CASE REPORT article
Front. Med.
Sec. Hematology
Case Report: a severe drug-induced immune hemolytic anemia caused by vancomycin
Provisionally accepted
- 1Ningbo No 2 Hospital, Ningbo, China
- 2Shanghai Blood Center, Shanghai, China
- 3Children's Hospital of Shanghai, Shanghai, China
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Background: Drug-induced immune hemolytic anemia (DIIHA) is an adverse effect of some therapeutics, which is potentially life-threatening. A high priority is required in clinical treatment, since the number of medications known to induce DIIHA continues to expand. This study reports on a case of vancomycin-induced hemolysis observed in a patient in China. Case description: A 50-year-old man with negative irregular antibody detection tests developed hemolytic anemia on the eighth day after replacement and repair surgery of left knee. The patient was treated with vancomycin-mixed bone cement in the surgery, as well as vancomycin intravenously in the postoperative period every day. On the eighth day after surgery, he developed a rapid decline in hemoglobin level, elevation of indirect bilirubin and lactate dehydrogenase levels in serum, and presence of hemoglobin in urine. Laboratory analysis revealed high-titer antibodies against vancomycin in the patient's serum, which were mainly immunoglobulin G (IgG) antibodies, and demonstrated greater specificity for the blood group N antigen. Conclusion: This case, together with previous reports, underscores the importance of considering DIIHA in patients who exhibit unexplained decreases in hemoglobin levels following a new medication, especially antibiotics. A thorough examination of the patient's medical history, and the identification of specific drug-dependent antibodies through serological tests can provide crucial insights for diagnosing DIIHA.
Keywords: Drug-induced immune hemolytic anemia, Vancomycin, Hemoglobin, antibody, serological test
Received: 15 Aug 2025; Accepted: 04 Nov 2025.
Copyright: © 2025 Xie, Wang, Deng, Zhu, Huang, Wang, Xiang and Yu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Dong Xiang, xiangdong@sbc.org.cn
Yong Yu, 8139884@qq.com
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