IMUNA TROMBOCITOPENIJA IZAZVANA LEKOVIMA

Slobodan M Janković

doi:10.5937/racter7-9017

Slobodan M Janković Univerzitet u Kragujevcu, Fakultet medicinskih nauka

DOI: https://doi.org/10.5937/racter7-9017

Ključne reči: immune thrombocytopenia||, ||imuna trombocitopenija, drug-induced||, ||lekovi, causality||, ||uzročno posledična veza,

Sažetak

Imuna trombocitopenija izazvana lekovima (ITIL) nastaje kao posledica destrukcije ili neadekvatne aktivacije trombocita usled dejstva imunog sistema provociranog trenutnim ili pređašnjim prisustvom leka u organizmu. Incidencija ITIL-a je oko 10 slučajeva na 1,000,000 stanovnika tokom jedne godine. Postoje četiri osnovna mehanizma nastanka ITIL-a: (1) vezivanje antitela zavisnih od lekova za trombocite; (2) blokada vezivanja fibrinogena za glikoproteinske IIb-IIIa receptore; (3) stvaranje autoantitela protiv trombocita koja nisu zavisna od prisustva leka; i (4) stvaranje imunih kompleksa lekova sa antitelima, što dalje dovodi do aktivacije trombocita i nastanka tromboza. Kod svih oblika imune trombocitopenije izazvane lekovima najvažnije je po utvrđivanju smanjenog broja trombocita što pre posumnjati da je uzročnik određeni lek. Ključni momenat u terapiji je prekid dalje primene leka-uzročnika, dok se transfuzija trombocita daje samo u slučaju ekstremnog pada njihovog broja u krvi. Heparinom-indukovana trombocitopenije je izuzetak, jer zahteva i lečenje tromboza pomoću direktnih inhibitora trombina.

Biografija autora

Slobodan M Janković, Univerzitet u Kragujevcu, Fakultet medicinskih nauka

Redovni profesor Farmakologije i toksikologije i Klinicke farmacije

Reference

Demir D, Öcal F, Abanoz M, Dermenci H. A case of thrombocytopenia associatedwith the use of hydroxychloroquine following open heart surgery. Int J Surg Case Rep 2014;5(12):1282-4.

Arnold DM, Nazi I, Warkentin TE, Smith JW, Toltl LJ, George JN, Kelton JG.Approach to the diagnosis and management of drug-induced immune thrombocytopenia. Transfus Med Rev 2013;27(3):137-45.

Reese JA, Li X, Hauben M, Aster RH, Bougie DW, Curtis BR, George JN, Vesely SK. Identifying drugs that cause acute thrombocytopenia: an analysis using 3 distinct methods. Blood 2010; 116(12): 2127-33.

George JN, Aster RH. Drug-induced thrombocytopenia: pathogenesis, evaluation, and management. Hematology Am Soc Hematol Educ Program 2009:153-8.

Bougie DW, Birenbaum J, Rasmussen M, Poncz M, Aster RH. Quinine-dependent, platelet-reactive monoclonals mimic antibodies found in patients with quinine-induced immune thrombocytopenia. Blood 2009; 113(5): 1105-11.

Mohamed M, Hayes R. Quinine-induced severe thrombocytopenia: the importance oftaking a detailed drug history. BMJ Case Rep 2013;2013.

Anand A, Chauhan HK. Piperacillin and vancomycin induced severethrombocytopenia in a hospitalized patient. Platelets 2011;22(4):294-301.

Visentin GP, Liu CY. Drug-induced thrombocytopenia. Hematol Oncol Clin North Am 2007;21(4): 685-96.

Mailman JF, Stigant C, Martinusen D. Moxifloxacin-Induced Immune-MediatedThrombocytopenia in a Chronic Kidney Disease Patient Receiving Hemodialysis. Ann Pharmacother 2014;48(7):919-922.

Mansour H, Saad A, Azar M, Khoueiry P. Amoxicillin/Clavulanic Acid-inducedthrombocytopenia. Hosp Pharm 2014;49(10):956-60.

Goraya JS, Virdi VS. Carbamazepine-induced immune thrombocytopenia. Neurol India 2003;51(1):132-3.

Curtis BR. Drug-induced immune thrombocytopenia: incidence, clinical features, laboratory testing, and pathogenic mechanisms. Immunohematology 2014;30(2):55-65.

Said SM, Hahn J, Schleyer E, Müller M, Fiedler GM, Buerke M, Prondzinsky R. Glycoprotein IIb/IIIa inhibitor-induced thrombocytopenia: diagnosis and treatment. Clin Res Cardiol 2007; 96(2): 61-9.

Аster RH. Immune thrombocytopenia caused by glycoprotein IIb/IIIa inhibitors. Chest 2005; 127(2 Suppl): 53S-59S.

Aster RH, Bougie DW. Drug-induced immune thrombocytopenia. N Engl J Med 2007; 357(6): 580-7.

Aster RH, Curtis BR, McFarland JG, Bougie DW. Drug-induced immune thrombocytopenia: pathogenesis, diagnosis, and management. J Thromb Haemost 2009; 7(6): 911-8.

Khatua S, Nair CN, Ghosh K. Immune-mediated thrombocytopenia following dactinomycin therapy in a child with alveolar rhabdomyosarcoma: the unresolved issues. J Pediatr Hematol Oncol 2004; 26(11): 777-9.

Madhok R, Pullar T, Capell HA, Dawood F, Sturrock RD, Dick HM. Chrysotherapy and thrombocytopenia. Ann Rheum Dis 1985; 44(9): 589-91.

Garner SF, Campbell K, Metcalfe P, Keidan J, Huiskes E, Dong JF, López JA, Ouwehand WH. Glycoprotein V: the predominant target antigen in gold-induced autoimmune thrombocytopenia. Blood 2002; 100(1): 344-6.

Krzych ŁJ, Nowacka E, Knapik P. Heparin-induced thrombocytopenia. Anaesthesiol Intensive Ther 2015; 47(1): 63-76.

Greinacher A. CLINICAL PRACTICE. Heparin-Induced Thrombocytopenia. N Engl J Med 2015; 373(3): 252-61.