Ceftriaxone-induced hemolysis
A 60-years-old lady, with no past history of any drug allergies, presented with fever and productive cough of five days duration. Clinically, she had fever, tachycardia, tachypnea with crackles in the right mammary area. X-ray chest confirmed pneumonia in the right middle zone []. On admission, her investigation were as in []\nA diagnosis of community-acquired pneumonia was made, and patient was started on intravenous ceftriaxone one gram 12 hourly. Her hemoglobin dropped down to 7.5 g/dL within 24 hrs and further to 5.5 g/dL after 72 hrs, with peripheral blood smear showing marked polychromasia with three nucleated red cells per 100 white blood cells, schistocytes, a corrected reticulocyte count of 4.0% and LDH of 1221 units/L. Serum bilirubin rose to 2 mg/dl with indirect of 1.5 mg/dl. Direct Coombs test was positive. Urine for hemoglobin and hemosiderin was negative. A diagnosis of ceftriaxone-induced AIHA was made, and the drug was stopped immediately. Two units of packed red blood cells were transfused as she had symptomatic anemia, her hemoglobin increased to 8.6 g/dl and thereafter to 9.8 g/dl at discharge, after two weeks with no further deterioration. Bilirubin normalized on day six [].