Drugs can cause thrombocytopenia by several mechanisms including direct bone marrow or other organ toxicity. This website provides our perspective about current information on. Identifying drugs that cause acute thrombocytopenia. Drug induced thrombocytopenia occurs when certain drugs or medications destroy platelets or interfere with the bodys ability to make enough of them. This paper presents a rare case of thrombocytopenia. Drugassociated thrombocytopenia american society of hematology. Platelets are cells in the blood that help the blood clot. Heparin induced thrombocytopenia adult inpatient clinical. What would cause this patients platelets to fall so dramatically. The list of drugs implicated in druginduced thrombocytopenia is extensive and growing. When medicines or drugs are the causes of a low platelet count, it is called drug induced thrombocytopenia. On occasion, outpatients with drug induced thrombocytopenia are treated for autoimmune thrombocytopenia and can have two or three recurrences before the drug causing the disorder is identified.
Ditp typically appears suddenly, is often severe, and can cause major bleeding and death. Druginduced thrombocytopenia archives of pathology. Five to seven days of drug exposure are usually needed to produce sensitization, so drug exposure in the weeks preceding the occurrence of thrombocytopenia. How we manage immune thrombocytopenia in the elderly. Thrombocytopenia is any disorder in which there are not enough platelets.
To characterize the spectrum of drugs associated with immune thrombocytopaenia itp in the berlin casecontrol surveillance study fakos. Druginduced thrombocytopenia induced by trastuzumab. Immune hemolytic anemia associated with drug therapy. A sudden drop in platelets can be from immunemediated mechanisms or drug induced thrombocytopenia dit. Druginduced immune thrombocytopenia new england journal. It has been described that drug induced immune thrombocytopenia is associated with several chemotherapeutic agents such as oxaliplatin 1, 2, fludarabine and irinotecan and with new targeted mabs such as abciximab, infliximab and rituximab, but thrombocytopenia induced. To document drugs and also beverages, foods and food supplements that have definite clinical evidence for causing immune. Druginduced immune thrombocytopaenia is a rare, serious condition that can be triggered by numerous medications.
Early diagnosis and proper treatment of drug induced anemias are crucial because of the seriousness of these disorders. Although in most cases, druginduced thrombocytopenia is. 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. 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. The mechanisms by which drugs cause thrombocytopenia. The following guideline is intended to guide the diagnosis and management of heparin induced thrombocytopenia. Drug induced thrombocytopenia should be suspected in any patient with acute thrombocytopenia of unknown cause.
The list of drugs implicated in drug induced thrombocytopenia is extensive and growing. To document drugs and also beverages, foods and food. Heparin induced thrombocytopenia 0 drugs learn more about thrombocytopenia drug induced. Drug induced thrombocytopenia requires a high suspicion for diagnosis and a broad investigation to exclude other etiologies of low platelets. It is imperative to provide rapid identification and removal of the offending agent before clinically significant bleeding or, in the. Quinine and quinidinedependent antibodies are classic examples of drug induced effects that cause severe, lifethreatening thrombocytopenia. Drug induced thrombocytopenia is the most common drug induced hematologic disorder, with reports suggesting that between 0. This paper aims to emphasize the broad range of drug induced hematological syndromes and to highlight some of the newer drugs and syndromes. This is a pdf file of an unedited manuscript that has.
Disorders with only a low platelet count immune thrombocytopenia itp drug induced thrombocytopenia ditp. Review of physiology platelets are fragments of the. Many medications are known to cause a degree of thrombocytopenia. Unexplained thrombocytopenia is a common clinical problem, and the possibility of drug induced thrombocytopenia must be considered, especially in hospitalized patients. Case report drug induced thrombocytopenia following a transvaginal oocyte retrieval for in vitro fertilization ioannaa. Approach to thrombocytopenia definition thrombocytopenia is defined as a platelet count of less than 150 x 109l. Thrombocytopenia is a condition characterized by abnormally low levels of thrombocytes, also known as platelets, in the blood a normal human platelet count ranges from 150,000 to 450,000 platelets per. Druginduced thrombocytopenia clinical lymphoma, myeloma. Although the incidence is low, more than 100 drugs have been implicated in. 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. The following guideline is intended to guide the management of heparin induced thrombocytopenia and includes recommendations for diagnosis and treatment agents. Although drugs are a common cause of acute immunemediated thrombocytopenia in adults, the drug etiology is often initially unrecognized. Although it occurs more often than drug induced anemia it is less well understood because techniques for studying drug plateletimmune interactions have been unavailable until recently. Adult hospitalized patients with new onset idiopathic, secondary or drug induced.
The discovery of isolated thrombocytopenia in a patient who is taking several medications presents a challenging clinical problem. Drugs can induce almost the entire spectrum of hematologic disorders, affecting white cells, red cells, platelets, and the coagulation system. A constant and relative to drug induced thrombocytopenia pdf produce nitric oxide supplements is one reason is best suitable to be around 1215. Acute immunemediated thrombocytopenia is a potentially serious adverse reaction to many drugs. Drug induced thrombocytopenia is a serious complication of drug therapy.
Because heparin is often given together with certain drugs that are likely to cause druginduced thrombocytopenia platelet inhibitors and. Cessation of the offending agent often results in recovery of platelet counts. Highlights of prescribing information history of drug. Identifying drugs that cause acute thrombocytopenia american. Heparin and anticancer drugs are thought to be most commonly associated drugs with this adverse reaction. Review article druginduced megaloblastic, aplastic, and. Platelet counts are affected by apoptosis programmed cell death. There are hundreds of drugs implicated in the pathogenesis of dit.
Diagnosis of hit is based on both clinical thrombocytopenia or new thrombosis and. Other types of druginduced thrombocytopenia are discussed separately. Drug induced immune thrombocytopenia, excluding heparin induced thrombocytopenia, is a rare adverse drug reaction for which the evidence about frequency, relative risk and risk factors mainly. The list of medications associated with drug induced thrombocytopenia is vast and growing. Removal of the offending drug is the primary treatment for drug induced oxidative hemolytic anemia.
Druginduced thrombocytopenia dit is a relatively common clinical disorder. Although many cases of ditp are mild, some are characterized by lifethreatening bleeding symptoms. Platelets on the web university of oklahoma health. Many drugs can induce antibodies that are capable of causing severe thrombocytopenia. The pathogenesis of ditp is complex, in that at least six different mechanisms have been proposed by which drug induced. Laboratory tests capable of determining whether thrombocytopenia is drug induced and which drug. Many, if not most, of these medications induce thrombo cytopenia by. Druginduced thrombocytopenia ditp, which also includes thrombocytopenia induced by beverages, foods, and herbal remedies, is an important clinical problem for hematologists. Case report druginduced thrombocytopenia following a. Ditp is often suspected in patients with acute thrombocytopenia unexplained by other causes, but documenting that.
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