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Pathophysiology and Diagnosis of Drug-Induced Immune Thrombocytopenia

1
EA 7501-Groupe Innovation et Ciblage Cellulaire (GICC), Université François Rabelais, CEDEX 01, 37032 Tours, France
2
Laboratoire d’Hématologie-Hémostase, Hôpital Trousseau, CHRU Tours, CEDEX 09, 37044 Tours, France
3
Laboratoire d’Hématologie, CNHU de Cotonou, Cotonou 01 BP 386, Benin
4
Département d’Immunologie plaquettaire, Institut National de la Transfusion Sanguine (INTS), 75015 Paris, France
5
Equipe ETRES (Ethics, Research, Translations), Centre de Recherche des Cordeliers, UMRS 1138, INSERM, Sorbonne Université, Université de Paris, 75006 Paris, France
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(7), 2212; https://doi.org/10.3390/jcm9072212
Received: 25 June 2020 / Revised: 9 July 2020 / Accepted: 10 July 2020 / Published: 13 July 2020
Drug-induced immune thrombocytopenia (DITP) is a life-threatening clinical syndrome that is under-recognized and difficult to diagnose. Many drugs can cause immune-mediated thrombocytopenia, but the most commonly implicated are abciximab, carbamazepine, ceftriaxone, eptifibatide, heparin, ibuprofen, mirtazapine, oxaliplatin, penicillin, quinine, quinidine, rifampicin, suramin, tirofiban, trimethoprim-sulfamethoxazole, and vancomycin. Several different mechanisms have been identified in typical DITP, which is most commonly characterized by severe thrombocytopenia due to clearance and/or destruction of platelets sensitized by a drug-dependent antibody. Patients with typical DITP usually bleed when symptomatic, and biological confirmation of the diagnosis is often difficult because detection of drug-dependent antibodies (DDabs) in the patient’s serum or plasma is frequently not possible. This is in contrast to heparin-induced thrombocytopenia (HIT), which is a particular DITP caused in most cases by heparin-dependent antibodies specific for platelet factor 4, which can strongly activate platelets in vitro and in vivo, explaining why affected patients usually have thrombotic complications but do not bleed. In addition, laboratory tests are readily available to diagnose HIT, unlike the methods used to detect DDabs associated with other DITP that are mostly reserved for laboratories specialized in platelet immunology. View Full-Text
Keywords: platelets; thrombocytopenia; drugs; heparin-induced thrombocytopenia platelets; thrombocytopenia; drugs; heparin-induced thrombocytopenia
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MDPI and ACS Style

Vayne, C.; Guéry, E.-A.; Rollin, J.; Baglo, T.; Petermann, R.; Gruel, Y. Pathophysiology and Diagnosis of Drug-Induced Immune Thrombocytopenia. J. Clin. Med. 2020, 9, 2212. https://doi.org/10.3390/jcm9072212

AMA Style

Vayne C, Guéry E-A, Rollin J, Baglo T, Petermann R, Gruel Y. Pathophysiology and Diagnosis of Drug-Induced Immune Thrombocytopenia. Journal of Clinical Medicine. 2020; 9(7):2212. https://doi.org/10.3390/jcm9072212

Chicago/Turabian Style

Vayne, Caroline; Guéry, Eve-Anne; Rollin, Jérôme; Baglo, Tatiana; Petermann, Rachel; Gruel, Yves. 2020. "Pathophysiology and Diagnosis of Drug-Induced Immune Thrombocytopenia" J. Clin. Med. 9, no. 7: 2212. https://doi.org/10.3390/jcm9072212

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