Ceftriaxone-induced Immune Hemolysis: Clinical Insights from a Case Report

Abstract

Background: Ceftriaxone is a widely used cephalosporin antibiotic, but rarely, it may cause drug-induced immune hemolytic anemia (DIHA), a potentially life-threatening adverse reaction. Prompt recognition is essential to prevent morbidity, particularly in patients with comorbidities and concurrent surgical needs. Aim: This report underscores the importance of vigilance in identifying antibiotic-related hemolysis and highlights the effectiveness of early drug withdrawal and supportive care in preventing adverse outcomes. Case Presentation: We describe a 63-year-old male with a history of hypertension, diabetes mellitus, and prior ischemic stroke, who presented with left hip and wrist pain following a fall. Imaging revealed a closed intertrochanteric fracture of the left femur and a closed distal radius fracture. During hospitalization, while on ceftriaxone therapy, the patient developed a sudden hemoglobin drop (12.4 g/dL to 7.0 g/dL), reticulocytosis, elevated LDH, and hyperbilirubinemia, consistent with hemolysis. Coombs test was negative. Ceftriaxone-induced hemolysis was suspected, and the drug was discontinued. Supportive care with blood transfusions stabilized his condition. On 2nd January 2025, he underwent closed reduction and internal fixation (CRIF) of the femur and open reduction and internal fixation (ORIF) of the radius. Postoperative recovery was uneventful, and hemoglobin levels gradually improved with close monitoring. Conclusion: This case emphasizes the importance of early identification of ceftriaxone-induced hemolysis in patients presenting with unexplained anemia during therapy. Timely drug withdrawal, supportive care, and coordinated perioperative management can lead to favorable outcomes.