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

Huang, Rong; Cai, Guangqing; Zhang, Junhua; Liu, Fengxia; Ma, Jinqi; Liu, Hong; Nie, Xin; Gui, Rong

doi:10.1111/trf.14267

Cited by 10 publications

(12 citation statements)

References 14 publications

(32 reference statements)

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“…The absence of drug-dependent antibody testing and bone marrow aspiration prevent us from drawing a firm conclusion regarding the mechanism of meropeneminduced pancytopenia in the present case. However, the hematological findings with the progressive development of thrombocytopenia, anemia, and then neutropenia suggest a possible mechanism of suppression of granulopoiesis or antibody-mediated destruction, as reported in recent studies [5,6].…”

Section: Discussionsupporting

confidence: 55%

“…A case report by Estella and colleagues [21] described meropenem-induced pancytopenia in a 3-year-old patient at 100 mg/kg given every 8 hours to manage the regrowth of meropenem-sensitive Morganella morganii in CSF cultures. 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.…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Background A post-marketing surveillance study has reported an association between meropenem use and the incidence of hematologic abnormalities, including leukopenia, thrombocytopenia, hemolysis, and neutropenia, but the precise incidence in neonates is unknown. Here, we report meropenem-induced pancytopenia in a preterm neonate. Case presentation A preterm newborn Pakistani received intravenous meropenem 40 mg/kg every 8 hours to treat Klebsiella pneumoniae in blood cultures and suspected meningitis. The baby developed severe thrombocytopenia, with a platelet count of 22 × 103 cells/mm3, low hemoglobin level of 9.7 g/dl, and low absolute neutrophil count (ANC) of 816 cells/mm3 on days 3, 14, and 17 of meropenem therapy, respectively. Based on the blood culture and institutional guidelines, meropenem treatment was continued with monitoring and supportive care for a total of 19 days. After discontinuation of meropenem, the baby was monitored continuously for hematological changes, and low counts persisted for 3 days. ANC improved to > 1500 cells/mm3 on the fourth day, and the platelet count reached > 150 × 103 cells/mm3 for the first time on the seventh day of meropenem discontinuation. All subsequent complete blood count (CBC) reports showed improving trends. The baby was discharged on the 48th day of life (DOL), with follow-up monitoring of CBC. The baby was kept on iron supplements, and hemoglobin level of 11.2 g/dl was observed on the 59th DOL. Conclusion Neonatal pancytopenia may lead to serious health complications; therefore, clinicians and pharmacists need to vigilantly monitor CBC in this vulnerable population, even when administering meropenem in septic doses for the recommended duration.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…Hanai et al [12] found that 48.4% of patients on linezolid developed thrombocytopenia [12]. Meropenem has also been linked with the platelet abnormality [13]. In this survey, 86.2% of patients receiving antibiotics developed thrombocytopenia (p = 0.001).…”

Section: Discussionmentioning

confidence: 59%

Prevalence of Intensive-care-unit-acquired Thrombocytopenia in a Tertiary Care Hospital in Sudan

Rahama¹,

Mirghani²,

Hussein³

et al. 2019

DSAHMJ

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“…There was the report that Meropenem® induced the transient coagulation factor X deficiency of a 12-month-old boy suffering from 25% TBSA and underwent hypocoagulability 3 days after the initiation of the antibiotic. And it is also considered to be responsible for drug-induced immune thrombocytopenia (DITP) that shows acute thrombocytopenia in patients [17]. The mechanism of Meropenem® to initiate different ways of coagulopathy still needs further investigation; however, in present case treatment, long-term usage of Meropenem® might eradicate vitamin K producing intestinal microflora, interdicted the vitamin K2 pathway and made it deprived of vitamin K storage in the patient.…”

Section: Discussionmentioning

confidence: 99%

Hypocoagulation induced by broad-spectrum antibiotics in extensive burn patients

Liu

et al. 2019

Burns &Amp; Trauma

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Background Patients with extensive burns usually develop pro-coagulation soon after the injury if there is no sepsis occurred. We describe the case of an extensive burn adult suffering from hypocoagulation not related to sepsis, but secondary to antibiotic treatment. Case presentation Here, we report a case of an adult male patient suffering from flame burns of 45% total body surface area (40% full thickness) combined with inhalation injury. Hypocoagulopathy with soaring prolonged activated partial thromboplastin time value occurred on third week post-burn while systemic infection had been under control by application of broad-spectrum antibiotics. Investigations showed that not the infection but vitamin K-related coagulation factor deficiency were responsible for unexpected bleeding. However, supplemental vitamin K was not the key as we expected, which prompted us trying to decode the underlying cause of coagulation disturbance in this patient and pick out the most effective treatment for live-saving. After the withdrawal of highly suspected broad-spectrum antibiotic, Meropenem®, disturbed vitamin K related coagulation factors gradually restored to their optimal levels so as to maintain normal coagulation status. Therefore, surgical procedures without further risk of bleeding could be carried out in time for wound recovery. The patient was discharged on post-burn day 67 and transferred to a secondary hospital for his rehabilitation. Conclusion Hypocoagulopathy may be devoted to different reasons other than sepsis in extensive burns. Early recognition of the cause for coagulation disturbance is critical to make appropriate treatment and save patients’ lives. This case illustrated the importance of unveiling the mist cause for coagulation disturbance occurred in extensive burn patient, which paved the way for optimal life-saving treatments. And we also recommend burn surgeons to be alerted to antibiotic-induced vitamin K deficiency-related coagulopathy among critical burn patients.

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

Abstract: Drug-induced immune thrombocytopenia should be considered in cases of acute thrombocytopenia in patients undergoing meropenem treatment. Clinicians should be cognizant of DITP, and a definitive diagnosis should be pursued, if feasible.

Cited by 10 publications

References 14 publications

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

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

Prevalence of Intensive-care-unit-acquired Thrombocytopenia in a Tertiary Care Hospital in Sudan

Hypocoagulation induced by broad-spectrum antibiotics in extensive burn patients

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