutination Tests; Anemia, Hemolytic; Anti-Bacterial Agents; Cefotetan; Ceftriaxone; Diagnosis, Differential; Drug Hypersensitivity; Humans

Most drug-induced immune hemolytic anemias since the late 1980s have been caused by the second- and third-generation cephalosporins, cefotetan and ceftriaxone, respectively. Cross-reactivity of cefotetan and ceftriaxone antibodies with other cephalosporins or penicillin has been studied only minimally. We tested 7 serum samples previously identified to contain cefotetan antibodies and one serum sample previously identified to contain ceftriaxone antibodies against 9 other cephalosporins, penicillin, and 7-aminocephalosporanic acid in the presence of RBCs and also used hapten inhibition to indicate cross-reactivity. Serum samples containing cefotetan antibodies showed some cross-reactivity with cephalothin and cefoxitin (and to a much lesser extent with penicillin and ceftazidime). The ceftriaxone antibodies showed very weak cross-reactivity with cefotaxime, cefamandole, and cefoperazone. There was very little cross-reactivity between cefotetan antibodies and the drugs tested in the present study. We have no data to determine whether the in vitro data relate to in vivo reactivity.

Topics: Anemia, Hemolytic; Antibodies; Cefamandole; Cefoperazone; Cefotaxime; Cefotetan; Cefoxitin; Ceftriaxone; Cells, Cultured; Cephalosporins; Cephalothin; Cross Reactions; Humans; Models, Chemical; Penicillins

A 5-year-old girl, with no underlying immune deficiency or haematologic disease, was treated with ceftriaxone for a urinary tract infection. After receiving ceftriaxone intramuscularly, massive haemolytic anaemia developed. Laboratory studies showed the presence of an antibody against ceftriaxone, and the findings reflected immune complex type haemolysis. High-dose corticosteroids appeared to be effective therapeutically.

Topics: Amikacin; Anemia, Hemolytic; Antigen-Antibody Complex; Ceftriaxone; Cephalosporins; Child, Preschool; Drug Therapy, Combination; Female; Humans; Methylprednisolone; United States; Urinary Tract Infections

A 48-year-old immunocompetent women treated with ceftriaxone 2 g daily i.v. for late Lyme borreliosis developed severe haemolytic anaemia. The patient had previously received the same antibiotic two times without any side effects. The first clinical signs began to appear on the seventh day of treatment. The patient developed severe anaemia with a haemoglobin level of 45 mg/l on day 10; thereafter she ceased to receive the antibiotic. The outcome was favourable. The clinical course and serologic results suggest that severe anaemia was induced by ceftriaxone and that drug adsorption as well as immune complex mechanisms were involved in the pathogenesis.

Topics: Anemia, Hemolytic; Ceftriaxone; Cephalosporins; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Hemoglobinometry; Humans; Lyme Disease; Middle Aged

A 14-year-old girl with perinatally acquired human immunodeficiency virus infection had fatal intravascular hemolysis after intravenous administration of ceftriaxone. Laboratory studies confirmed the presence of an antibody against ceftriaxone in the serum and on the patient's red blood cells. No evidence of sepsis, glucose-6-phosphate dehydrogenase deficiency or anaphylaxis was found.

Topics: Adolescent; AIDS-Related Opportunistic Infections; Anemia, Hemolytic; Antibodies; Ceftriaxone; Cephalosporins; Fatal Outcome; Female; Hemolysis; HIV Infections; Humans

Topics: Acquired Immunodeficiency Syndrome; Anemia, Hemolytic; Ceftriaxone; Cephalosporins; Child; Fatal Outcome; Hemolysis; HIV-1; Humans; Infusions, Intravenous; Male

Fatal hemolytic anemia developed in a 52-year-old woman who was treated with a cephalosporin, ceftriaxone. The patient's red cells (RBCs) were coated with C3, but no RBC-bound IgG, IgA, or IgM was detected. Her serum contained an antibody that did not react with cephalosporin-coated RBCs but reacted strongly with RBCs in vitro when her serum was added to drug and RBCs. This is the first case of immune hemolytic anemia associated with ceftriaxone, the first case of fatal cephalosporin-induced hemolytic anemia, and the second case in which a cephalosporin antibody showed in vitro and in vivo characteristics usually thought to be associated with the so-called immune complex mechanism.

Topics: Anemia, Hemolytic; Antibodies; Ceftriaxone; Complement C3; Coombs Test; Erythrocytes; Female; Humans; Immune Complex Diseases; Immunoglobulin G; Immunoglobulin M; Middle Aged