Abstract
Drug-induced immune thrombocytopenia (DITP) is a life-threatening clinical syndrome that is under-recognized and difficult to diagnose. Many drugs can cause immune-mediated thrombocytopenia, but the most commonly implicated are abciximab, carbamazepine, ceftriaxone, eptifibatide, heparin, ibuprofen, mirtazapine, oxaliplatin, penicillin, quinine, quinidine, rifampicin, suramin, tirofiban, trimethoprim-sulfamethoxazole, and vancomycin. Several different mechanisms have been identified in typical DITP, which is most commonly characterized by severe thrombocytopenia due to clearance and/or destruction of platelets sensitized by a drug-dependent antibody. Patients with typical DITP usually bleed when symptomatic, and biological confirmation of the diagnosis is often difficult because detection of drug-dependent antibodies (DDabs) in the patient’s serum or plasma is frequently not possible. This is in contrast to heparin-induced thrombocytopenia (HIT), which is a particular DITP caused in most cases by heparin-dependent antibodies specific for platelet factor 4, which can strongly activate platelets in vitro and in vivo, explaining why affected patients usually have thrombotic complications but do not bleed. In addition, laboratory tests are readily available to diagnose HIT, unlike the methods used to detect DDabs associated with other DITP that are mostly reserved for laboratories specialized in platelet immunology.
Highlights
Many drugs and components including herbal remedies, food, and nutritional supplements can cause thrombocytopenia by inhibiting platelet production and/or favoring their elimination or destruction from the peripheral blood [1]
The objective of this review is to present and summarize the different pathophysiological mechanisms and drugs involved in drug-induced immune thrombocytopenia (DITP), and some practical key points useful for their diagnosis are discussed
Thrombocytopenia may rarely be associated with paradoxical thrombotic events [59,60,61], which may be related to the ability of some antibodies to activate platelets after cross-linking FcγRIIa receptors [61], in a way similar to the process involved in heparin-induced thrombocytopenia
Summary
Many drugs and components including herbal remedies, food, and nutritional supplements can cause thrombocytopenia by inhibiting platelet production and/or favoring their elimination or destruction from the peripheral blood [1]. Peripheral drug-induced thrombocytopenia, characterized by increased clearance of platelets by mononuclear phagocytes, is most often mediated via an immunological mechanism implicating drug-dependent antibodies, which may induce direct platelet destruction [2,3,4,5]. This latter entity called drug-induced immune thrombocytopenia (DITP) is not exceptional, but often is a real diagnostic challenge. The objective of this review is to present and summarize the different pathophysiological mechanisms and drugs involved in DITP, and some practical key points useful for their diagnosis are discussed
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