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Review
. 2020 Jul 13;9(7):2212.
doi: 10.3390/jcm9072212.

Pathophysiology and Diagnosis of Drug-Induced Immune Thrombocytopenia

Caroline Vayne  1   2 , Eve-Anne Guéry  2 , Jérôme Rollin  1   2 , Tatiana Baglo  2   3 , Rachel Petermann  4   5 , Yves Gruel  1   2
Affiliations
Review

Pathophysiology and Diagnosis of Drug-Induced Immune Thrombocytopenia

Caroline Vayne et al. J Clin Med. .

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.

Keywords: drugs; heparin-induced thrombocytopenia; platelets; thrombocytopenia.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Schematic representation of the binding of a “quinine-type” drug-dependent antibody to a platelet glycoprotein. CDR, complementary-determining region; DDab, drug-dependent antibody.
Figure 2
Figure 2
Practical approach for the diagnosis of DITP, adapted from Arnold et al. 2013 [5]. DITP: drug-induced immune thrombocytopenia; Iv Ig: Intravenous immunoglobulins.
Figure 3
Figure 3
Example of flow cytometry analysis applied for the diagnosis of DITP due to vancomycin. Results obtained are shown in the lower panel. The procedure used was adapted from Curtis et al. [43]. Abbreviations: DITP: drug-induced immune thrombocytopenia; WP: washed platelets.
See this image and copyright information in PMC

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