title: Severe thrombocytopenia induced by iodinated contrast after coronary angiography: The use of gadolinium contrast and intravascular ultrasound as an alternative to guide percutaneous coronary intervention.
abstract: Acute contrast-induced thrombocytopenia is a rare event with the use of modern low osmolarity iodinated contrast media. The pathophysiological mechanism that causes platelet counts to drop has not been identified, but an immunological mechanism is suspected due to cytotoxicity after previous exposure to contrast. We report the case of a 47-year-old male patient with acute severe thrombocytopenia due to iodinated contrast media exposure. His platelet count after the procedure with the highest amount of contrast was zero, which is the lowest reported platelet count to date. Percutaneous coronary revascularization under both intravascular ultrasound and gadolinium contrast guidance was performed without complications. The most feared complication after the use of gadolinium is nephrogenic systemic fibrosis, especially in patients on hemodialysis.
authors.affiliation: Haemodynamic and Interventional Cardiology, University Hospital Virgen del Rocío, Seville, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Cubero-Gómez
authors.affiliation: Haemodynamic and Interventional Cardiology, University Hospital Virgen del Rocío, Seville, Spain. Electronic address: guerreromar24@gmail.com.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Guerrero Márquez
authors.affiliation: Haemodynamic and Interventional Cardiology, University Hospital Virgen del Rocío, Seville, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Diaz-de la-Llera
authors.affiliation: Haemodynamic and Interventional Cardiology, University Hospital Virgen del Rocío, Seville, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: Fernández-Quero
authors.affiliation: Haemodynamic and Interventional Cardiology, University Hospital Virgen del Rocío, Seville, Spain.
authors.forename: Agustín
authors.initials: A
authors.lastname: Guisado-Rasco
authors.affiliation: Haemodynamic and Interventional Cardiology, University Hospital Virgen del Rocío, Seville, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Villa-Gil-Ortega
mesh_terms: D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography; D005682:Gadolinium; D006571:Heterocyclic Compounds; D006801:Humans; D017613:Iodine Compounds / Q000009:adverse effects*; D007485:Ioxaglic Acid / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012720:Severity of Illness Index; D025321:Surgery, Computer-Assisted; D013921:Thrombocytopenia / Q000139:chemically induced*; D018084:Ultrasonography, Interventional
chemical_list: D003287:Contrast Media; D006571:Heterocyclic Compounds; D017613:Iodine Compounds; D009942:Organometallic Compounds; C062402:gadoteridol; D005682:Gadolinium; D007485:Ioxaglic Acid
keywords: Agentes de contraste; Contrast agents; Ecografia intracoronária; Imagem; Imaging; Intervenção copronária percutânea; Intravascular ultrasound; Percutaneous coronary intervention