ACUTE INTRAVASCULAR HAEMOLYSIS ASSOCIATED WITH INTRAVENOUS ADMINISTRATION OF MEROPENEM IN A SIXTY FOUR YEAR OLD MAN

Main Article Content

Simon P Lambden
Judith Akeru
Nicholas A Barrett

Keywords

meropenem, haemolysis

Abstract

We present the first reported case of severe intravascular haemolysis associated with the use of meropenem in a 64 year old man. The report highlights a further possible drug related cause of intravascular haemolysis. The patient, who had a background of dialysis dependent renal failure, epilepsy and learning difficulties, was admitted to the intensive care unit following laparotomy and large bowel resection. His background also included a reported childhood allergy to penicillin. Along with initial haemodynamic and ventilatory support he was treated with cefuroxime, metronidazole and gentamicin without incident. He went on to develop an abdominal collection, for which treatment included meropenem. Associated with the administration of meropenem was the development of severe intravascular haemolysis confirmed by laboratory analysis and microscopy, which resolved on cessation of meropenem therapy. We discuss the possible mechanisms involved in the development of drug induced haemolysis and suggest the most likely cause in this case.

Abstract 258 | PDF Downloads 86

References

1. Romano A, Viola M, Guéant-Rodriguez RM, Gaeta F, Valluzzi R, Guéant JL. Brief communication: tolerability of meropenem in patients with IgE-mediated hypersensitivity to penicillins. Annals of Internal Medicine 2007;146:I53.
2. Edwards JR. Meropenem: a microbiological overview. Journal of Antimicrobial Chemotherapy 1995;36:Suppl. A.1-17.
3. Norrby SR, Newell PA, Faulkner KL, Leskf W. Safety profile of meropenem: international clinical experience based on the first 3125 patients treated with meropenem. Journal of Antimicrobial Chemotherapy 1995;36:Suppl. A. 207-23.
4. Solberg CO, Sjursen H. Safety and efficacy of meropenem in patients with septicaemia: a randomised comparison with ceftazidime, alone or combined with amikacin. Journal of Antimicrobial Chemotherapy 1995;36:Suppl. A.157-66.
5. Norrby SR, Gildon KM. Safety profile of meropenem: a review of nearly 5,000 patients treated with meropenem. Scandinavian Journal of Infectious Disease 1999;31:3-10.
6. Dhaliwal G, Cornett PA, Tierney LM. Hemolytic anemia. American Family Physician 2004;69:2599-606.
7. Salama A. Drug-induced immune hemolytic anemia. Expert Opinion on Drug Safety 2009;8:73-9.
8. Holt AW, Bersten AD, Plummer JL, Bierer P, Chalmers AH. Haemolysis associated with continuous venovenous renal replacement circuits. Anaesthesia Intensive Care 1998;26:272-5.