A case of ceftriaxone-induced immune haemolytic anaemia in an ambulatory care setting
Background: Drug-induced immune haemolytic anaemia (DIIHA) is a rare adverse effect which varies between mild to fatal (Garratty, 2010). One of the most common class of drugs reported to cause severe DIIHA are the second and third generation cephalosporins (e.g. ceftriaxone) (Garratty, 2010; Hill et...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-01-01
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| Series: | Clinical Infection in Practice |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590170224000013 |
| _version_ | 1827329768977072128 |
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| author | Rakhee Mistry Luke S.P. Moore Nabeela Mughal Andrew Godfrey Stephen Hughes |
| author_facet | Rakhee Mistry Luke S.P. Moore Nabeela Mughal Andrew Godfrey Stephen Hughes |
| author_sort | Rakhee Mistry |
| collection | DOAJ |
| description | Background: Drug-induced immune haemolytic anaemia (DIIHA) is a rare adverse effect which varies between mild to fatal (Garratty, 2010). One of the most common class of drugs reported to cause severe DIIHA are the second and third generation cephalosporins (e.g. ceftriaxone) (Garratty, 2010; Hill et al., 2017).We report an event of severe, life-threatening DIIHA caused by ceftriaxone administered in an ambulatory setting to a patient via Outpatient Parenteral Antimicrobial Therapy (OPAT) service and our subsequent management of the adverse reaction. Case report: A 60-year old male was referred to the OPAT service for radiologically-confirmed osteomyelitis. He was commenced on ceftriaxone 4 g daily intravenous infusions in the ambulatory care unit. Shortly after receiving the ninth dose, he became acutely pale, tachycardic, tachypnoeic, and hypotensive with multiple witnessed syncopal episodes inside the unit. Haemoglobin level fell to <30 g/L on blood gas and on formal laboratory analysis (Abbott® Alinity) 39 g/L (from baseline of 97 g/L). No obvious source of bleeding was identified which suggested an acute haemolytic process.Management included high-dose corticosteroids and a single dose of intravenous immunoglobulin. Ceftriaxone was immediately discontinued and a beta-lactam free regimen was commenced. Haemoglobin level improved within 24 h with a gradual return to baseline within seven days. Conclusions: Our case highlights the need for ambulatory care and OPAT teams to be aware of this rare, idiosyncratic adverse reaction which may occur in otherwise clinically stable patients. We advocate weekly haematological monitoring in OPAT patients. |
| first_indexed | 2024-03-07T15:45:54Z |
| format | Article |
| id | doaj.art-cf7622f0cf6d4cc9af31c4e6c7b019f6 |
| institution | Directory Open Access Journal |
| issn | 2590-1702 |
| language | English |
| last_indexed | 2024-03-07T15:45:54Z |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical Infection in Practice |
| spelling | doaj.art-cf7622f0cf6d4cc9af31c4e6c7b019f62024-03-05T04:30:53ZengElsevierClinical Infection in Practice2590-17022024-01-0121100341A case of ceftriaxone-induced immune haemolytic anaemia in an ambulatory care settingRakhee Mistry0Luke S.P. Moore1Nabeela Mughal2Andrew Godfrey3Stephen Hughes4Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK; Corresponding author.Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK; North West London Pathology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UKChelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK; North West London Pathology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UKChelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UKChelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UKBackground: Drug-induced immune haemolytic anaemia (DIIHA) is a rare adverse effect which varies between mild to fatal (Garratty, 2010). One of the most common class of drugs reported to cause severe DIIHA are the second and third generation cephalosporins (e.g. ceftriaxone) (Garratty, 2010; Hill et al., 2017).We report an event of severe, life-threatening DIIHA caused by ceftriaxone administered in an ambulatory setting to a patient via Outpatient Parenteral Antimicrobial Therapy (OPAT) service and our subsequent management of the adverse reaction. Case report: A 60-year old male was referred to the OPAT service for radiologically-confirmed osteomyelitis. He was commenced on ceftriaxone 4 g daily intravenous infusions in the ambulatory care unit. Shortly after receiving the ninth dose, he became acutely pale, tachycardic, tachypnoeic, and hypotensive with multiple witnessed syncopal episodes inside the unit. Haemoglobin level fell to <30 g/L on blood gas and on formal laboratory analysis (Abbott® Alinity) 39 g/L (from baseline of 97 g/L). No obvious source of bleeding was identified which suggested an acute haemolytic process.Management included high-dose corticosteroids and a single dose of intravenous immunoglobulin. Ceftriaxone was immediately discontinued and a beta-lactam free regimen was commenced. Haemoglobin level improved within 24 h with a gradual return to baseline within seven days. Conclusions: Our case highlights the need for ambulatory care and OPAT teams to be aware of this rare, idiosyncratic adverse reaction which may occur in otherwise clinically stable patients. We advocate weekly haematological monitoring in OPAT patients.http://www.sciencedirect.com/science/article/pii/S2590170224000013CeftriaxoneDrug-induced immune haemolytic anaemiaBacterial infectionsOutpatient parenteral antimicrobial therapy |
| spellingShingle | Rakhee Mistry Luke S.P. Moore Nabeela Mughal Andrew Godfrey Stephen Hughes A case of ceftriaxone-induced immune haemolytic anaemia in an ambulatory care setting Clinical Infection in Practice Ceftriaxone Drug-induced immune haemolytic anaemia Bacterial infections Outpatient parenteral antimicrobial therapy |
| title | A case of ceftriaxone-induced immune haemolytic anaemia in an ambulatory care setting |
| title_full | A case of ceftriaxone-induced immune haemolytic anaemia in an ambulatory care setting |
| title_fullStr | A case of ceftriaxone-induced immune haemolytic anaemia in an ambulatory care setting |
| title_full_unstemmed | A case of ceftriaxone-induced immune haemolytic anaemia in an ambulatory care setting |
| title_short | A case of ceftriaxone-induced immune haemolytic anaemia in an ambulatory care setting |
| title_sort | case of ceftriaxone induced immune haemolytic anaemia in an ambulatory care setting |
| topic | Ceftriaxone Drug-induced immune haemolytic anaemia Bacterial infections Outpatient parenteral antimicrobial therapy |
| url | http://www.sciencedirect.com/science/article/pii/S2590170224000013 |
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