Predisposing factors the use of certain drugs and medication is the greatest risk factor for developing druginduced thrombocytopenia. Hence, the clinical evidence that drug induced apoptosis might be. Itp guidelines were published in 1996 by the american society of. Many drugs have been associated with the development of thrombocytopenia. Drug induced thrombocytopenia definition thrombocytopenia is any disorder in which there are not enough platelets. Thrombocytopenia or low platelet count is a lower than normal number of platelets less than 150,000 platelets per microliter in the blood thrombocytopenia may be inherited or acquired when conditions occur, such as the use of certain drugs. Drug induced thrombocytopenia moderate to severe can range from asymptomatic to evidence of clinical bleeding detailed history of recent prescription medications, nutritional supplements, and.
Database from drug dependent plateletreactive antibody testing at the bloodcenter of wisconsin, 19952018. Druginduced thrombocytopenia presents several diagnostic and management challenges. Unexplained thrombocytopenia is a common clinical problem, and the possibility of druginduced thrombocytopenia must be considered, especially in hospitalized patients. Heparininduced thrombocytopenia in patients treated with low molecularweight heparin or unfractionated heparin. Bone marrow suppression or increased peripheral destruction of platelets could be involved. Jul 01, 2007 posttransfusion purpura is a rare selflimiting thrombocytopenia occurring five to 10 days post transfusion of blood products in patients lacking a specific platelet antigen, usually hpa1a. The clinical presentation depends on the severity of thrombocytopenia, ranging from mild ecchymoses and petechiae to lifethreatening central nervous system or gastrointestinal bleeding. Drug induced hematology lecturer nin prapongsena huachiew chalermprakiet university 2. Immune thrombocytopenia itp in children follows acute viral infection by days to weeks. Although in most cases, druginduced thrombocytopenia is. 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. 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.
Acute immunemediated thrombocytopenia is a potentially serious adverse reaction to many drugs. Identifying drugs that cause acute thrombocytopenia. Unexplained thrombocytopenia is a common clinical problem, and the possibility of drug induced thrombocytopenia must be considered, especially in hospitalized patients. Although the incidence is low, more than 100 drugs have been implicated in thrombocyto. The list of drugs implicated in druginduced thrombocytopenia is extensive and growing.
Although not common, more than 100 drugs as well as some herbal remedies and certain foods have been shown to trigger thrombocytopenia. Thrombocytopenia definition thrombocytopenia is an abnormal drop in the number of blood cells involved in forming blood clots. Druginduced thrombocytopenia should be suspected in any patient with acute thrombocytopenia of unknown cause. Many hospitalized patients receive heparin to prevent clotting. When antibodies form against heparin, they can also bind to a protein on platelets causing them to become very sticky. Heparin, a blood thinner, is the most common cause of drug induced immune thrombocytopenia. The authors files were searched to identify additional articles. This is a pdf file of an unedited manuscript that has been accepted for publication. In some cases, the thrombocytopenia is also immunemediated. Many of the cytotoxic drugs used for cancer chemotherapy and other. Some of the more common types of substanceinduced thrombocytopenia include. Druginduced thrombocytopenia occurs when certain drugs or medications destroy platelets or interfere with the bodys ability to make enough of them. Drug induced thrombocytopenia ditp is an exclusion diagnosis, which is obtained by ruling out other underlying causes that resulted in thrombocytopenia. Thrombotic thrombocytopenic purpura hemolytic uremic.
The etiology of drug induced immune thrombocytopenia is complex, at least six distinct pathologic mechanisms having been identified table 1. Isolated thrombocytopenia 30,000 to 50,000mm3 without signs of bleeding in adults. Thrombocytopenia is a serious side effect of such treatment and occurs mostly due to rifampicin rif. Drug induced thrombocytopenia occurs when certain medicines destroy platelets or interfere with the bodys ability to make enough of them. Heparininduced thrombocytopenia hit is an adverse reaction to the drug heparin resulting in an abnormally low amount of platelets thrombocytopenia. The mechanisms by which drugs cause thrombocytopenia are varied. Approach to the diagnosis and management of druginduced. Immune thrombocytopenia may happen when your immune system attacks and destroys your platelets. Drug induced thrombocytopenia is a rare immunemediated reaction in which platelet destruction is induced by several mechanisms, most important being bone marrow suppression and or antibody formation. Drug induced thrombocytopenia presents several diagnostic and management challenges. Other types of druginduced thrombocytopenia are discussed separately. Hit is usually an immune response which typically occurs 410 days after exposure to heparin. 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.
An 18yearold female patient was diagnosed with smearpositive pulmonary tuberculosis. Druginduced thrombocytopenia drug induced thrombocytopenia. Druginduced thrombocytopenia is a common adverse effect reported in the literature. Major bleeding occurred in 23 of 247 9% ci, 6% to 14% patients with level i or ii evidence of drug induced thrombocytopenia. Some of the more common types of substance induced thrombocytopenia include. Thrombocytopenia with infection is usually caused by bone marrow suppression. Druginduced thrombocytopenia occurs when certain medicines destroy platelets or interfere with the bodys ability to make enough of them. Table 3 mechanisms of drug induced thrombocytopenia.
It is common, yet underrecognized, difficult to diagnose and associated with severe bleeding complications. Recent international travel especially tropical rickettsia l disease. If a medicine causes your body to produce antibodies, which seek and destroy your platelets, the condition is called druginduced. Thrombocytopenia can have several causes, including the use of certain drugs. Drugs can cause thrombocytopenia by several mechanisms including direct bone marrow or other organ toxicity.
Platelets are cells that help the blood clot or stop bleeding. Ditp should be suspected when a patient, child or adult, has sudden, severe thrombocytopenia. The mechanism behind druginduced thrombocytopenia is either a decrease in platelet production bone marrow toxicity. Posttransfusion purpura is a rare selflimiting thrombocytopenia occurring five to 10 days post transfusion of blood products in patients lacking a specific platelet antigen, usually hpa1a. The mechanism behind drug induced thrombocytopenia is either a decrease in platelet production bone marrow toxicity. Thrombocytopenia drug induced multimedia encyclopedia. To document drugs and also beverages, foods and food supplements that have definite clinical evidence for causing immune. Severity of thrombocytopenia can be subdivided into 3 main groups, platelet count between 100,000 to 150,000microl are defined as mild thrombocytopenia, platelet count between 50,000 to 99,000micro as moderate thrombocytopenia and thrombocytopenia. There are very few reported cases of thrombocytopenia due to isoniazid inh. Drug induced immune thrombocytopenia medication list about thrombocytopenia drug induced. However, a large drop in platelets 20k 50k that is not as immediate 47 days after may indicate heparin induced thrombocytopenia hit which is not normal.
Heparin induced thrombocytopenia hit is technically the most common cause of drug associated thrombocytopenia, but the drop in platelet levels in patients with hit is rarely sufficient to provoke bleeding and thrombosis is the major. 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. If a medicine causes your body to produce antibodies, which seek and destroy your platelets, the condition is called druginduced immune thrombocytopenia. Drugimmune thrombocytopenia with thrombosis versus heparin. Drug induced thrombocytopenia can affect any individual irrespective of age, gender, race or ethnic group status. If a medicine causes your body to produce antibodies, which seek and destroy your platelets, the condition is called drug induced immune thrombocytopenia. Although different guidelines are currently available, the diagnosis of itp still. When platelet levels are low, bleeding may occur anywhere in your body. 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. Heparininduced thrombocytopenia hit is a type of druginduced immune thrombocytopenia ditp. As a service to our customers we are providing this early version of the manuscript. What are the risk factors for drug induced thrombocytopenia. Heparininduced thrombocytopenia genetic and rare diseases.
It is not uncommon for patients with ditp to be initially diagnosed as having autoimmune thrombocytopenic purpura. Feb 03, 2020 immune thrombocytopenia may happen when your immune system attacks and destroys your platelets. Thrombocytopenia as an adverse effect of complementary and. Both were reported in a letter to the editor describing quinine induced thrombocytopenia. Druginduced thrombocytopenia ditp, which also includes thrombocytopenia induced by beverages, foods, and herbal remedies, is an important clinical problem for hematologists. Druginduced thrombocytopenia dit is a relatively common clinical disorder. 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. Ditp refers to acute, immunemediated thrombocytopenia. Druginduced thrombocytopenia definition of druginduced. Druginduced thrombocytopenia is a rare immunemediated reaction in which platelet destruction is induced by several mechanisms, most important being bone marrow suppression and or antibody formation. May 03, 2012 heparin induced thrombocytopenia hit is an adverse reaction to the drug heparin resulting in an abnormally low amount of platelets thrombocytopenia. Linezolid induced thrombocytopenia thrombocytopenia is a notable adverse effect of linezolid. Heparininduced thrombocytopenia 0 drugs learn more about thrombocytopenia drug induced.
Thrombocytopenia is a condition characterized by abnormally low levels of thrombocytes, also known as platelets, in the blood. When medicines or drugs are the causes of a low platelet count, it is called drug induced thrombocytopenia. Vincents east family medicine introduction a 66yearold caucasian male admitted to the emergency room for a platelet count of 0. Immune thrombocytopenia may also be called idiopathic thrombocytopenia or itp. 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. Druginduced thrombocytopenia can affect any individual irrespective of age, gender, race or ethnic group status. Heparin, a blood thinner, is the most common cause of druginduced immune thrombocytopenia. Generally, platelet count falls rapidly within 23 days of taking a drug which has. 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. There are two types of druginduced thrombocytopenia. Journal of chemical and pharmaceutical research, 2016, 82. Some of the evidence behind the onset, duration, and the extent of platelet decrease will briefly be described here and summarized in bullets at the bottom of the discussion.
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. Drugassociated thrombocytopenia hematology american society. Drug induced thrombocytopenia dit is a relatively common clinical disorder. Although drugs are a common cause of acute immunemediated thrombocytopenia in adults, the drug etiology is often initially unrecognized. Drug induced thrombocytopenia should be suspected in any patient with acute thrombocytopenia of unknown cause. Platelets are cells in the blood that help the blood clot.
Ditp typically appears suddenly, is often severe, and can cause major bleeding and death. Thrombotic thrombocytopenic purpura hemolytic uremic syndrome. 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. Abha soni, jose rodriguez barrantes, md, shawn morehead md st. Diminished production caused by viral infections, vitamin deficiencies, aplastic anemia.
Thrombocytopenia or low platelet count is a lower than normal number of platelets less than 150,000 platelets per microliter in the blood thrombocytopenia may be inherited or acquired when conditions occur, such as the use of certain drugs causes of thrombocytopenia can be classified in three groups. Predisposing factors the use of certain drugs and medication is the greatest risk factor for developing drug induced thrombocytopenia. Drug induced thrombocytopenia occurs when certain drugs or medications destroy platelets or interfere with the bodys ability to make enough of them. Drug induced 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 normal amount of platelets is usually between 150,000 and 450,000. Typically patients present with a low platelet count with signs and symptoms ranging from bruising to bleeding. Description thrombocytopenia is a blood disease characterized by an abnormally low number of platelets in the bloodstream. Two deaths were attributable to thrombocytopenic bleeding fatal bleeding rate, 0. Ditp is even more strongly suspected when a patient has repeated episodes of sudden, severe thrombocytopenia. Cytomegalovirus cmv epstein barr virus ebv, mononucleosis varicella zoster virus vzv, chicken pox rocky mountain spotted fever. What are the risk factors for druginduced thrombocytopenia. Drugassociated thrombocytopenia hematology american.
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