Meropenem-Associated Severe Hematological Complications Leading to Cardiovascular Collapse in Elderly Critically Ill Patients: A Case Series

Meropenem is a broad-spectrum carbapenem antibiotic widely used in critically ill patients and is generally considered safe. However, rare but serious hematological adverse effects including leukopenia, bone marrow suppression, and hemolytic anemia have been reported. We present a case series of two elderly postoperative patients with multiple comorbidities who developed severe hematological complications during meropenem therapy. The first patient developed profound leukopenia suggestive of acute marrow suppression, followed by rapid cardiovascular collapse. The second patient developed acute hemolytic anemia with associated cytopenias, which partially improved after drug discontinuation but was ultimately followed by sudden cardiac arrest. Although both patients had significant baseline comorbidities, the temporal association between meropenem administration and hematological deterioration suggests probable drug-induced toxicity. These cases highlight the importance of close hematological monitoring in elderly and critically ill patients receiving meropenem.