TY - JOUR
T1 - Recognition and management of drug-induced cytopenias
T2 - The example of idiosyncratic drug-induced thrombocytopenia
AU - Andres, Emmanuel
AU - Dali-Youcef, Nassim
AU - Serraj, Khalid
AU - Zimmer, Jacques
PY - 2009/3
Y1 - 2009/3
N2 - Background: Several hundred drugs, toxins and herbs have been reported to cause blood abnormalities, and drugs account for 20 - 40% of all instances of cytopenias. Objective: In the present paper, we report and discuss the recognition and management of moderate to severe idiosyncratic drug-induced thrombocytopenia. Methods: A bibliographic search was performed on the PubMed database of the US National Library of Medicine for articles published from January 1990 to November 2008. Results/conclusions: Moderate to severe idiosyncratic drug-induced thrombocytopenia (platelet count < 100 × 109/l) is a relatively rare and potentially serious disorder. The origin may be myelosuppression or peripheral, owing to either the consumption of platelets or their immune-mediated destruction. The most common molecules responsible are heparins, quinidine, sulfonamides and gold salts. Clinically, the most classical symptom is a typical pattern of bleeding of variable intensity depending on the severity of thrombocytopenia and the molecule involved. Immune-mediated thrombocytopenia induced by heparin (type II) is more often associated with thrombotic events. The diagnosis is based on medical history and a set of clinical criteria, which also specify the level of imputability. Although the role of serological tests is not well established, they seem particularly valuable in some situations in which differential diagnosis is difficult or in type II heparin-induced thrombocytopenia. The treatment includes discontinuation of the suspected drug, and symptomatic measures that depend on the severity of clinical symptoms.
AB - Background: Several hundred drugs, toxins and herbs have been reported to cause blood abnormalities, and drugs account for 20 - 40% of all instances of cytopenias. Objective: In the present paper, we report and discuss the recognition and management of moderate to severe idiosyncratic drug-induced thrombocytopenia. Methods: A bibliographic search was performed on the PubMed database of the US National Library of Medicine for articles published from January 1990 to November 2008. Results/conclusions: Moderate to severe idiosyncratic drug-induced thrombocytopenia (platelet count < 100 × 109/l) is a relatively rare and potentially serious disorder. The origin may be myelosuppression or peripheral, owing to either the consumption of platelets or their immune-mediated destruction. The most common molecules responsible are heparins, quinidine, sulfonamides and gold salts. Clinically, the most classical symptom is a typical pattern of bleeding of variable intensity depending on the severity of thrombocytopenia and the molecule involved. Immune-mediated thrombocytopenia induced by heparin (type II) is more often associated with thrombotic events. The diagnosis is based on medical history and a set of clinical criteria, which also specify the level of imputability. Although the role of serological tests is not well established, they seem particularly valuable in some situations in which differential diagnosis is difficult or in type II heparin-induced thrombocytopenia. The treatment includes discontinuation of the suspected drug, and symptomatic measures that depend on the severity of clinical symptoms.
KW - Cytopenia
KW - Drug-induced thrombocytopenia
KW - Drugs
KW - Thrombocytopenia
UR - http://www.scopus.com/inward/record.url?scp=66949167813&partnerID=8YFLogxK
U2 - 10.1517/14740330902784162
DO - 10.1517/14740330902784162
M3 - Review article
C2 - 19309246
AN - SCOPUS:66949167813
SN - 1474-0338
VL - 8
SP - 183
EP - 190
JO - Expert Opinion on Drug Safety
JF - Expert Opinion on Drug Safety
IS - 2
ER -