This study aims to quantify the risk for thrombocytopenia following exposure. Heparininduced thrombocytopenia hit is technically the most common cause of drugassociated thrombocytopenia, but the drop in platelet levels in patients with hit is rarely sufficient to provoke bleeding and thrombosis is the major. Druginduced thrombocytopenia should be suspected in any patient with acute thrombocytopenia of unknown cause. This child recovered from his third episode within 10 days, with ivig treatment. The laboratory approach to diagnosing druginduced thrombocytopenia is 2pronged. Second, testing for drugdependent platelet antibodies, available at specialized reference laboratories, often can identify the offending medication. Druginduced thrombocytopenia occurs when certain drugs or medications destroy platelets or interfere with the bodys ability to make enough of them.
Unexplained thrombocytopenia is a common clinical problem, and the possibility of druginduced thrombocytopenia must be considered, especially in hospitalized patients. Chemotherapyinduced thrombocytopenia derives from the. Druginduced thrombocytopenia occurs when certain medicines destroy platelets or interfere with the bodys ability to make enough of them. Disorders with low platelet counts associated with anemia caused by blood clots in small vessels. Review of physiology platelets are fragments of the large megakaryocyte, produced in the bone marrow. Drug induced thrombocytopenia is a common adverse effect reported in the literature. Drug induced thrombocytopenia can be caused by dozens of different medications and should be suspected in any patient who presents with acute thrombocytopenia of unknown origin. Although in most cases, druginduced thrombocytopenia is. Druginduced immune thrombocytopenia ditp is a challenging. Because many patients are taking several drugs when thrombocytopenia is first discovered, clinicians need to know the probability of a causal role for each drug.
When the drug is stopped, the platelet count typically begins to increase within 1 to 2 days and recovers to. Normal adult platelet count ranges between 150,000 to 450,000microliter of circulating blood. Heparin, a blood thinner, is the most common cause of druginduced immune thrombocytopenia. Most common cause of drug induced immune thrombocytopenia thrombotic thrombocytopenic purpura ttp a blood disorder that causes blood clots to form in small blood vessels around the body and leads to a low platelet count. Table 3 mechanisms of drug induced thrombocytopenia. Unexplained thrombocytopenia is a common clinical problem, and the possibility of drug induced thrombocytopenia must be considered, especially in hospitalized patients. The etiology of druginduced immune thrombocytopenia is complex, at least six distinct pathologic mechanisms having been identified table 1. If a medicine causes your body to produce antibodies, which seek and destroy your platelets, the condition is called drug induced immune thrombocytopenia. Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that todays audiences expect. In hospitalized patients, unexpected thrombocytopenia may be attributed to complications such as sepsis. The mechanism behind druginduced thrombocytopenia is either a decrease in platelet production bone marrow toxicity or an increased destruction immunemediated thrombocytopenia.
Druginduced thrombocytopenia is a serious complication of drug therapy. Thrombocytopenia caused by a drug usually is corrected by stopping the drug. Thrombocytopenia caused by autoimmune destruction of platelets as in immune thrombocytopenia is treated with prednisone to lessen platelet destruction, drugs to increase production of platelets in the bone marrow, and sometimes removal of the spleen splenectomy. Approach to the diagnosis and management of druginduced.
However, in contrast to the agents identified in this study, heparin usually does not induce severe thrombocytopenia, and the main clinical effect of heparin induced thrombocytopenia is thrombosis rather than bleeding. Drug induced thrombocytopenia occurs when certain medicines destroy platelets or interfere with the bodys ability to make enough of them. Find out about the many possible causes of a low count. If a medicine causes your body to produce antibodies, which seek and destroy your platelets, the condition is called drug induced. Drug induced thrombocytopenia dit is a condition in which a drug or medication causes a decrease in the number of platelets in blood. Heparin induced thrombocytopenia hit treatment page 2 of 7 disclaimer. This website provides our perspective about current information on. Drug induced thrombocytopenia should be treated by withdrawal of the drug concerned, which retrospectively confirms the diagnosis strong agreement. This article looks at platelets and their role within the body. Thrombocytopenia drug induced multimedia encyclopedia. Drug induced thrombocytopenia dit is a relatively common clinical disorder. A brief discussion of the most common etiologies seen in both settings is provided. In most patients, thrombocytopenia was discovered after the occurrence of minor purpura.
Drug induced thrombocytopenia causes low platelets and. Drug induced thrombocytopenia should be suspected in any patient with acute thrombocytopenia of unknown cause. Type2 is a druginduced, immunemediated thrombocytopenia that. Druginduced thrombocytopenia occurs typically when a drug bound to the platelet creates a new and foreign antigen, causing an immune reaction. His past medical history was only significant for hypertension controlled by lisinoprilhctz. There are two types of drug induced thrombocytopenia. Nov 16, 2018 a low platelet count is a blood disorder that can sometimes be serious. Druginduced thrombocytopenia is the most common druginduced. Hundreds of drugs have been implicated in its pathogenesis, among those, drugs most often associated with ditp are.
Many drugs have been associated with the development of thrombocytopenia. Thrombocytopenia is a serious side effect of such treatment and occurs mostly due to rifampicin rif. Feb 03, 2020 immune thrombocytopenia may happen when your immune system attacks and destroys your platelets. 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. Druginduced immune thrombocytopenia, excluding heparininduced thrombocytopenia, is a rare adverse drug reaction for which the evidence about frequency, relative risk and risk factors mainly originates from case reports and case studies. Abha soni, jose rodriguez barrantes, md, shawn morehead md st. If a medicine causes your body to produce antibodies, which seek and destroy your platelets, the condition is called druginduced immune thrombocytopenia. In addition, pseudothrombocytopenia, an in vitro effect, has to be distinguished from true druginduced. Platelets are blood cells that are responsible for the clotting process in the body. Thrombocytopenia occurs when the bone marrow makes too few platelets or when too many platelets are destroyed or accumulate within an enlarged spleen. If a medicine causes your body to produce antibodies, which seek and destroy your platelets, the condition is called druginduced. Druginduced immune thrombocytopenia sepsis, a severe bacterial infection in your blood helicobacter pylori h. Immune thrombocytopenia may happen when your immune system attacks and destroys your platelets. Immune thrombocytopenia itp druginduced thrombocytopenia ditp low platelet counts that occur during pregnancy.
Hence, the clinical evidence that drug induced apoptosis might be. Druginduced thrombocytopenia was first described in the 19th century, yet our understanding of its pathogenesis continues to evolve. Ditp typically appears suddenly, is often severe, and can cause major bleeding and death. Approach to thrombocytopenia joanne yeung definition thrombocytopenia is defined as a platelet count of less than 150 x 109l. Typically, a patient will have taken the sensitizing drug for about 1 week or intermittently over a longer period of time before presenting with petechial hemorrhages. Winner of the standing ovation award for best powerpoint templates from presentations magazine. Druginduced thrombocytopenia definition of druginduced. The normal amount of platelets is usually between 150,000 and 450,000. There are two types of druginduced thrombocytopenia. Many of the cytotoxic drugs used for cancer chemotherapy and other. Thrombocytopenia is a low number of platelets thrombocytes in the blood, which increases the risk of bleeding. Thrombocytopenia differential diagnosis falsely low platelet count in vitro platelet clumping caused by edtadependent agglutinins giant platelets common causes of thrombocytopenia pregnancy gestational thrombocytopenia, preeclampsia drug induced thrombocytopenia i.
Drug induced hematology lecturer nin prapongsena huachiew chalermprakiet university 2. Under the influence of thrombopoietin, a chemical made by the liver and. Major bleeding occurred in 23 of 247 9% ci, 6% to 14% patients with level i or ii evidence of druginduced thrombocytopenia. Heparin induced thrombocytopenia in patients treated with low molecularweight heparin or unfractionated heparin. When platelet levels are low, bleeding may occur anywhere in your body. Functional assays combine both high sensitivity and specificity for clinically. Although different guidelines are currently available, the diagnosis of itp still represents. Heparin, a blood thinner, is the most common cause of drug induced immune thrombocytopenia. Bone marrow suppression or increased peripheral destruction of platelets could be involved. Thrombocytopenia definition thrombocytopenia is an abnormal drop in the number of blood cells involved in forming blood clots. Ditp should be suspected when a patient, child or adult, has sudden, severe thrombocytopenia.
Heparininduced thrombocytopenia in patients treated with low molecularweight heparin or unfractionated heparin. First, it can be difficult to definitively prove that a decrease in platelet count is drugrelated, especially in the absence of sufficiently frequent platelet counts to allow for a clearly defined temporal relationship between drug administration and thrombocytopenia. However, highdose glucocorticosteroid and ivig are often administered because of the high risk of bleeding associated with severe thrombocytopenia. However, in contrast to the agents identified in this study, heparin usually does not induce severe thrombocytopenia, and the main clinical effect of heparininduced thrombocytopenia is thrombosis rather than bleeding. Typically patients present with a low platelet count with signs and symptoms ranging from bruising to bleeding. Druginduced thrombocytopenia moderate to severe can range from asymptomatic to evidence of clinical bleeding detailed history of recent prescription medications, nutritional supplements, and. First, nondrug causes of thrombocytopenia must be ruled out.
There are very few reported cases of thrombocytopenia due to isoniazid inh. Multimedia encyclopedia druginduced thrombocytopenia. Although it occurs more often than druginduced anemia it is less well understood because techniques for studying drugplateletimmune interactions have been unavailable until recently. 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. Below is a list of common medications used to treat or reduce the symptoms of acquired thrombocytopenia. Two deaths were attributable to thrombocytopenic bleeding fatal bleeding rate, 0.
Major bleeding occurred in 23 of 247 9% ci, 6% to 14% patients with level i or ii evidence of drug induced thrombocytopenia. 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 microliter of blood. Description thrombocytopenia is a blood disease characterized by an abnormally low number of platelets in the bloodstream. Bone marrow suppression or increased peripheral destruction of. Reduced platelet content in the blood is not always a serious problem.
Thrombocytopenia is any disorder in which there are not enough platelets. It is common, yet underrecognized, difficult to diagnose and associated with severe bleeding complications. Platelets on the web university of oklahoma health. Heparininduced thrombocytopenia 0 drugs learn more about thrombocytopenia drug induced. Drug induced thrombocytopenia moderate to severe can range from asymptomatic to evidence of clinical bleeding detailed history of recent prescription medications, nutritional supplements, and. The mechanisms by which drugs cause thrombocytopenia are varied. Most cases of druginduced thrombocytopenia ditp are caused by. 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. Combining clinical and laboratory criteria to identify implicated drugs. Druginduced thrombocytopenia dit is a condition in which a drug or medication causes a decrease in the number of platelets in blood. This disorder is indistinguishable from itp except for the history of drug ingestion. Ditp is even more strongly suspected when a patient has repeated episodes of sudden, severe thrombocytopenia. Thrombocytopenia is a condition characterized by abnormally low levels of thrombocytes, also known as platelets, in the blood. The drug most frequently implicated in ditp is heparin.
Provan described how allergic reactions to some medicines can. Drug induced thrombocytopenia occurs when certain drugs or medications destroy platelets or interfere with the bodys ability to make enough of them. Heparin induced thrombocytopenia hit treatment page 1 of 7. I p the itp support association platelet reprint series. Platelets are cells that help the blood clot or stop bleeding. Pdf heparininduced thrombocytopenia hit is a major health problem. Combining these data, 451 35% reports described definite or probable evidence for a causal relation of the suspected drug to thrombocytopenia. Druginduced thrombocytopenia ditp, which also includes thrombocytopenia induced by beverages, foods, and herbal remedies, is an important clinical problem for hematologists. The list of drugs implicated in drug induced thrombocytopenia.
Drug induced thrombocytopenia is a frequent condition. Combining heparin with aspirin reduces the risk of thrombosis by 75%2. Immune thrombocytopenia may also be called idiopathic thrombocytopenia or itp. Both were reported in a letter to the editor describing quinine induced thrombocytopenia. Drugs causing thrombocytopenia or low platelet count. A low platelet count is a blood disorder that has a long list of possible causes. Thrombotic microangiopathy thrombocytopenia associated with mechanical hemolytic anemia should suggest thrombotic microangiopathy, even in the absence of organ failure strong agreement. Ditp refers to acute, immunemediated thrombocytopenia. When medicines or drugs are the causes of a low platelet count, it is called druginduced thrombocytopenia. Although the incidence is low, more than 100 drugs have been implicated in thrombocyto. Platelet counts are affected by apoptosis programmed cell death. Pdf ranitidineinduced thrombocytopenia in a neonate a case.
Vincents east family medicine introduction a 66yearold caucasian male admitted to the emergency room for a platelet count of 0. Drug induced thrombocytopenia is a serious condition that should be considered part of the differential diagnosis in a patient with thrombocytopenia who is receiving medication. Thrombocytopenia differential diagnosis falsely low platelet count in vitro platelet clumping caused by edtadependent agglutinins giant platelets common causes of thrombocytopenia pregnancy gestational thrombocytopenia, preeclampsia druginduced thrombocytopenia i. Druginduced thrombocytopenia presents several diagnostic and management challenges. Platelets are cells in the blood that help the blood clot. Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. Results of a prospective phase 2 study combining imatinib mesylate and cytarabine for the. Drug induced thrombocytopenia presents several diagnostic and management challenges. Compare current acquired thrombocytopenia drugs and. Trivalent inactivated influenza vaccination was reported to precede the sudden occurrence of severe thrombocytopenia by 6. Overview of thrombocytopenia blood disorders merck. Guidelines for managing thrombocytopenia in the icu.
This algorithm has been developed for md anderson using a multidisciplinary approach considering circumstances particular to md andersons specific patient population, services and structure, and clinical information. A fourdrug regimen inh, rif, ethambutol emb, and pyrazinamide. Drugs can cause thrombocytopenia by several mechanisms including direct bone marrow or other organ toxicity. An 18yearold female patient was diagnosed with smearpositive pulmonary tuberculosis. Drug induced thrombocytopenia was first described in the 19th century, yet our understanding of its pathogenesis continues to evolve.
Drugassociated thrombocytopenia american society of hematology. Thrombocytopenia can have several causes, including the use of certain drugs. Thrombotic thrombocytopenic purpura hemolytic uremic syndrome. Drugassociated thrombocytopenia hematology american.
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