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Treatment of drug-induced immune thrombocytopenias
Several therapeutic agents can cause thrombocytopenia by either immune-mediated or non-immune-mediated mechanisms. Non-immune-mediated thrombocytopenia is due to direct toxicity of drug molecules to platelets or megakaryocytes. Immune-mediated thrombocytopenia, on the other hand, involves the format...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Fondazione Ferrata Storti
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9152960/ https://www.ncbi.nlm.nih.gov/pubmed/35642486 http://dx.doi.org/10.3324/haematol.2021.279484 |
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author | Marini, Irene Uzun, Gunalp Jamal, Kinan Bakchoul, Tamam |
author_facet | Marini, Irene Uzun, Gunalp Jamal, Kinan Bakchoul, Tamam |
author_sort | Marini, Irene |
collection | PubMed |
description | Several therapeutic agents can cause thrombocytopenia by either immune-mediated or non-immune-mediated mechanisms. Non-immune-mediated thrombocytopenia is due to direct toxicity of drug molecules to platelets or megakaryocytes. Immune-mediated thrombocytopenia, on the other hand, involves the formation of antibodies that react to platelet-specific glycoprotein complexes, as in classic drug-induced immune thrombocytopenia (DITP), or to platelet factor 4, as in heparin-induced thrombocytopenia (HIT) and vaccine-induced immune thrombotic thrombocytopenia (VITT). Clinical signs include a rapid drop in platelet count, bleeding or thrombosis. Since the patient's condition can deteriorate rapidly, prompt diagnosis and management are critical. However, the necessary diagnostic tests are only available in specialized laboratories. Therefore, the most demanding step in treatment is to identify the agent responsible for thrombocytopenia, which often proves difficult because many patients are taking multiple medications and have comorbidities that can themselves also cause thrombocytopenia. While DITP is commonly associated with an increased risk of bleeding, HIT and VITT have a high mortality rate due to the high incidence of thromboembolic complications. A structured approach to drug-associated thrombocytopenia/thrombosis can lead to successful treatment and a lower mortality rate. In addition to describing the treatment of DITP, HIT, VITT, and vaccine-associated immune thrombocytopenia, this review also provides the pathophysiological and clinical information necessary for correct patient management. |
format | Online Article Text |
id | pubmed-9152960 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Fondazione Ferrata Storti |
record_format | MEDLINE/PubMed |
spelling | pubmed-91529602022-06-13 Treatment of drug-induced immune thrombocytopenias Marini, Irene Uzun, Gunalp Jamal, Kinan Bakchoul, Tamam Haematologica Review Series Several therapeutic agents can cause thrombocytopenia by either immune-mediated or non-immune-mediated mechanisms. Non-immune-mediated thrombocytopenia is due to direct toxicity of drug molecules to platelets or megakaryocytes. Immune-mediated thrombocytopenia, on the other hand, involves the formation of antibodies that react to platelet-specific glycoprotein complexes, as in classic drug-induced immune thrombocytopenia (DITP), or to platelet factor 4, as in heparin-induced thrombocytopenia (HIT) and vaccine-induced immune thrombotic thrombocytopenia (VITT). Clinical signs include a rapid drop in platelet count, bleeding or thrombosis. Since the patient's condition can deteriorate rapidly, prompt diagnosis and management are critical. However, the necessary diagnostic tests are only available in specialized laboratories. Therefore, the most demanding step in treatment is to identify the agent responsible for thrombocytopenia, which often proves difficult because many patients are taking multiple medications and have comorbidities that can themselves also cause thrombocytopenia. While DITP is commonly associated with an increased risk of bleeding, HIT and VITT have a high mortality rate due to the high incidence of thromboembolic complications. A structured approach to drug-associated thrombocytopenia/thrombosis can lead to successful treatment and a lower mortality rate. In addition to describing the treatment of DITP, HIT, VITT, and vaccine-associated immune thrombocytopenia, this review also provides the pathophysiological and clinical information necessary for correct patient management. Fondazione Ferrata Storti 2022-06-01 /pmc/articles/PMC9152960/ /pubmed/35642486 http://dx.doi.org/10.3324/haematol.2021.279484 Text en Copyright© 2022 Ferrata Storti Foundation https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution Noncommercial License (by-nc 4.0) which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. |
spellingShingle | Review Series Marini, Irene Uzun, Gunalp Jamal, Kinan Bakchoul, Tamam Treatment of drug-induced immune thrombocytopenias |
title | Treatment of drug-induced immune thrombocytopenias |
title_full | Treatment of drug-induced immune thrombocytopenias |
title_fullStr | Treatment of drug-induced immune thrombocytopenias |
title_full_unstemmed | Treatment of drug-induced immune thrombocytopenias |
title_short | Treatment of drug-induced immune thrombocytopenias |
title_sort | treatment of drug-induced immune thrombocytopenias |
topic | Review Series |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9152960/ https://www.ncbi.nlm.nih.gov/pubmed/35642486 http://dx.doi.org/10.3324/haematol.2021.279484 |
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