meropenem and Anemia--Hemolytic

Topics: Adult; Anemia, Hemolytic; Anti-Bacterial Agents; Diagnosis, Differential; Escherichia coli Infections; Female; Hemolytic-Uremic Syndrome; Humans; Meropenem; Plasma Exchange; Purpura, Thrombotic Thrombocytopenic; Sepsis

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.

Topics: Aged; Anemia, Hemolytic; Antibodies; Coombs Test; Female; Humans; Meropenem; Serologic Tests; Thienamycins

Massive hemolysis secondary to sepsis caused by Clostridium perfringens is a rare entity but appears fairly often in the literature. In nearly all published reports, the clinical course is rapid and fatal. We describe the case of a 75-year-old woman with diabetes who was admitted with symptoms consistent with acute cholecystitis. Deteriorating hemodynamics and laboratory findings were consistent with intravascular hemolysis, coagulation disorder, and renal failure. Gram-positive bacilli of the Clostridium species were detected in blood along with worsening indicators of hemolysis. In spite of antibiotic and surgical treatment, hemodynamic support and infusion of blood products, the patient continued to decline and died in the postoperative recovery unit 14 hours after admission. Mortality ranges from 70% to 100% in sepsis due to Clostridium perfringens, and risk of death is greater if massive hemolysis is present, as in the case we report. Only a high degree of clinical suspicion leading to early diagnosis and treatment can improve the prognosis. This bacterium should therefore be considered whenever severe sepsis and hemolysis coincide.

Topics: Acute Kidney Injury; Aged; Anemia, Hemolytic; Anti-Bacterial Agents; Bacteremia; Blood Component Transfusion; Cholecystectomy; Cholecystitis; Clindamycin; Clostridium perfringens; Combined Modality Therapy; Delayed Diagnosis; Diabetes Complications; Emergencies; Fatal Outcome; Female; Gas Gangrene; Hemofiltration; Humans; Meropenem; Norepinephrine; Postoperative Complications; Shock, Septic; Thienamycins