Drug-Induced Haemolytic Anaemia Caused by
Ceftriaxone Sodium in
a 7-Year Boy

By Geyao Qi¹, Jin Xu²

Affiliations

1. Department of Internal Medicine, No. 32186 Hospital of People's Liberation Army of China, Baoding, China
2. Department of Endocrinology, No. 940 Hospital of Logistics Support Force of People's Liberation Army of China, Lanzhou, China

doi: 10.29271/jcpsp.2025.10.1363

Sir,

Ceftriaxone sodium, a widely used third-generation cephalo- sporin antibiotic, is favoured by clinicians for its broad- spectrum antibacterial activity, favourable pharmacokinetic properties, and low incidence of side effects.¹ However, it can still cause some adverse reactions such as medicine-induced haemolytic anaemia.^2-4 This case report aims to describe the occurrence of ceftriaxone sodium-induced haemolytic anaemia in a 7-year boy, providing insights for clinicians.

A 7-year male patient, measuring 1.32 m in height and 26.40 kg in weight, reported no personal and family history of hereditary haematological or autoimmune disorders.

On 3^rd January 2025, three days before disease onset, the patient received ceftriaxone sodium (skin test negative) for right lower lobe pneumonia in the hospital’s outpatient department. On January 5, one day before disease onset, about 1 hour after ceftriaxone sodium infusion, the patient experienced lumbosacral pain lasting 30 minutes, which then disappeared. Concurrently, the patient’s urine turned tea-red in colour. However, these symptoms did not attract the attention of the paediatrician.

Figure 1: The patient's general vital signs curve graph. (A) Blood pressure; (B) Heart rate and respiratory rate; (C) Body temperature.

Table I: Partial laboratory test results of this patient.
 

Variables	January 3	January 6	January 7	January 8	January 11	January 16	February 15
Blood sample	-	-	-	-	-	-	-
Haemoglobin (Hb), g/L	120.00	41.00	106.00	99.00	109.00	120.00	133.00
White blood cell (WBC), 10^9/L	5.56	25.82	11.84	10.85	12.41	12.36	6.30
Platelet (Plt), 10^9/L	200.00	212.00	223.00	207	267.00	371.00	256.00
Lactate dehydrogenase (LDH), IU/L	NR*	2177.00	1204.00	850.00	567.00	331.00	132.00
LDH isoenzyme 1 (LDH-1), IU/L	NR	262.00	205.00	194.00	132.00	77.00	26.00
Total bilirubin (TBIL), μmol/L	NR	104.00	54.10	44.83	33.20	26.00	16.76
Direct bilirubin (DBIL), μmol/L	NR	7.52	11.90	9.47	5.53	5.06	3.41
Indirect bilirubin (IBIL), μmol/L	NR	96.48	42.20	35.36	27.67	20.94	13.35
K+, mmol/L	NR	4.28	3.94	3.81	4.29	4.52	4.00
Na+, mmol/L	NR	135.10	137.90	138.90	141.80	139.80	136.00
Creatinine (CR), μmol/L	NR	34.00	26.60	34.00	31.70	31.30	45.00
Blood urea nitrogen (BUN), mmol/	NR	5.60	6.39	5.20	7.54	9.41	7.20
Urine sample	-	-	-	-	-	-	-
Blood (BLO)	NR	+ + +	+ -	-	-	-	-
Protein (PRO)	NR	+ + +	+ -	-	-	-	-
Urobilinogen (UBG)	NR	-	-	-	-	-	-
Bilirubin (BIL)	NR	+	-	-	-	-	-
NR = Not recorded.

At 11:30 AM on January 6, approximately 40 minutes after ceftriaxone sodium infusion, the patient experienced lumbo-sacral pain again, and the pain was more intense than that experienced the previous day. The patient presented with pallor, dark red urine, cold extremities, weakness, and a transient episode of amaurosis. His heart rate was 140 bpm, and his blood pressure was 100/50 mmHg (Figure 1). The paediatrician immediately interrupted the ceftriaxone sodium infusion and initiated emergency measures, including oxygen therapy and vital signs monitoring. By 13:30 PM, the patient was transferred to the ICU.

Following admission to the ICU, the medical team initiated a treatment via intravenous methylprednisolone, 1.4% sodium bicarbonate (to alkalinise the urine), dopamine, and omeprazole. About 1 hour later, the patient received a transfusion of washed red blood cells (WRBC) and immunoglobulins. By 6:00 AM on January 7, the patient’s systemic pain had been resolved, and his urine colour returned to normal (Table I). Over the next 10 days, the patient continued to receive the treatment with immunoglobulins, methylprednisolone, 1.4% sodium bicarbonate, and omeprazole. On January 17, the patient was discharged from the hospital after recovery.

Through the continuous accumulation of such case reports, the safety of ceftriaxone sodium can receive higher attention. More efficient treatment strategies will protect patients from these potential adverse medicine reactions.

COMPETING  INTEREST:
The authors declared no conflict of interest.

AUTHORS’  CONTRIBUTION:
GQ: Literature search, data acquisition, and manuscript preparation.
JX: Concepts, manuscript review, and guarantor.
Both authors approved the final version of the manuscript to be published.


 

REFERENCES

1. Zeng L, Wang C, Jiang M, Chen K, Zhong H, Chen Z, et al. Safety of ceftriaxone in paediatrics: A systematic review. Arch Dis Child 2020; 105(10):981-5. doi: 10.1136/arch dischild-2019-317950.
2. Yue L, Hong-meng Z, Yi L, Wan-yu F. Literature analysis of ceftriaxone-induced haemolytic anaemia. Clin Med J 2017; 15(7):35-9. doi: 10.3969/j.issn.1672-3384.2017.07.008.
3. Guleria VS, Sharma N, Amitabh S, Nair V. Ceftriaxone- induced hemolysis. Indian J Pharmacol 2013; 45(5):530-1. doi: 10.4103/0253-7613.117758.
4. Wilkerson RG. Drug hypersensitivity reactions. Immunol Allergy Clin North Am 2023; 43(3):473-89. doi: 10.1016/ j.iac.2022.10.005.