MEROPENEM INDUCED THROMBOCYTOSIS – A RARE ADVERSE DRUG REACTION

Thrombocytosis is defined as platelet count greater than 400, 000/mm³. Thrombocytosis can be either primary or secondary. Meropenem is a parenteral carbapenem antibiotic that has great bactericidal activity against almost all significant aerobes and anaerobes. Common adverse effects such as pain at the injection site, skin rash, transitory metabolic disorders such as increased liver enzyme levels, increased creatinine blood levels, or increased urea levels, or hematological disorders (thrombocytosis, eosinophilia) may be observed. Thrombocytosis due to Meropenem is relatively rare and here we report one such case of Meropenem induced thrombocytosis in a 26-year-old patient post cesarean delivery. A 26-year-old primigravida with 38 weeks gestation presented in labour for four hours. Her investigations revealed hemoglobin of 10.3, deranged LFT and thrombocytopenia. A provisional diagnosis of primigravida with 38 weeks gestation with Fetal Growth Restrictionwith jaundice, thrombocytopenia (TTP) in latent phase of labour was made. Later, the patient was taken up for emergency caesarean in view of fetal distress. Postoperatively the patient was given injectable ceftriaxone and metronidazole. Patient developed high grade fever (101 -103 F) on day 4 for which sepsis screen was done. Vaginal swab culture showed growth of Klebsiella pneumoniae which was sensitive to meropenem. Meropenem was started. A repeat complete blood count on postop day 5 revealed moderate anemia with thrombocytosis. It was observed that the patient’s general condition improved and fever resolved after 4 days of antibiotics but the platelet count peaked to 1400×1000/mm3 by POD9. In view of improved general condition of patient a possibility of reactionary drug induced thrombocytosis was considered and the decision to stop meropenem was made. As soon as meropenem was stopped the platelet count gradually dropped to 1000×1000/cumm by post op day 13.On her next visit her platelet count showed reducing trend and became normal within few weeks.