Objective  To discuss the occurrence and characteristics of hemolytic anemia induced by piperacillin-tazobactam to provide a reference for clinically safe drug use.

Methods  PubMed, Web of Science, CNKI, WanFang Data, and VIP were electronically searched to collect case reports of hemolytic anemia induced by piperacillin-tazobactam from inception to December 2023, and statistical analysis was conducted on patients' basic information, drug use, hemolytic anemia, complications and outcomes.

Results  A total of 27 patients were included in 25 literature, including 14 males (51.85%) and 13 females (48.15%), aged from 4 days to 77 years old, and the time of first occurrence of hemolytic anemia ranged from 24 h to 18 days. The minimum hemoglobin level of hemolytic anemia was determined in 25 cases, ranging from 27 to 113 g·L^-1, of which 14 cases were severe  or extremely severe anemia (<60 g·L^-1). After drug withdrawal, antibiotic change, and symptomatic supportive treatment, the hemolytic anemia of 25 patients (92.59%) was improved or recovered. Among them, the anemia of 1 patient was improved after stopping piperacillin-tazobactam, but the patient died of multiple organ failure 15 days after drug withdrawal. The other two patients of anemia did not improve, and eventually discharged themselves or died clinically.

Conclusion  Hemolytic anemia is a rare adverse reaction of piperacillin-tazobactam, and the clinical symptoms have no obvious specificity. Hemoglobin levels should be monitored in clinical use, and once the abnormality is found, if it is clear that piperacillin-tazobactam is the suspicious drug, it should be promptly discontinued, and measures such as red blood cell transfusion should be taken if necessary.

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