Quinine-Induced Thrombocytopenia in a Patient With Myocardial Infarction

Abstract

Quinine-induced thrombocytopenia is a relatively rare phenomenon likely mediated by both quinine-induced production of anti-platelet antibodies as well as the production of antibodies leading to apoptosis of megakaryocytes. We report the case of a gentleman who presented with evidence of acute inferior myocardial infarction in the setting of quinine-induced thrombocytopenia. We discuss the history and pathogenesis of quinine-induced thrombocytopenia as well as the relationship between platelet count and risk and outcome of myocardial infarction. The patient successfully underwent percutaneous coronary intervention and the placement of a bare metal stent, chosen in preference to a drug-eluting stent due to the wish to minimize the duration of dual anti-platelet therapy in the setting of thrombocytopenia. His platelets increased significantly with no intervention other than holding tonic water, and he suffered no bleeding complications related to catheterization. We conclude that cardiac catheterization can be successfully performed in the setting of quinine-induced thrombocytopenia and believe that this is one of the first reported cases of quinine-induced thrombocytopenia in the setting of myocardial infarction. J Hematol. 2015;4(1):137-140 doi: http://dx.doi.org/10.14740/jh92w