LEKOVIMA UZROKOVANA TROMBOCITOPENIJA
Sažetak
Lekovi predstavljaju čest uzrok trombocitopenije, pogotovo kod hospitalizovanih bolesnika. Učestalost ove neželjene reakcije na lekove kreće se oko 10/1 000 000 stanovnika godišnje i prema mehanizmu nastanka može sе klasifikovati kao imunska i neimunska. Lekovi poput citostatika, linezolida, ganciklovira, valaciklovira, Aspirina i vankomicina dovode do neimunskog oblika trombocitopenije, tako što deluju proapoptotički na trombocite ili direktno citotoksično na megakariocite i trombocite. S druge strane, imunski oblik uzrokovan je antitelima specifičnim za lek koja se, u prisustvu leka ili njegovog metabolita, vezuju za trombocitne antigene dovodeći do ubrzane razgradnje trombocita. Osim ovog klasičnog oblika lekom uzrokovane imune trombocitopenije (LITP), koji se odlikuje akutnom trombocitopenijom teškog stepena (nadir broja trombocita < 20x109/L) i krvarenjem, prepoznati su i posebni oblici: heparinom uzrokovana trombocitopenija (HIT), trombocitopenija uzrokovana blokatorima kontrolnih tačaka i vakcinom indukovana trombozna trombocitopenija (VITT). HIT je najčešća LITP u kojoj je nadir broja trombocita najčešće oko 60x109/L, a kliničkom slikom dominiraju tromboze, i to venske i, ređe, arterijske. S druge strane, VITT se odlikuje nastankom tromboze i trombocitopenije 4 do 30 dana od primene adenovirusnih vektorskih vakcina a smrtnost u ovom obliku LITP se kreće između 25% i 60%.
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