Thrombocytopenia - drug induced
Drug-induced thrombocytopenia; Immune thrombocytopenia - drug
Thrombocytopenia is any disorder in which there are not enough platelets. Platelets are cells in the blood that help the blood clot. A low platelet count makes bleeding more likely.
When medicines or drugs are the causes of a low platelet count, it is called drug-induced thrombocytopenia.
Blood clotting normally occurs when there is damage to a blood vessel. Platelets immediately begin to adhere to the cut edges of the vessel and release chemicals to attract even more platelets. A platelet plug is formed, and the external bleeding stops. Next, small molecules, called clotting factors, cause strands of blood-borne materials, called fibrin, to stick together and seal the inside of the wound. Eventually, the cut blood vessel heals and the blood clot dissolves after a few days.
Blood clots (fibrin clots) are the clumps that result when blood coagulates.
Causes
Drug-induced thrombocytopenia occurs when certain medicines destroy platelets or interfere with the body's ability to make enough of them.
There are two types of drug-induced thrombocytopenia: immune and nonimmune.
If a medicine causes your body to produce antibodies, which seek and destroy your platelets, the condition is called drug-induced immune thrombocytopenia. Heparin, a blood thinner, is the most common cause of drug-induced immune thrombocytopenia.
If a medicine prevents your bone marrow from making enough platelets, the condition is called drug-induced nonimmune thrombocytopenia. Chemotherapy drugs and a seizure medicine called valproic acid may lead to this problem.
Other medicines that cause drug-induced thrombocytopenia include:
- Furosemide
- Gold, used to treat arthritis
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Penicillin
- Quinidine
- Quinine
- Ranitidine
- Sulfonamides
- Linezolid and other antibiotics
- Statins
Symptoms
Decreased platelets may cause:
- Abnormal bleeding
- Bleeding when you brush your teeth
- Easy
bruising - Pinpoint red spots on the skin (
petechiae )
Treatment
The first step is to stop using the medicine that is causing the problem.
For people who have life-threatening bleeding, treatments may include:
- Immunoglobulin therapy (IVIG) given through a vein
- Plasma exchange (plasmapheresis)
- Platelet transfusions
- Corticosteroid medicine
Possible Complications
Bleeding can be life threatening if it occurs in the brain or other organs.
A pregnant woman who has antibodies to platelets may pass the antibodies to the baby in the womb.
When to Contact a Medical Professional
Call your healthcare provider if you have unexplained bleeding or bruising and are taking medicines, such as the ones mentioned above under Causes.
References
Abrams CS. Thrombocytopenia. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 163.
Warkentin TE. Thrombocytopenia caused by platelet destruction, hypersplenism, or hemodilution. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 132.
Version Info
Last reviewed on: 7/22/2021
Reviewed by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
