Vancomycin Induced Thrombocytopenia from Impregnated Cement Beads

Ramdass Vede,Nader Kamyar,Fraimow Henry

doi:10.23937/2378-3656/1410339

Abstract

Vancomycin Induced Thrombocytopenia from Impregnated Cement Beads

Highlights

IntroductionVancomycin is a glycopeptide protein that is commonly used in the treatment of gram positive infections such as Methicillin-resistant Staphylococcus aureus bacteria (MRSA) [1]
We present a patient who developed persistent thrombocytopenia caused by vancomycin-impregnated cement beads
This patient had a hip replacement that was complicated by a septic hip joint and the elution of the vancomycin from the cement beads resulted in thrombocytopenia that was refractory to treatment and persisted for a longer duration than expected

Summary

Introduction

Vancomycin is a glycopeptide protein that is commonly used in the treatment of gram positive infections such as Methicillin-resistant Staphylococcus aureus bacteria (MRSA) [1]. In this report we present a case in which vancomycin-impregnated cement beads used in orthopedic surgery induced thrombocytopenia [3,4,5]. A patient initially presented to an outside hospital (OSH) concerning for a Septic Prosthetic Hip Joint. On initial presentation, both blood and hip aspirate cultures were obtained and patient was started on intravenous vancomycin and cefazolin. On arrival to our institution, patient was afebrile, platelet count 1,000/μL, vancomycin trough 17.9 μg/mL and imaging of the patient’s hip demonstrated the presence of the impregnated beads (Figure 1). The peripheral smear did not show schistocytes or platelet clumping, and coagulation studies were normal On infectious workup, both HIV and hepatitis panel studies were negative, and IgG positive Helicobacter pylori (H. pylori). Repeat imaging of patient’s hip revealed smaller quantity of beads (Figure 1), indicating that the beads were eluting, supported by a vancomycin trough of 0.17

Discussion

Conclusion