Ranitidine-induced Thrombocytopenia in a Neonate – A Case Report and Review of Literature

Hoste, Levi; George, Isabel

doi:10.5863/1551-6776-24.1.66

Cited by 6 publications

(6 citation statements)

References 50 publications

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“…This dearth of information on the association of ranitidine and thrombocytopenia in children supports the statement that druginduced thrombocytopenia caused by H2-antagonists is a rare phenomenon [33]. Except for the mentioned case above, no other case on drug-induced thrombocytopenia from ranitidine administration in children has been reported.…”

Section: Resultssupporting

confidence: 73%

“…Despite extensive literature search, the authors could not find an article on the incidence of thrombocytopenia specifically associated with ranitidine administration in children. There was however a case report of ranitidine-induced thrombocytopenia in a small-for-gestational-age late preterm neonate who showed thrombocytopenia on day 5 of life which was minimally responsive to platelet transfusion, but which recovered completely 5 days after discontinuation of ranitidine [33].…”

Section: Resultsmentioning

confidence: 99%

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The Prevalence of Ranitidine-Associated Thrombocytopenia in Children Admitted in Gov. Celestino Gallares Memorial Hospital

Oncog¹,

Fernandez²

2019

Chinese J Med Res

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Objective: To determine the prevalence of ranitidine-associated thrombocytopenia in children admitted to Gov. Celestino Gallares Memorial Hospital. Methodology: This is a prospective cohort descriptive study that utilized total population sampling. This study included all patients aged 1 month to 14 years admitted to the pediatrics ward of Gov. Celestino Gallares Memorial Hospital who were given ranitidine for any gastrointestinal indication. Excluded from the study were patients with conditions that pose the risk of thrombocytopenia by themselves, patients with conditions that can possibly increase the platelet count, patients who had no repeat CBC on the third day of hospitalization, patients given less than 9 doses of ranitidine, and patients who were discharged before the third day of hospitalization. The research protocol was approved by the hospital institutional review board, and a waiver of consent was duly filled up. The researcher noted down the hospital number, age and sex of the patient, platelet count on admission, number of ranitidine doses given, and the repeat platelet count on the third day of hospitalization. All data were tabulated. Mean frequencies and percentages were calculated to describe the demographic features and degree of thrombocytopenia of patients prescribed ranitidine. Pearson's correlation and chi-square test for association were used to measure the association between thrombocytopenia and demographic features of patients who were given ranitidine. Significance was set a p-value of <0.05. All data analyses were generated using Statistical Package for Social Science (SPSS) version 20.0. Results: There was a total of 59 patients who completed 9 doses of ranitidine. Two of the 59 patients who were given ranitidine had thrombocytopenia, comprising 3.39% of the cases. Majority of the patients were 1 to 4.9 years of age, with an average age of 2 years. One of the two patients who had thrombocytopenia was 4 years old, and the other child was 10 years old. Both children who had thrombocytopenia were males. Majority of the patients who were given ranitidine for 9 doses did not manifest thrombocytopenia. One had mild thrombocytopenia with a platelet count of 102,000/uL, and the other patient had moderate thrombocytopenia with a platelet count of 90,000/uL. Correlation studies between the demographic features and thrombocytopenia in patients who were given ranitidine revealed that there is no significant association between age and gender and thrombocytopenia, with p values of 0.534 and 0.418 respectively. Conclusion: Ranitidine-associated thrombocytopenia is a rare condition that occurs in non-critical patients regardless of age and gender. Clinicians should be aware of this risk inasmuch as ranitidine is a commonly-used medication in pediatric population. To date, there is still no published data on the association of ranitidine and thrombocytopenia in children. This study attempted to answer this gap in knowledge.

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Section: Resultssupporting

confidence: 73%

Section: Resultsmentioning

confidence: 99%

The Prevalence of Ranitidine-Associated Thrombocytopenia in Children Admitted in Gov. Celestino Gallares Memorial Hospital

Oncog¹,

Fernandez²

2019

Chinese J Med Res

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“…While ranitidine has been associated with neutropenia in some clinical reports 11 , 12 , it did not induce neutropenia in healthy individuals over a six week time course (Table 1 ) even when used at a relatively high clinical dose. Ranitidine has also been associated clinically with thrombocytopenia 40 , 41 but we did not observe such impact (Table 1 ). A sixfold increase in plasma G-CSF levels was observed after cessation of ranitidine treatment (Table 2 ).…”

Section: Discussioncontrasting

confidence: 61%

Histamine receptor 2 blockade selectively impacts B and T cells in healthy subjects

Meghnem

Oldford

Haidl

et al. 2021

Sci Rep

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Histamine receptor 2 (H2R) blockade is commonly used in patients with gastric, duodenal ulcers or gastroesophageal reflux disease. Beyond the gastrointestinal tract, H2R is expressed by multiple immune cells, yet little is known about the immunomodulatory effects of such treatment. Clinical reports have associated H2R blockade with leukopenia, neutropenia, and myelosuppression, and has been shown to provide clinical benefit in certain cancer settings. To systematically assess effects of H2R blockade on key immune parameters, a single-center, single-arm clinical study was conducted in 29 healthy subjects. Subjects received daily high dose ranitidine for 6 weeks. Peripheral blood immunophenotyping and mediator analysis were performed at baseline, 3 and 6 weeks into treatment, and 12 weeks after treatment cessation. Ranitidine was well-tolerated, and no drug related adverse events were observed. Ranitidine had no effect on number of neutrophils, basophils or eosinophils. However, ranitidine decreased numbers of B cells and IL-2Rα (CD25) expressing T cells that remained lower even after treatment cessation. Reduced serum levels of IL-2 were also observed and remained low after treatment. These observations highlight a previously unrecognised immunomodulatory sustained impact of H2R blockade. Therefore, the immune impacts of H2R blockade may require greater consideration in the context of vaccination and immunotherapy.

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“…Furthermore, H 2 RAs also strongly inhibit platelet aggregation in vitro [39,40] and ranitidine, in combination with hydrocortisone, has been shown to reduce complications after arterial thrombolysis in pediatric patients who developed arterial obstruction after cardiac catheterization [41]. These agents may therefore exert stabilizing effects on coagulation in patients with disturbed clotting function, the caveat being the potential for thrombocytopenia and/or hemolytic anemia [42][43][44][45][46].…”

Section: Cardiovascular Protective Effectsmentioning

confidence: 99%

No Time to Waste: Real-World Repurposing of Generic Drugs as a Multifaceted Strategy Against COVID-19

Rogosnitzky¹,

Berkowitz²,

Jadad³

2020

JMIRx Med

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Real-world drug repurposing—the immediate “off-label” prescribing of drugs to address urgent clinical needs—is an indispensable strategy gaining rapid traction in the current COVID-19 crisis. Although off-label prescribing (ie, for a nonapproved indication) is legal in most countries, it tends to shift the burden of liability and cost to physicians and patients, respectively. Nevertheless, in urgent public health crises, it is often the only realistic source of a meaningful potential solution. To be considered for real-world repurposing, drug candidates should ideally have a track record of safety, affordability, and wide accessibility. Although thousands of such drugs are already available, the absence of a central repository of off-label uses presents a barrier to the immediate identification and selection of the safest, potentially useful interventions. Using the current COVID-19 pandemic as an example, we provide a glimpse at the extensive literature that supports the rationale behind six generic drugs, in four classes, all of which are affordable, supported by decades of safety data, and pleiotropically target the underlying pathophysiology that makes COVID-19 so dangerous. Having previously fast-tracked this paper to publication in summary form, we now expand on why cimetidine/famotidine (histamine type-2 receptor antagonists), dipyridamole (antiplatelet agent), fenofibrate/bezafibrate (cholesterol/triglyceride-lowering agents), and sildenafil (phosphodiesterase-5 inhibitor) are worth considering for patients with COVID-19 based on their antiviral, anti-inflammatory, renoprotective, cardioprotective, and anticoagulation properties. These examples also reveal the unlimited opportunity to future-proof public health by proactively mining, synthesizing, and cataloging the off-label treatment opportunities of thousands of safe, well-established, and affordable generic drugs.

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Ranitidine-induced Thrombocytopenia in a Neonate – A Case Report and Review of Literature

Cited by 6 publications

References 50 publications

The Prevalence of Ranitidine-Associated Thrombocytopenia in Children Admitted in Gov. Celestino Gallares Memorial Hospital

The Prevalence of Ranitidine-Associated Thrombocytopenia in Children Admitted in Gov. Celestino Gallares Memorial Hospital

Histamine receptor 2 blockade selectively impacts B and T cells in healthy subjects

No Time to Waste: Real-World Repurposing of Generic Drugs as a Multifaceted Strategy Against COVID-19

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