Intravascular Hemolytic Anemia in a Patient with Antibodies Related to Meropenem

Abstract

A 76-year-old woman treated with meropenem developed intravascular hemolytic attacks. A direct antiglobulin test was positive for C3d and IgG, and drug-dependent antibody testing indicated that the antibodies were indeed drug-dependent and reacted with drug-treated RBCs and RBCs in the presence of the drug. To our knowledge, this is the first reported case in which the causative antibodies related to meropenem were identified. This case highlights the importance of maintaining a high level of suspicion for drug-induced immune hemolytic anemia in patients with explained hemolysis as well as conducting specialized serologic testing.

Meropenem‐induced immune thrombocytopenia and the diagnostic process of laboratory testing

“…Diarrhea, nausea and vomiting, headache, rash, and thrombophlebitis are common side effects of meropenem; they are generally mild and self‐limited. Although meropenem has been implicated as a causative agent of immune hemolytic anemia in a few cases, its involvement in immune thrombocytopenia has not been previously reported. Drug‐induced immune thrombocytopenia (DITP) is a life‐threatening clinical syndrome and a distinctive drug reaction known to occur with only a few drugs .…”

Meropenem-induced pancytopenia in a preterm neonate: a case report

“…Huang et al [6] reported a case of meropenem-induced immune thrombocytopenia in a 59-year-old patient, by detecting meropenem-dependent platelet antibodies and platelet count recovery after discontinuation of meropenem. Oka et al [5] reported the development of severe anemia with clinical signs in a 76-year-old female patient, who received 2 g meropenem per day. On further investigation, they found that a direct antiglobulin test (DAT) was positive for immunoglobulin G (IgG) and C3d, and reported the presence of meropenem-dependent antibodies in the patient's serum [5].…”

“…Oka et al [5] reported the development of severe anemia with clinical signs in a 76-year-old female patient, who received 2 g meropenem per day. On further investigation, they found that a direct antiglobulin test (DAT) was positive for immunoglobulin G (IgG) and C3d, and reported the presence of meropenem-dependent antibodies in the patient's serum [5].…”

“…An in vitro study of several beta-lactam antibiotics established the presence of well-differentiated myeloid cells and copious granulocyte precursors along with dose-dependent suppression of granulopoiesis [4]. Antibody-mediated hemolytic anemia and thrombocytopenia have also been established in meropenem-treated patients [5,6]. Several medications can cause pancytopenia including chemotherapeutics, antiepileptics, antidepressants, and antibiotics [3,5,7].…”

“…Antibody-mediated hemolytic anemia and thrombocytopenia have also been established in meropenem-treated patients [5,6]. Several medications can cause pancytopenia including chemotherapeutics, antiepileptics, antidepressants, and antibiotics [3,5,7]. A case-control epidemiological surveillance study was conducted over a follow-up period of 78.7 million person-years to assess the incidence of drug-induced agranulocytosis.…”