Sudhir Kumar Vujhini¹, PanduRangaRao Sanagapati ², Mahesh Kandukuri³

¹Assistant Professor, Department of Transfusion Medicine and Immunohematology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India, ² Professor and Head, Department of Transfusion Medicine and Immunohematology, Nizams Institute of Medical Sciences, Hyderabad, Telangana , India, ³ Assistant Professor, Department of Pathology, Malla Reddy Institute of Medical Sciences, Hyderabad, Telangana, India.

Corresponding Author: Dr. Sudhir Kumar Vujhini, Department of Transfusion Medicine and Immunohematology, NIMS, Punjagutta, Hyderabad, Telangana, India.

Email: vujhini07@yahoo.com

Introduction: Ceftriaxone, a third generation cephalosporin is the commonest antibiotic of choice in any tertiary care hospital. Drug-induced Immune hemolytic anemia is uncommon adverse effect of ceftriaxone. A 52 year old diabetic woman presented to surgical outpatient department with fever and cellulitis of left foot since one week. Patient was started on intravenous ceftriaxone, 1 gram 12 hourly. She complained of chest pain, breathlessness, rash, chills and peri-oral tingling sensation. Her hemoglobin was dropped down to 8.2 g/dl within 24 hours. Peripheral smear showed marked polychromasia, nucleated RBC’s, schistocytes and neutrophilia. A diagnosis of ceftriaxone induced hemolysis was made and the drug was stopped immediately. Dexamethasone was given and intravenous ciprofloxacin was started. Three units of packed cells were transfused and her hemoglobin increased to 10.4 g/dl, at the time of discharge, ten days later. Ceftriaxone-induced hemolysis is a rare, sometimes fatal adverse reaction and the physicians should be aware of it and be vigilant while prescribing this drug.

Key Words: Ceftriaxone, Hemolysis, Adverse reaction