Cefoperazone/sulbactam‐induced haemolytic anaemia and thrombocytosis: A case report and literature review

Cefoperazone/sulbactam (CPZ/SUL) is a broad-spectrum β-lactam/β-lactamase inhibitor combination. Drug-induced immune haemolytic anaemia (DIIHA) is a rare yet serious condition, whereas reactive thrombocytosis typically occurs as a secondary response to inflammatory, infectious or neoplastic processes. We report a case of a 58-year-old woman who presented with haemolytic anaemia and reactive thrombocytosis following administration of CPZ/SUL for pneumonia. The patient underwent neuroendoscopic evacuation of the intracranial haematoma, followed by decompressive craniectomy and debridement. Following 15 days of CPZ/SUL therapy, serial blood tests revealed a progressive decline in haemoglobin (HB), haematocrit (HCT) and red blood cell count, accompanied by a marked elevation in platelet count. Furthermore, the strongly positive anti-IgG (+++) and negative anti-C3d direct antiglobulin test results, together with the clinical and laboratory profile, confirmed the diagnosis of haemolytic anaemia and reactive thrombocytosis. After discontinuing CPZ/SUL and providing intermittent red blood cell transfusions over 7 days, the patient's haematological parameters normalized, which permitted discharge. This case presented a rare occurrence of CPZ/SUL-induced haemolytic anaemia and thrombocytosis, classified as 'probable' according to the Naranjo algorithm. This case describes a rare, suspected association between CPZ/SUL therapy and the concurrent development of immune haemolytic anaemia and reactive thrombocytosis. Clinicians should maintain awareness of these potential adverse haematological reactions during CPZ/SUL treatment and institute regular complete blood count monitoring.