II. Causes: Thrombocytopenia

  1. Chemotherapeutic agents
    1. Alkylating Agents
    2. Antimetabolites
    3. Interferon
    4. Fludarabine
    5. Oxaliplatin
  2. Antibiotics
    1. Sulfonamides (e.g. Bactrim)
    2. Penicillins
    3. Cephalosporins
    4. Rifampin
    5. Vancomycin
    6. Fluoroquinolones
    7. Linezolid
    8. Ganciclovir
  3. Cardiovascular Agents
    1. Abciximab (ReoPro)
    2. Eptifibatide (Integrilin)
    3. Tirofiban
    4. Digoxin
    5. Methyldopa
    6. Procainamide
    7. Cinchona alkaloids (Quinidine, Quinine)
    8. Thiazide Diuretics (Hydrochlorothiazide, Chlorthalidone)
  4. H2 Antagonists
    1. Cimetidine (Tagamet)
    2. Ranitidine (Zantac)
  5. Neuropsychiatric agents
    1. Barbiturates
    2. Phenytoin (Dilantin)
    3. Valproic Acid (Depakene)
    4. Carbamazepine (Tegretol)
  6. Miscellanous Agents
    1. Chronic Alcohol Abuse
    2. Estrogens
    3. Gold Salts
    4. MMR Vaccine
    5. Sulfasalazine (Azulfidine)
    6. Propylthiouracil
    7. Heparin Induced Thrombocytopenia
      1. Occur in 5% of patients on >5 days Heparin
      2. In vivo platelet aggregation due to immune complexes against platelet factor 4 (PF4) and Heparin

III. Causes: Platelet impaired function

  1. Common causes
    1. Consider agents that affect coagulation (Heparin, Warfarin)
    2. Aspirin
    3. Nonsteroidal Antiinflammatory Drugs (NSAIDs)
    4. Clopidogrel (Plavix)
  2. Other causes
    1. Antidepressants
      1. Tricyclic Antidepressants
      2. Selective Serotonin Reuptake Inhibitors
    2. Antihistamines
      1. Azatadine
      2. Brompheniramine
      3. Clemastine fumarate
    3. Clofibrate
    4. Dipyridamole
    5. Furosemide (Lasix)
    6. Ginkgo Biloba
    7. Nitrofurantoin (Furadantin)
    8. Propranolol
    9. Sulfinpyrazone

IV. Management

  1. Discontinue offending agent and recheck Platelet Count in 1 week
  2. See Thrombocytopenia
  3. See Thrombocytopenia Causes

V. Course

  1. Onset within 5 to 7 days of starting the medication
  2. Expect recovery in 7-14 days after discontinuation of medication

VI. References

  1. Merrill and Gillen (2016) Crit Dec Emerg Med 30(3): 3-8
  2. Kenney (2009) Arch Pathol Lab Med 133(2): 309-14 [PubMed]

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Ontology: Thrombocytopenia due to drugs (C0340977)

Concepts Pathologic Function (T046)
SnomedCT 191322006
English Thrombocytopenia (due to): drugs, Thrombocytopenia due to drugs, Thrombocytopenia due to drugs (disorder), drugs; thrombocytopenia, thrombocytopenia; drugs
Dutch geneesmiddel; trombocytopenie, trombocytopenie; geneesmiddelen
Spanish trombocitopenia medicamentosa (trastorno), trombocitopenia medicamentosa, trombocitopenia por fármacos

Ontology: Drug Induced Thrombocytopenia (C2063616)

Definition (NCI) Thrombocytopenia caused by ingested or injected drugs. It may be the result of decreased platelet production due to bone marrow suppression or increased rate of platelet destruction.
Concepts Disease or Syndrome (T047)
English drug-induced thrombocytopenia (diagnosis), drug-induced thrombocytopenia, Drug Induced Thrombocytopenia, DITP, Drug-Induced Immune Thrombocytopenia