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Ceftriaxone-Induced Hemolysis in Pediatric Patients with Sickle Cell Disease

Stacy KAUTZA, Tsz-Yin SO
8.231 1.223


OBJECTIVE: To provide a review on the case reports of ceftriaxone-induced hemolytic anemia in pediatric patients with sickle cell disease, present a proposed mechanism of the reaction, and provide an alternative antimicrobial regimen for these patients.
DATA SOURCES: Literature retrieval was accessed through PUBMED (1985-present) using the terms pediatric, sickle cell disease, ceftriaxone, hemolytic anemia, and hemolysis. In addition, reference citations identified from these publications were reviewed.
STUDY SELECTION AND DATA EXTRACTION: All articles in English identified from the data sources were evaluated. All case reports and studies were included in the review.
DATA SYNTHESIS: Ceftriaxone, a third-generation cephalosporin that is frequently used for the empiric treatment of suspected infections in pediatric patients with sickle cell disease, has been linked to cases of hemolytic anemia. Ceftriaxone has many favorable attributes to promote its use: broad-spectrum anti-microbial activity, long half-life, and no requirement for dose adjustment in patients with renal dysfunction. Hemolytic anemia is a very serious condition and can be fatal. Children with sickle cell disease have a reduced number of red blood cells, and therefore, hemolytic anemia can potentially be detrimental in these children. Five case reports of ceftriaxone-induced hemolytic anemia are presented, in which the typical onset was three to seven days into therapy and all patients had received ceftriaxone courses during prior hospitalizations. There have been several proposed mechanisms of drug-induced hemolytic anemia and ceftriaxone appears to be inducing hemolysis through an immune reaction involving immunoglobulin M and complement found on the surfaces of red blood cells. The hemolysis can be managed by immediately stopping the offending agent, giving packed red blood cell transfusions, and there is possibly a role for intravenous corticosteroids, plasmapheresis, and intravenous immunoglobulin. Cefotaxime is a safe and effective alternative antibiotic in this patient population.
CONCLUSIONS: Although rare, ceftriaxone appears to induce hemolytic anemia in pediatric patients with sickle cell disease. Cefotaxime provides a safe and effective alternative in this population.


ceftriaxone, pediatric, sickle cell disease, hemolytic anemia, hemolysis

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