Thrombocytopenia associated with auranofin therapy: evidence for a gold-dependent immunologic mechanism.
Thrombocytopenia associated with gold therapy is thought to be due to an immune-mediated mechanism. Relatively few patients have been studied so far, and precise details of the pathophysiology of this disease remain undetermined. We report a patient with gold-induced thrombocytopenia resulting from auranofin therapy. The patient's plasma contained platelet-reactive antibodies detectable only in the presence of gold salts. Antibody binding occurred at gold concentrations ranging from 0.01 to 10,000 ng/ml. The binding occurred independently of gold salt used, suggesting that substitution of a different gold preparation in this patient would result in a similar thrombocytopenia. These data support a drug-dependent immune mechanism for platelet destruction.
Kosty
M P
MP
Department of Internal Medicine (Hematology/Oncology Division), Naval Hospital, San Diego, CA 92134-5000.
Hench
P K
PK
Tani
P
P
McMillan
R
R
D000906:Antibodies / Q000032:analysis; D001310:Auranofin / Q000009:adverse effects*; D001696:Biomechanical Phenomena; D001792:Blood Platelets / Q000276:immunology / Q000378:metabolism; D005260:Female; D006046:Gold / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000378:metabolism; D008875:Middle Aged; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000276:immunology
D000906:Antibodies; D007074:Immunoglobulin G; D001310:Auranofin; D006046:Gold