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.


  1. 1. Garratty, G. (2010) Drug-Induced Immune Hemolytic Anemia. Clinical Advances in Hematology & Oncology, 8, 98-101.

  2. 2. Garratty, G. (2010) Immune Hemolytic Anemia Associated with Drug Therapy. Blood Reviews, 24, 143-150.

  3. 3. Thomé, S.D. and Petz, L.D. (2002) Manual of Clinical Hematology. In: Mazza, J.J., Ed., Hemolytic Anemia: Hereditary and Acquired, Lippincott Williams and Wilkins, Pennsylvania, 90-117.

  4. 4. Pierce, A. and Nester, T. (2011) Pathology Consultation on Drug-Induced Hemolytic Anemia. American Journal of Clinical Pathology, 136, 7-12.

  5. 5. Guleria, V.S., Sharma, N., Amitabh, S. and Nair, V. (2013) Ceftriaxone-Induced Hemolysis. Indian Journal of Pharmacology, 45, 530-531.

  6. 6. Arndt, P.A. and Garratty, G. (2005) The Changing Spectrum of Drug-Induced Immune Hemolytic anemia. Seminars in Hematology, 42, 137-144.

  7. 7. Neuman, G., Boodhan, S., Wurman, I., Koren, G., Kirby-Allen, M. and Ito, S. (2014) Ceftriaxone-Induced Immune Hemolytic Anemia. Annals of Pharmacotherapy, 48, 1594-1604.

  8. 8. Snapper, I., Marks, D., Schwartz, L. and Hollander, L. (1953) Hemolytic Anemia Secondary to Mesantoin. Annals of Internal Medicine, 39, 619-623.

  9. 9. Harris, J.W. (1954) Studies on Mechanism of Drug-Induced Hemolytic Anemia. Journal of Laboratory and Clinical Medicine, 44, 809-810.

  10. 10. Harris, J.W. (1956) Studies on Mechanism of Drug-Induced Hemolytic Anemia. Journal of Laboratory and Clinical Medicine, 47, 760-775.

  11. 11. Garratty, G. (2009) Drug-Induced Immune Hemolytic Anemia. ASH Education Book, 2009, 73-79.

  12. 12. Quillen, K., Lane, C., Hu, E., Pelton, S. and Bateman, S. (2008) Prevalence of Ceftriaxone-Induced Red Blood Cell Antibodies in Pediatric Patients with Sickle Cell Disease and Human Immunodeficiency Virus Infection. Pediatric Infectious Disease, 27, 357-358.

  13. 13. Centers for Disease Control and Prevention (2011) Sickle Cell Disease. Data & Statistics.

  14. 14. Sickle Cell Disease. American Academy of Pediatrics.

  15. 15. Bernini, J.C., Mustafa, M.M., Sutor, L.J. and Buchanan, G.R. (1995) Fatal Hemolysis Induced by Ceftriaxone in a Child with Sickle Cell Anemia. Journal of Pediatrics, 126, 813-815.

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