Life-threatening vancomycin-induced immune hemolytic anemia: A rare case report
Year: 2025
Type: article
Study design: Case Report
Abstract: RATIONALE: Drug-induced immune hemolytic anemia is a rare but serious cause of autoimmune hemolytic anemia, most frequently triggered by antimicrobials. Vancomycin is an exceedingly rare culprit, with only a handful of cases reported. PATIENT CONCERNS: A 64-year-old woman developed acute-onset fever, tachycardia, dyspnea, and dark-colored urine on the 7th day after revision knee arthroplasty, during which she was receiving intravenous vancomycin prophylaxis. DIAGNOSES: Laboratory findings revealed a dramatic drop in hemoglobin, indirect hyperbilirubinemia, elevated lactate dehydrogenase, and reticulocytosis, consistent with hemolysis. The direct antiglobulin test was positive for IgG and C3, confirming immune-mediated hemolysis. A comprehensive workup ruled out infections, autoimmune diseases, and malignancies. The association with vancomycin was categorized as "probable" on the Naranjo scale. INTERVENTIONS: Vancomycin was immediately discontinued. The patient received intravenous methylprednisolone and immunoglobulins. Due to rapid progression to life-threatening anemia and hemodynamic instability, therapeutic plasma exchange and washed red blood cell transfusions were initiated. OUTCOMES: Following these interventions, the patient's condition gradually stabilized. Hemoglobin levels improved, hemolytic markers normalized, and she was successfully weaned from mechanical ventilation. She was discharged after 1 month on a prolonged steroid taper, with a full hematologic recovery observed on follow-up. LESSONS: Vancomycin can induce life-threatening immune hemolytic anemia. Clinicians must maintain a high index of suspicion for drug-induced immune hemolytic anemia in patients with abrupt hemolysis after initiating a new drug, as immediate discontinuation of the offending agent is the cornerstone of management.
Source: Medicine
Authors: Jiang-Chen Peng, Yuan Gao
Institutions: Shanghai Jiao Tong University, Renji Hospital
Language: English
Topic: Blood groups and transfusion
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,950
OpenAlex ID: W4416365095