Thrombocytopenia
From Ganfyd
ΕΤΥΜΟΛΟΓΙΑ
English(1920's). thrombocyte, Greek. thrombos - blood clot, kutos - vessel, penia - povertyWeb Resources for Thrombocytopenia
Relevant Clinical Literature
UK Guidance
Other Wikis
Medpedia on Thrombocytopenia (Less technical, good quality control)
Wikipedia on Thrombocytopenia (Less technical, ? quality control)
Relative deficiency of thrombocytes, the platelets.
If cause is unknown may be idopathic thrombocytopenic purpura (ITP) which is not quite the same as immune thrombocytopenic purpura - see below..
Consider a wide range of drugs[1][2][3][4] which induce thrombocytopenia by one of 3 mechanisms[5]:
- Antibody binds to the drug or drug-metabolite-glycoprotein complex - classic drug induced immune thrombocytopenia
- Usually severe -platelet counts <20,000/cc eg:
- Quinine - the commonest due to large use of quinine
- Vancomycin
- Many other drugs
- Acetazolamide - level 2 evidence (no re-challenge or individual case report)
- Allylisopropylacetylcarbamide - the first case report
- Aminogluthethimide
- Aminosalicylic acid
- Amiodarone
- Amrinone
- Amphotericin B
- Ampicillin - level 2 evidence (no re-challenge or individual case report)
- Atorvastatin
- Captopril - level 2 evidence (no re-challenge or individual case report)
- Cephalothin
- Cimetidine
- Chlordiazepoxide–clidinium bromide - level 2 evidence (no re-challenge or individual case report)
- Chlopropmazine
- Chlorothiazide
- Chlorpropamide - level 2 evidence (no re-challenge or individual case report)
- Clopidogrel - level 2 evidence (no re-challenge or individual case report)
- Co-trimoxazole
- Danazol
- Deferoxamine
- Diatrizoate meglumine (Urografin)
- Diatrizoate sodium
- Diazepam
- Diazoxide
- Diclofenac
- Diethylstilbestrol
- Diflurmethylornithine
- Digoxin
- Ethambutol
- Fluconazole - level 2 evidence (no re-challenge or individual case report)
- Glibenclamide - level 2 evidence (no re-challenge or individual case report)
- Gold
- Haloperidol
- Hydrochlorothiazide - level 2 evidence (no re-challenge or individual case report)
- Ibuprofen - level 2 evidence (no re-challenge or individual case report)
- Indinavir
- Interferon-alpha
- Iopanoic acid
- Isoniazid
- Levamisole
- Lithium
- Lotrafiban - level 2 evidence (no re-challenge or individual case report)
- Meclofenamate
- Mesalamine
- Methicillin
- Methyldopa
- Minoxidil
- Nalidixic acid
- Naphazoline
- Naproxen - level 2 evidence (no re-challenge or individual case report)
- Nitroglycerine
- Novobiocin
- Octreotide
- Oxprenolol
- Oxyphenbutazone - level 2 evidence (no re-challenge or individual case report)
- Oxytetracycline - level 2 evidence (no re-challenge or individual case report)
- Paracetamol
- Pentoxifylline
- Phenytoin - level 2 evidence (no re-challenge or individual case report)
- Piperacillin
- Procainamide - level 2 evidence (no re-challenge or individual case report)
- Quinidine
- Ranitidine - level 2 evidence (no re-challenge or individual case report)
- Rifampicin
- Rituximab
- Roxifiban - level 2 evidence (no re-challenge or individual case report)
- Salbutamol
- Simvastatin - level 2 evidence (no re-challenge or individual case report)
- Sulfamethoxypyridine - level 2 evidence (no re-challenge or individual case report)
- Sulfapyridine - level 2 evidence (no re-challenge or individual case report)
- Sulfasalazine
- Sulfisoxazole
- Sulindac - level 2 evidence (no re-challenge or individual case report)
- Tamoxifen
- Terbinafine - level 2 evidence (no re-challenge or individual case report)
- Thiothixene
- Ticlopidine - level 2 evidence (no re-challenge or individual case report)
- Tolmetin
- Less severe with carbimazole -platelet counts >60,000/cc
- As complex is with less abundant platelet-endothelial-cell adhesion molecule 1
- Usually severe -platelet counts <20,000/cc eg:
- GPIIb/IIIa antagonist binds to GPIIb/IIIa receptor, exposing a neoepitope somewhere else on the GPIIb/IIIa complex.
- Heparin-induced thrombocytopenia where IgG recognises PF4 bound to a heparin causing clustering of FcλIIa receptors leading to platelet activation.
- Unfractionated heparin the worse
References
- ↑ George JN, Raskob GE, Shah SR, Rizvi MA, Hamilton SA, Osborne S, Vondracek T. Drug-induced thrombocytopenia: a systematic review of published case reports. Ann Intern Med.1998;129(11):886-90
- ↑ Rizvi MA, Kojouri K, George JN. Drug-induced thrombocytopenia: an updated systematic review. Annals of internal medicine 2001;134:346.
- ↑ Hibbard AB, Medina PJ, Vesely SK. Reports of drug-induced thrombocytopenia. Annals of internal medicine 2003;138:239.
- ↑ Li X, Hunt L, Vesely SK. Drug-induced thrombocytopenia: an updated systematic review. Annals of internal medicine 2005;142:474-5.
- ↑ Warkentin TE. Drug-induced immune-mediated thrombocytopenia--from purpura to thrombosis. The New England journal of medicine 2007;356:891-3. (Direct link – subscription may be required.)
