Piperacillin-induced mild haemolytic anaemia in a 44-year-old patient with cystic fibrosis

Abstract

Piperacillin-tazobactam is an antipseudomonal antibiotic frequently used in patients with cystic fibrosis (CF) to treat pulmonary exacerbations. Drug-induced immune haemolytic anaemia is a rare complication during treatment with piperacillin. So far, piperacillin-induced immune haemolytic anaemia (PIHA) is regarded as an acute and severe haemolytic anaemia resulting into life-threatening events. Here we report on a patient with mild PIHA, which did not result in any clinical symptoms or necessity for treatment. To the best of our knowledge, this is the first case report of PIHA without an acute severe haemolytic anaemia. Further research is needed to clarify if this case is a solitary clinical manifestation of PIHA or if mild clinical courses of PIHA might be under-reported. Cases of PIHA have been largely reported in patients with CF. This unequal distribution maybe due to the frequent administration of piperacillin for pulmonary exacerbation in patients with CF or due to CF-related cofactors of yet unknown aetiology.

Risk of piperacillin‐induced hemolytic anemia in patients with cystic fibrosis and antipseudomonal treatment: a prospective observational study

“…Therefore, PIHA has been regarded as a highly acute and life‐threatening event, particularly if it remains undetected in due time. In contrast, the two patients described in the present study and in a patient from a previously published case report developed only mild PIHA …”

“…The presence of an association between hypersensitivity reactions to antibiotics and drug‐induced hemolysis of RBCs remains ambiguous. Patient number 2 had urticaria and our previous patient (described in the case report by Meinus et al) had drug fever due to piperacillin before developing PIHA. In these two cases, a sequence of different immune responses to piperacillin could be observed.…”

“…PIHA is usually characterized by acute intravascular hemolysis due to complement activation . We recently reported a mild course of hemolytic anemia due to piperacillin/tazobactam treatment in a patient with CF …”

Severe piperacillin–tazobactam‐induced hemolysis in a cystic fibrosis patient

“…Symptoms occur 24 h to 2 weeks after piperacillin–tazobactam initiation . The typical hemoglobin nadir is 3–5 g/dL , although mild cases are likely underreported . Upon chart review, our patient had decreases in hemoglobin levels during prior piperacillin–tazobactam courses that may have been missed DIIHA.…”

The First-Reported Case of Drug-Induced Hemolytic Anemia by Piperacillin-Tazobactam in a Premature Neonate: A Case Report and Literature Review

“…A review of prior studies and reports showed that piperacillin-tazobactam-induced hemolytic anemia is more common in patients with cystic fibrosis, which may be attributed to their repeated exposure to recurrent infections [ 6 , 7 ]. A recent study has reported an instance of piperacillin-tazobactam-induced pancytopenia in a neonate.…”