title: Impaired platelet function associated with parenteral nafcillin.
abstract: A 44-year-old Caucasian female was admitted with a subarachnoid hemorrhage owing to a multilobular tubular anterior communicating artery aneurysm. Eleven days after the original craniotomy, an epidural hematoma was evacuated. The patient was placed on empiric nafcillin antimicrobial coverage (two g every six hours). Within 24 hours, the onset of epistaxis and oozing of blood from the endotracheal tube and craniotomy site was noted. Recurrent subdural and epidural hematomas necessitated a third emergent craniotomy. The development of an acquired qualitative platelet defect was suggested by the findings of a prolonged template bleeding time and markedly abnormal platelet aggregation/ATP release studies despite a normal platelet count. Nafcillin therapy was immediately discontinued. Clinical bleeding resolved. Subsequent bleeding times and platelet aggregation studies confirmed the nafcillin-induced platelet dysfunction.
authors.affiliation: Department of Pathology/Laboratory Medicine, Medical University, Charleston, SC 29425.
authors.forename: E K
authors.initials: EK
authors.lastname: Jeter
authors.forename: A
authors.initials: A
authors.lastname: Scott
authors.forename: J
authors.initials: J
authors.lastname: Kizer
authors.forename: J
authors.initials: J
authors.lastname: Lazarchick
mesh_terms: D000328:Adult; D001760:Bleeding Time; D002543:Cerebral Hemorrhage / Q000188:drug therapy*; D005260:Female; D006407:Hematoma, Epidural, Cranial / Q000139:chemically induced*; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D009254:Nafcillin / Q000009:adverse effects*; D010974:Platelet Aggregation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors; D010976:Platelet Count; D011182:Postoperative Care
chemical_list: D010975:Platelet Aggregation Inhibitors; D009254:Nafcillin