Case Report: A severe drug-induced immune hemolytic anemia caused by vancomycin

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 his left knee. The patient was treated with vancomycin-mixed bone cement during 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.