MED7 Ciprofloxacin immune hemolytic anemia. (Medicine).

MED7 CIPROFLOXACIN IMMUNE HEMOLYTIC ANEMIA. Imran P. Haque, MD. University of Virginia School of Medicine, Roanoke-Salem Internal Medicine Program, Roanoke, Va.

Drug-induced hemolytic anemia is not an uncommon occurrence with certain antibiotics. There are few case reports in the world of ciprofloxacin induced immune hemolytic anemia. This case presents a 58-year-old white male of French origin who presents with fatigue, shortness of breath, malaise, dark urine, and paleness for ten days. The pateint had been treated with a ten-day course of ciprofloxacin for an epididymitis prior to presentation. He has a previous history significant for a diverticular bleed one year prior to presentation. On physical examination, the patient had pale conjunctiva, tachycardia, guaiac-negative stools, and generalized reduced strength. On laboratory examination, hemoglobin was 5.6 g/dL, hematocrit, 16.0% with normal indices, positive direct Coombs' test, elevated indirect bilirubin, low serum haptoglobin, and no urinary hemosiderin. The patient's peripheral smear showed ovalocytes with occasional "bite cells." Bone marrow biopsy was consistent with hemolysis showing erythroid hyperplasia. The patient's symptoms coincided with the institution of ciprofloxacin, which was discontinued. Laboratory tests and bone marrow examination were consistent with hemolysis. The patient's symptoms and hematocrit did improve but did not begin to resolve until prednisone was added in his hospital course. There are only a few case reports of ciprofloxacin associated immune hemolytic anemia. Drug-induced immune hemolytic anemia occurs when drugs including penicillin, cephalosporin, thiazide diuretics and NSAIDs interact with the red blood cell membrane, causing the cell to become antigenic. The antibodies subsequently combine with the affected red blood cells and result in their premature destruction. Drug-induced immune hemolytic anemia occurs generally seven to ten days into the course of antibiotics. Discontinuation of the offending agent and if necessary prednisone generally provides improvement in patients.