Adalimumab‐induced platelet antibodies resulting in severe thrombocytopenia

Abstract

Anti-tumour necrosis factor-α (TNFα) agents are effective in diseases including Crohn's disease but may cause cytopenias. The mechanisms involved in anti-TNFα agent-induced thrombocytopenia are scarce. We report a 73-year-old male with Crohn's disease for which he currently used adalimumab, an anti-TNFα agent. He had received mesalazine and infliximab before the treatment of adalimumab. No comorbidities were present. Routine laboratory tests revealed a deep thrombocytopenia (thrombocytes 24 × 10 9 /L), after which adalimumab was discontinued. Bleeding symptoms included cutaneous haematomas and mild epistaxis. Direct monoclonal antibody-specific immobilization of platelet antigens revealed autoantibodies specific to glycoprotein IIb/IIIa and glycoprotein V platelet receptors. There was no bone marrow suppression. Other causes of the thrombocytopenia were ruled out. The platelet count normalized after adalimumab discontinuation. No further interventions were required. Monitoring thrombocyte levels after initiating anti-TNFα agents is recommended, which could lead to prevention of this potentially fatal phenomenon.

Crohn’s disease with acute gastrointestinal bleeding caused by perianal fistula: a case description

“…This case involved a rare etiology of acute GIB in CD. Initially, infliximab-related thrombocytopenia was once considered as the cause of GIB in this case due to the report of a similar case ( 2 ). However, age discrepancy, normal value of platelet count, and follow-up data did not support this possibility.…”

“…The source of bleeding is more commonly a blood vessel being eroded by a deep ulcer. A case was reported in which the side effect of medicine might have resulted in thrombocytopenia, which is a risk factor for GIB ( 2 ). However, few cases have been reported on GIB caused by perianal fistula in CD.…”

Hematologic side effects of biologics and kinase inhibitors used in rheumatologic diseases: a review of the current evidence

“…Autoantibodies specific to glycoprotein IIb/IIIa and glycoprotein V platelet receptors were positive. Platelet counts showed improvement in 6 days of adalimumab discontinuation and normalized by 4 weeks [ 17 ]. Casanova et al proposed that TNF alpha inhibitors could lead to apoptosis of Th1 lymphocytes causing an excess of Th2, which in turn may provoke antiplatelet antibody production and thus platelet destruction and thrombocytopenia [ 16 ].…”