Vancomycin-Induced Immune Thrombocytopenia

Drygalski, Annette von; Curtis, Brian R.; Bougie, Daniel W.; McFarland, Janice G.; Ahl, Scott; Limbu, Indra; Baker, Kelty R.; Aster, Richard H.

doi:10.1056/nejmoa065066

Cited by 188 publications

(172 citation statements)

References 26 publications

Supporting

Mentioning

165

Contrasting

Unclassified

Order By: Relevance

“…Drug-dependent platelet antibodies should be suspected in refractory patients with no evidence of alloimmunization or when they fail to respond to HLA-matched platelets, and the refractory responses are temporally related to drug therapy [21].…”

Section: Discussionmentioning

confidence: 99%

Detection and Identification of Platelet-Associated Alloantibodies by a Solid-Phase Modified Antigen Capture Elisa (MACE) Technique and Its Correlation to Platelet Refractoriness in Multi platelet Concentrate Transfused Patients

Sarkar

Philip

Jain

2014

Indian J Hematol Blood Transfus

View full text Add to dashboard Cite

Platelets express glycoproteins (IIb/IIIa, Ib/IX, Ia/IIa, IV, and HLA-1) that are polymorphic and can become targets for antibody responses. Patients at threat are those who received multiple platelet transfusions. Modified antigen capture elisa (MACE) is a qualitative solid phase Elisa designed to detect IgG antibodies against platelet specific antigens. The study has been carried out over a period of 2 years. A total of 100 patients were selected, who had been transfused with at least 15 units of platelet concentrate. All patients were having either hematological malignancies or bone marrow failure syndromes. Platelet antibodies were identified using MACE-1&2. Data was analysed statistically, using odds ratio (OR) with 95 % confidence interval. 39 % of the patients were found to be alloimmunized against platelet antigens, of which eleven showed refractoriness. Six patients (54.5 %) with HLA-1, two patients (9.5 %) with GPIb/IX, two patients (40 %) with both HLA-1 and GPIIb/IIIa, and one patient with GPIIb/IIIa antibodies showed refractoriness. Production of HLA-1 antibody and the development of refractoriness was found to be significant with OR 14.05 and P value 0.0025. MACE-1&2 enabled specific detection and identification of platelet antibodies, which in turn correlated well with the development of refractoriness in multi transfused patients. GPIb/IX was detected as the commonest antibody in our patient population, which is in variance with Europian studies where it is GPIa/IIIa (HPA1a/5b). This technique should be utilised in patients who are at an increased risk of developing alloimmunisation due to repeated platelet transfusions.

show abstract

Section: Discussionmentioning

confidence: 99%

Detection and Identification of Platelet-Associated Alloantibodies by a Solid-Phase Modified Antigen Capture Elisa (MACE) Technique and Its Correlation to Platelet Refractoriness in Multi platelet Concentrate Transfused Patients

Sarkar

Philip

Jain

2014

Indian J Hematol Blood Transfus

View full text Add to dashboard Cite

show abstract

“…The primary therapy is to stop the offending drug and transfuse platelets as dictated by the clinical situation. Other therapies that have been suggested include steroids, immune globulin, and intravenous anti-D antibodies [5,6].…”

Section: Discussionmentioning

confidence: 99%

Thrombocytopenia of Unusual Etiology in the Intensive Care Unit

Wetzel

2013

J Med Cases

View full text Add to dashboard Cite

Thrombocytopenia is a relatively common laboratory finding in the intensive care unit (ICU) that may be caused by a variety of triggers. Vancomycin may lead to the production of antibodies that could precipitate a severe drop in platelet count. The objective of the current report was to describe the development of severe thrombocytopenia during the infectious work-up of a critical care patient, where an association between vancomycin and thrombocytopenia was unexpectedly identified. The current report describes the case of a 64-year-old female who presented with dyspnea on exertion and resting hypoxia to an outside facility and was initially treated for a chronic obstructive pulmonary disease exacerbation. She was then transferred to Mayo Clinic for further care. After 72 h, she acutely decompensated requiring increasing oxygen support with a questionable infiltrate on chest imaging and was transferred to the ICU. She was placed on non-invasive ventilation with poor gas exchange and ultimately required intubation. Antibiotics were expanded to include vancomycin. Within 72 h of antibiotic initiation, her platelet count decreased from 379 × 10 9 /L to 7 × 10 9 /L. After a negative heparin-induced thrombocytopenia panel and serotonin assay, the antibiotics were discontinued and her platelet count subsequently increased. Despite the fact that heparin is a common culprit of drug-induced thrombocytopenia, the patient had no evidence of this association. She received three doses of vancomycin prior to the recognition of the association between this medication and thrombocytopenia. Her platelet count only started to recover once vancomycin was discontinued. In conclusion, vancomycin is commonly administered in the critical care setting and may lead to the development of thrombocytopenia. Vancomycin-induced thrombocytopenia is caused by antibodies that may remain for years after last exposure. Appreciation of the association between vancomycin and thrombocytopenia may ultimately lead to improved patient outcomes.

show abstract

“…An immunological mechanism is postulated for many drugs, but so far there is clear evidence of drugdependent antiplatelet antibodies only for a few of them (rifampicin, abciximab, quinine, ranitidine, vancomycin, teicoplanin, sulfonamide, tamoxifene, heparin, and few others) [2,[6][7][8][9][10][11][12][13][14][15][16]. Drug binding to platelet surface can form a new epitope or cause the exposure of a neo-epitope.…”

Section: Discussionmentioning

confidence: 99%

Flow cytometry in the diagnosis of drug‐induced thrombocytopenia: Two illustrative cases

et al. 2007

View full text Add to dashboard Cite

Drug-induced thrombocytopenia is a challenging diagnosis in the clinical practice because of the many drugs or alternative causes that may be implicated. Exact identification of such drug(s) is required to guide future management and avoid re-exposure. We describe two cases of isolated thrombocytopenia in which cytometric analysis, a readily available technique, allowed the identification of the causative drug in the context of complex therapies (rifampicin and abciximab causing late onset thrombocytopenia). Am. J. Hematol. 83:326-329, 2008. V

show abstract

Vancomycin-Induced Immune Thrombocytopenia

Cited by 188 publications

References 26 publications

Detection and Identification of Platelet-Associated Alloantibodies by a Solid-Phase Modified Antigen Capture Elisa (MACE) Technique and Its Correlation to Platelet Refractoriness in Multi platelet Concentrate Transfused Patients

Detection and Identification of Platelet-Associated Alloantibodies by a Solid-Phase Modified Antigen Capture Elisa (MACE) Technique and Its Correlation to Platelet Refractoriness in Multi platelet Concentrate Transfused Patients

Thrombocytopenia of Unusual Etiology in the Intensive Care Unit

Flow cytometry in the diagnosis of drug‐induced thrombocytopenia: Two illustrative cases

Contact Info

Product

Resources

About