The bleeding history does not help in diagnosing the nature of the thrombocytopenia, but gives important clues about its duration and defines its clinical phenotype. Valproic acidinduced thrombocytopenia european journal of. Nothing in the chemical structure, pharmacology, and biological activity of sch 900875 predicted the destruction of red blood cells and platelets that was observed in rats. Many drugs have been associated with the development of thrombocytopenia. Many of the cytotoxic drugs used for cancer chemotherapy and other. Druginduced thrombocytopenia dit deserves a special focus since its cumulative incidence can be as high as 10 cases per million population per year, with a prevalence of approximately 25% in. Ditp typically appears suddenly, is often severe, and can cause major bleeding and death. Many reports of druginduced thrombocytopenia do not provide. Drug induced immune thrombocytopenia ditp is often suspected in patients with acute thrombocytopenia unexplained by other causes, but documenting that a drug is the cause of thrombocytopenia can. The clinical picture associated with dit is characterized by thrombocytopenia, petechiae, purpuric lesions, and occasionally serious bleeding such as intracranial hemorrhage.
Rapidonset vancomycininduced thrombocytopenia with. The discovery of isolated thrombocytopenia in a patient who is taking several medications presents a challenging clinical problem. Druginduced immune thrombocytopenia is a serious clinical problem that is underrecognized. In itp of mature rst step is drug corticosteroid and. Drug induced thrombocytopenia is the most common drug induced hematologic disorder, with reports suggesting that between 0. Acetazolamideinduced thrombocytopenia coagulation disorders.
Drugassociated thrombocytopenia american society of hematology. Druginduced immune thrombocytopenia ditp can be triggered by a wide. Drugimmune thrombocytopenia with thrombosis versus heparin. Platelets on the web university of oklahoma health. The important diagnostic issue is to distinguish between drug induced thrombocytopenia and idiopathic thrombocytopenic purpura because the latter diagnosis requires the exclusion of other causes of thrombocytopenia. Patients with isolated thrombocytopenia commonly have druginduced thrombocytopenia, immune thrombocytopenic purpura.
It is capable of inhibiting both free and clotassociated thrombin. Unexplained thrombocytopenia is a common clinical problem, and the possibility of drug induced thrombocytopenia must be considered, especially in hospitalized patients. Download ebook drug induced diseases 2nd edition pdf. Druginduced thrombocytopenia dit is a relatively common clinical disorder. Thrombocytopenia due to drug sensitization is an uncommon but serious complication which may cause serious bleeding or lead to death from brain. Drug induced thrombocytopenia is the most common druginduced hematologic disorders, with some reports suggesting that as many as 5% of patients who receive heparin develop heparin induced thrombocytopenia. Drug induced thrombocytopenia dit is a relatively common clinical disorder. Druginduced thrombocytopenia is a common adverse effect reported in the literature. Although drugs are a common cause of acute immunemediated thrombocytopenia in adults, the drug etiology is often initially unrecognized. Drug induced thrombocytopenia occurs when certain drugs or medications destroy platelets or interfere with the bodys ability to make enough of them. Druginduced thrombocytopenia ditp, which also includes thrombocytopenia induced by beverages, foods, and herbal remedies, is an important clinical problem for hematologists. A clinical diagnosis of vit was made, and the drug was withdrawn on day 3 of therapy.
In contrast to immunemediated thrombocytopenia, nonimmune drug induced thrombocytopenia is described as a direct cytotoxic effect of the drug molecules on the megakaryocytes andor platelets, leading to dysfunctional thrombopoiesis within the bone marrow or increased platelet destruction in the circulation, respectively. Thrombocytopenia is commonly seen in laboratory findings, especially in critically ill patients. A free powerpoint ppt presentation displayed as a flash slide show on id. Ditp should be suspected when a patient, child or adult, has sudden, severe thrombocytopenia. Pdf thrombocytopenia is the result of falling the number of platelet from 150000microl. Approach to the diagnosis and management of druginduced. This website provides our perspective about current information on. Immune thrombocytopenia itp is an acquired thrombocytopenia, defined as a platelet count drug induced thrombocytopenia. Heparin induced thrombocytopenia is the most common ditp and has distinct pathogenesis, diagnosis, and treatment options. Ditp is even more strongly suspected when a patient has repeated episodes of sudden, severe thrombocytopenia.
This study describes the pathogenesis of an unusual drug induced hemolysis and thrombocytopenia. Case report drug induced thrombocytopenia following a transvaginal oocyte retrieval for in vitro fertilization ioannaa. Acetazolamideassociatedthrombocytopenia was previously described as part of aplastic anemia or otherorgan involvement. After a month of prescription of the drug the patient was absolutely seizure free. Reviews of druginduced thrombocytopenia have resulted in extensive lists of drugs. Heparininduced thrombocytopenia hit is a type of druginduced immune thrombocytopenia ditp. Drugs can cause thrombocytopenia by several mechanisms including direct bone marrow or other organ toxicity. Platelet counts are affected by apoptosis programmed cell death.
Download ebook drug induced diseases 2nd edition free pdf medical books free. It is common, yet underrecognized, difficult to diagnose and associated with severe bleeding complications. Article information, pdf download for rapidonset vancomycininduced. Drug induced thrombocytopenia dit is a relatively common and potentially serious side effect of therapy with a variety of structurally unrelated drugs. Test methods must show drugdependence, immunoglobulin binding, plt specificity and ideally should be reproducible across laboratories. Drug induced thrombocytopenia is a common adverse effect reported in the literature. Thrombocytopenia and sarcoidosis jama jama network. Although in most cases, druginduced thrombocytopenia is associated with bleeding, lifethreatening. Although many cases of ditp are mild, some are characterized by lifethreatening bleeding symptoms.
Amoxicillinclavulanic acidinduced thrombocytopenia. Druginduced thrombocytopenia presents several diagnostic and management challenges. Ditp refers to acute, immunemediated thrombocytopenia. Hereinwe report an acetazolamideinduced pure thrombocytopenia with the highestlevel of evidence for a causal relationship of the drug to thrombocytopenia. Thrombocytopenia low platelet count thrombocytopenia is a platelet count below the normal range thrombocytopenia decreased production increased destruction sequestration pseudothrombocytopenia itp no treatment platelets 1020k, no major bleeding or bleeding. Druginduced immune thrombocytopenia can be treated by withholding the causative drug and, in severe cases. Typically patients present with a low platelet count with signs and symptoms ranging from bruising to bleeding.
First, it can be difficult to definitively prove that a decrease in platelet count is drug related, especially in the absence of sufficiently frequent platelet counts to allow for a clearly defined temporal relationship between drug administration and thrombocytopenia. Diagnosis of diit is complicated by its similarity to other non drug induced immune thrombocytopenias, including autoimmune thrombocytopenia, posttransfusion purpura, and platelet transfusion refractoriness, and must be differentiated by temporal association of exposure to a candidate drug with an acute, severe drop in platelet count. Druginduced immune thrombocytopenia ditp can be triggered by a wide range of medications. Heparin induced thrombocytopenia 0 drugs learn more about thrombocytopenia drug induced. Drug induced immune thrombocytopenia diit is a relatively uncommon adverse reaction caused by drug dependent antibodies ddabs that react with platelet membrane glycoproteins only when the. Our goal was to provide a database describing the level of evidence for a causal role for each drug and clinical outcomes 1. Our goal for continuing to update our database is to provide an accessible resource moon. A low platelet count may be the initial manifestation of infections such as hiv and hepatitis c virus or it may re. Howtoapproachthrombocytopenia robertostasi1 1departmentofhaematology,stgeorgeshospital,london,unitedkingdom thrombocytopenia is a common hematologic. Most cases of drug induced thrombocytopenia ditp are caused by drug dependent antibodies that are specific for the drug structure and bind tightly to platelets by their fab regions but only in the presence of the drug.
Druginduced immune thrombocytopenia teresa kam, maurice. How to approach thrombocytopenia hematology american. To document drugs and also beverages, foods and food supplements that have definite clinical evidence for causing immune. Immune thrombocytopenia itp drug induced thrombocytopenia ditp low platelet counts that occur during pregnancy. Case report druginduced thrombocytopenia following a. Valporic acid is the common used antiepileptic drug. Although the incidence is rare, drug induced immune thrombocytopenia ditp is a serious complication that is often overlooked as a cause of thrombocytopenia. Rapidonset vancomycininduced thrombocytopenia with reexposure. The pathogenesis of ditp is complex in that at least six different mechanisms have been proposed by which drug induced antibodies can promote platelet. Drs iannuzzi and fontana introduced their grand rounds with an unusual case of sarcoidosis, a woman who also had thrombocytopenia. Drug induced thrombocytopenia should be suspected in any patient with acute thrombocytopenia of unknown cause. It is imperative to provide rapid identification and removal of the offending agent before clinically significant bleeding or, in the case of heparin, thrombosis occurs. Drug induced thrombocytopenia moderate to severe can range from asymptomatic to evidence of clinical bleeding detailed history of recent prescription medications, nutritional supplements, and. Although most patients with drug induced thrombocytopenia dit have an increased risk of bleeding, those with dit due to heparin, or heparin induced thrombocytopenia hit, have a low risk of bleeding but, paradoxically, an increased risk of thrombotic complications.
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