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Oral Abstract

Immunohematology and Genetic Testing (red cells, leukocytes and platelets)

Oral Abstract Session - Hematology & Coagulation

#OA2-AM25-MN-21 - Rapidly Fatal Adult Case of Ceftriaxone-Induced Immune Hemolytic Anemia

Monday, October 27, 2025
3:45 PM - 4:45 PM  PT
Room: SDCC 30AB
Oral Abstracts
Background/Case Studies: A 78-year-old female was admitted through the ED (April 2025) for suspected hemorrhagic versus septic shock. Over the past 2 years, she had four prior admissions for urinary tract infections, diabetic ulcers with osteomyelitis and infected prosthetic joints, which were treated with ceftriaxone 1-2g IV. Last p</span>rior treatment was in Dec 2024 (2g IV x1 dose, 1g IV x3 doses). On this admission, she had similar mixed infections and chronic anemia (Hgb 11.9 g/dL and type and screen and urinalysis were unremarkable). Two hours after admission she was given 2g ceftriaxone IV. Shortly thereafter, she became hemodynamically unstable and received IV fluids and 4 units of uncrossmatched blood. At 2.5 hours after admission (30 minutes after ceftriaxone), her Hgb dropped to 7.0 g/dL (partially hemodilution). Subsequent specimens collected at 2.5-, 4-, 6-, and 7-hours post-admission showed progressively increasing hemolysis and were panreactive in solid phase screens, panels and autocontrols. No specificity was identified in P</span>EG or LISS panels. DAT polyspecific (poly) was positive. Eluate without drug on the 4.5-hour post-drug specimen (red cells only) was negative. At 7.5 hours after admission a transfusion reaction was called on the 4 uncrossmatched RBC units. Transfusion reaction plasma was brown with positive type and screen and panel, DAT was 2+ poly AHG (3+ anti-IgG and negative anti-C3) and eluate was negative. On the final sample, the LDH was >1800 U/L and patient’s red cells began gelling and hemolyzing in the EDTA collection tube. She developed DIC, secondary to hemolysis, with D-Dimers >35,000 ng/ml, fibrin split products >20 mcg/ml, and undetectable fibrinogen. Patient died approximately 8 hours after receiving ceftriaxone.

Study

Design/Methods: Antibody screens and panels were performed using solid phase testing methods (Werfen, Barcelona Spain). DATs were performed in tube. Acid eluates (Werfen) were prepared and tested using IAT. Titrations were p</span>erformed using standard serial dilution with normal saline and tested in tubes. Drug testing was performed in tube according to Judd’s Methods in Immunohematology, 4th ed. 2022.

Results/Findings:

Additional DATs, elution and ceftriaxone drug study results are in Table 1. Drug studies performed in the presence of ceftriaxone (1 mg/mL) was positive in all samples after administration of drug.


 

Conclusions: This is the first rapidly fatal case of a ceftriaxone-induced immune hemolytic anemia in an adult.