# Ceftriaxone-Induced Immune Hemolytic Anemia and Subsequent Disseminated Intravascular Coagulation

## TL;DR

A 78-year-old woman died shortly after receiving ceftriaxone due to a rare and severe immune reaction causing blood cell destruction and coagulation issues.

## Contribution

This case highlights the rapid and fatal progression of ceftriaxone-induced immune hemolytic anemia with secondary DIC.

## Key findings

- Ceftriaxone-induced DIIHA can lead to abrupt clinical deterioration and DIC within minutes of administration.
- The patient's death occurred despite aggressive resuscitation, emphasizing the severity of this condition.
- Laboratory tests confirmed ceftriaxone-dependent antibodies and a positive DAT, supporting the diagnosis.

## Abstract

Drug-induced immune hemolytic anemia (DIIHA) is a rare but potentially life-threatening complication, most often associated with β-lactam antibiotics such as ceftriaxone. We report a 78-year-old woman who developed abrupt clinical deterioration and disseminated intravascular coagulation (DIC) within 30 minutes of ceftriaxone administration for pneumonia, resulting in death eight hours after exposure despite aggressive resuscitation. Laboratory studies confirmed ceftriaxone-dependent antibodies and a positive direct antiglobulin test (DAT), establishing the diagnosis of ceftriaxone-induced DIIHA with secondary DIC. This case underscores the fulminant and often fatal course of ceftriaxone-induced hemolytic anemia and highlights the critical importance of swift recognition and discontinuation of suspected offending agents in patients presenting with acute hemolysis and coagulopathy following antibiotic therapy.