{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T15:51:35Z","timestamp":1783612295201,"version":"3.55.0"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Drug-induced immune hemolytic anemia (DIIHA) is a rare but potentially severe adverse reaction, with antibiotics being common culprits. Amoxicillin, a widely used \u03b2-lactam antibiotic, has been infrequently reported to cause DIIHA, posing diagnostic challenges due to its nonspecific presentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to report a case of amoxicillin-induced DIIHA, detailing the diagnostic approach and laboratory methods for detecting drug-dependent antibodies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A 60-year-old female presented with jaundice, dark urine, and severe anemia following amoxicillin administration. Laboratory investigations included direct and indirect antiglobulin tests, antibody screening and identification, and drug-specific antibody detection using amoxicillin-sensitized red blood cells and drug-added assays. Clinical causality was assessed using the Naranjo Adverse Drug Reaction Probability Scale.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The patient\u2019s direct antiglobulin test was weakly positive for IgG without C3d activation. Serum showed pan-reactivity in saline, which resolved after dithiothreitol treatment, suggesting the presence of IgM cold antibodies. Serum reacted positively with amoxicillin-coated red cells in the indirect antiglobulin test but not with untreated cells, confirming the presence of amoxicillin-dependent antibodies. Hemoglobin and bilirubin levels improved after amoxicillin discontinuation. The Naranjo score was 7, indicating a \u201cprobable\u201d association between amoxicillin and hemolysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Amoxicillin can induce immune hemolytic anemia through a drug-dependent antibody mechanism. A combination of detailed drug history, serological testing, and drug-specific assays is essential for accurate diagnosis. Immediate withdrawal of the implicated drug remains critical for clinical recovery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1773873","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T06:48:36Z","timestamp":1772520516000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Case Report: Diagnosis and detection of amoxicillin-induced immune hemolytic anemia"],"prefix":"10.3389","volume":"17","author":[{"given":"Mengyuan","family":"Ding","sequence":"first","affiliation":[{"name":"Blood Group Reference Laboratory, Suzhou Blood Center","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanyan","family":"Qin","sequence":"additional","affiliation":[{"name":"Blood Screening Test Department, Suzhou Blood Center","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingwei","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Transfusion, Sichuan Academy of Medical Sciences, Sichuan Provincial People\u2019s Hospital","place":["Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Jiang","sequence":"additional","affiliation":[{"name":"Blood Group Reference Laboratory, Suzhou Blood Center","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Xiao","sequence":"additional","affiliation":[{"name":"Administration Division, Suzhou Blood Center","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiu","family":"Zhou","sequence":"additional","affiliation":[{"name":"Clinical Laboratory, Characteristic Medical Center of the Chinese People\u2019s Armed Police Force","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guanggang","family":"Dou","sequence":"additional","affiliation":[{"name":"Clinical Laboratory, Suzhou Hongci Hematology Hospital","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1517\/14740338.2012.678832","article-title":"Immune hemolytic anemia caused by drugs","volume":"11","author":"Garratty","year":"2012","journal-title":"Expert Opin Drug Saf"},{"key":"B2","doi-asserted-by":"publisher","first-page":"66","DOI":"10.21307\/immunohematology-2019-100","article-title":"Drugs that have been shown to cause drug-induced immune hemolytic anemia or positive direct antiglobulin tests: some interesting findings since 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