is a misdiagnosis that leads to unnecessary diagnostic procedures and therapeutic interventions at hospitals, as demonstrated in our case report. The presentation of hematuria due to CIIHA parallels the presentation of hematuria due to sickle cell-related nephropathy microinfarcts in renal papillae. The dramatic drop in Hb due to CIIHA may be labelled as an exacerbation of chronic hemolysis (aka acute sickling crisis) or transfusion reaction, either hemolytic or delayed. Overlapping clinical presentations also include warm autoimmune hemolytic anemia, as patients with SCD have the same risk of this as the general population, and clinical sepsis due to hyposplenic function +/− DIC.
Given the high prevalence of SCD, the frequent use of ceftriaxone per pediatric empiric infectious standard of care guidelines, and the delayed diagnosis that increases adverse outcomes, a thorough analysis is warranted to better identify factors within the pediatric sickle cell population that may increase the predisposition for CIIHA. Anticipated benefits of a thorough analysis would encourage earlier recognition of DIIHA in children with SCD, thereby decreasing pediatric patient fatality via increased awareness and screening. At the very least, it should minimize invasive diagnostics and unnecessary costly therapeutic interventions. In response to this case, we have initiated a state-wide review to better identify risk factors within the pediatric sickle cell population that increases the predisposition for DIIHA. We encourage other institutions to explore possibilities of how to mitigate this fatal complication, particularly in patients with SCD.
Cite this paper
Khurana, M. and Raj, S.S. (2017) Drug-Induced Hemolytic Anemia: A Fatal Complication Further Under-Recognized in Sickle Cell Disease. Open Journal of Blood Diseases, 7, 79-85. https://doi.org/10.4236/ojbd.2017.73008
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