[Definition and mechanism of drug-induced thrombocytopenia].
Drug-induced thrombocytopenia is common, but most previous reports do not present evidence for drugs as a definite or probable cause of the thrombocytopenia. The important diagnostic issue is to distinguish between drug-induced thrombocytopenia and idiopathic thrombocytopenic purpura, because the latter diagnosis requires the exclusion of other causes of thrombocytopenia. Drug-induced thrombocytopenia includes at least three mechanisms, such as marrow suppression, immunological, and nonimmunological thrombocytopenia. In immunological thrombocytopenia, demonstration of drug-dependent antiplatelet antibodies was included as evidence confirming the causal role of a drug. However, there are no standard assays for drug-dependent antiplatelet antibodies, no standard criteria for distinguishing positive from negative results, and no data on the sensitivity and specificity of these assays based on clinical criteria for a causal relation. Nonimmunological thrombocytopenia includes heparin-dependent thrombocytopenia and thrombotic thrombocytopenic purpura.
Nomura
Shosaku
S
Division of Hematology, Kishiwada City Hospital, Kishiwada 596-8501.
D000925:Anticoagulants / Q000009:adverse effects; D001323:Autoantibodies; D001581:Benzothiadiazines; D001792:Blood Platelets / Q000276:immunology; D003937:Diagnosis, Differential; D004232:Diuretics; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D008533:Megakaryocytes; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000209:etiology; D011802:Quinidine / Q000009:adverse effects; D011803:Quinine / Q000009:adverse effects; D049993:Sodium Chloride Symporter Inhibitors / Q000009:adverse effects; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis
D000925:Anticoagulants; D001323:Autoantibodies; D001581:Benzothiadiazines; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors; D006493:Heparin; D011803:Quinine; D011802:Quinidine