First application of whole blood exchange–lymphoplasmapheresis combined transfusion for restoring immune homeostasis of ceftriaxone-induced hemolytic crisis: a case report

Background: Ceftriaxone-induced hemolytic crisis is a rare, rapid, and severe drug adverse reaction. Once diagnosed, immediate discontinuation of ceftriaxone is the preferred treatment, but death remains unavoidable in some severe cases. This study reports a case of novel plasma exchange treatment for ceftriaxone-induced hemolytic crisis. Case presentation: A 57-year-old woman with a history of "acute gastroenteritis" still experienced abdominal pain after 4 days of treatment with "cefotaxime" in another hospital. One hour after receiving ceftriaxone in our hospital, the patient suddenly experienced dark brown urine and shock. Moreover, the hemoglobin (Hb) level declined sharply to 26 g/L with a positive direct Coombs test. The subsequent results indicated ceftriaxone antibody titers with IgG (1:2) and IgM (1:16) in the patient's plasma, and the diagnosis was confirmed as ceftriaxone-induced hemolytic crisis. Immediately, ceftriaxone was discontinued. After anti-shock treatment, administration of glucocorticoids and whole blood exchange-lymphoplasmapheresis combined transfusion (WLCT) was performed. The hemolysis, liver function, and IgM titer of the patient significantly improved, with the direct Coombs test being negative. The patient was discharged after 10 days of hospitalization and remained stable during the 3-month follow-up. Conclusion: This case was the first successful application of WLCT for ceftriaxone-induced acute hemolytic crisis. Moreover, WLCT may represent a promising therapeutic option for the rapid restoration of intravascular immune homeostasis, but its efficacy and safety remain to be validated in future studies.