Zhang Liqian, Huang Wenfeng, Xu Jiakai, Li Yunxing, Zhu Jihong
Department of Emergency, Peking University People's Hospital, Beijing, China.
Front Pharmacol. 2025 Jan 7;15:1505366. doi: 10.3389/fphar.2024.1505366. eCollection 2024.
Ceftriaxone is widely used in clinical practice for its efficacy against infections. However, its increasing association with life-threatening immune hemolytic reactions urge clinicians to enhance recognition and maintain sharp vigilance. This report details a rare and severe case of ceftriaxone-induced hemolytic anemia (CIHA), hemodynamic instability and hemolytic crisis in a 54-year-old woman after intravenous infusion of ceftriaxone following a respiratory infection. Clinicians must promptly identify symptoms suggestive of CIHA, such as fatigue, pallor, nausea, vomiting, and trunk pain, and immediately discontinue ceftriaxone. Laboratory examination can also assist in confirming the diagnosis of CIHA. Effective management measures include rigorous monitoring of vital signs, circulatory support, respiratory support, timely blood transfusion, administration of steroid hormones, IVIG infusion as necessary, plasma exchange, and symptomatic treatment of possible complications. Even after the patient has achieved full recovery, careful consideration should be given to the choice of subsequent antibiotics to prevent recurrence of CIHA.
头孢曲松因其抗感染疗效而在临床实践中广泛应用。然而，其与危及生命的免疫溶血反应的关联日益增加，促使临床医生提高认识并保持高度警惕。本报告详细介绍了一名54岁女性在呼吸道感染后静脉输注头孢曲松后发生的罕见且严重的头孢曲松诱导的溶血性贫血（CIHA）、血流动力学不稳定和溶血危机病例。临床医生必须迅速识别提示CIHA的症状，如疲劳、苍白、恶心、呕吐和躯干疼痛，并立即停用头孢曲松。实验室检查也有助于确诊CIHA。有效的管理措施包括严密监测生命体征、循环支持、呼吸支持、及时输血、给予类固醇激素、必要时输注静脉注射免疫球蛋白（IVIG）、血浆置换以及对可能的并发症进行对症治疗。即使患者已完全康复，后续抗生素的选择也应慎重考虑，以防止CIHA复发。
