ABSTRACT
A 62-year-old woman with prosthetic mitral valve was admitted for explant of an infected prosthetic knee. Perioperatively, she was bridged with heparin and started on empiric vancomycin and piperacillin-tazobactam. Platelet counts dropped precipitously within 2 days reaching a nadir of 6000/µL, without any bleeding. Decline persisted despite substituting heparin with bivalirudin. Antiplatelet factor 4 and anti-PLA1 antigen were negative. Schistocytes were absent. Antibiotics were substituted with daptomycin for suspected drug-induced thrombocytopenia. Pulse dose of intravenous immunoglobulin was initiated with rapid normalization of platelet count. She tested positive for IgG antiplatelet antibodies to vancomycin and piperacillin-tazobactam thereby confirming the diagnosis. Drug-induced immune-mediated thrombocytopenia is an underrecognized cause of thrombocytopenia in the intensive care units. Clinicians should be cognizant of this entity, and a definitive diagnosis should be sought if feasible.
Subject(s)
Penicillanic Acid/analogs & derivatives , Purpura, Thrombocytopenic, Idiopathic/chemically induced , Vancomycin/adverse effects , Device Removal , Female , Humans , Immunoglobulin G/immunology , Intensive Care Units , Middle Aged , Penicillanic Acid/administration & dosage , Penicillanic Acid/adverse effects , Piperacillin/administration & dosage , Piperacillin/adverse effects , Piperacillin, Tazobactam Drug Combination , Prosthesis-Related Infections/surgery , Purpura, Thrombocytopenic, Idiopathic/diagnosis , Purpura, Thrombocytopenic, Idiopathic/immunology , Vancomycin/administration & dosageSubject(s)
Arthroplasty, Replacement, Knee , Lymphohistiocytosis, Hemophagocytic/etiology , Lymphoma, Large B-Cell, Diffuse/complications , Aged , Antineoplastic Combined Chemotherapy Protocols , Biopsy , Bone Marrow/pathology , Humans , Lymphohistiocytosis, Hemophagocytic/diagnosis , Lymphohistiocytosis, Hemophagocytic/drug therapy , Lymphoma, Large B-Cell, Diffuse/diagnosis , Lymphoma, Large B-Cell, Diffuse/drug therapy , Macrophages/metabolism , Macrophages/pathology , Male , Neoplasm StagingSubject(s)
Anemia, Sideroblastic/genetics , Genetic Testing/methods , Mutation , Phosphoproteins/genetics , Ribonucleoprotein, U2 Small Nuclear/genetics , Adult , Aged , Anemia, Sideroblastic/classification , Anemia, Sideroblastic/diagnosis , Child , DNA Mutational Analysis , Diagnosis, Differential , Female , Humans , Male , Middle Aged , RNA Splicing Factors , Sensitivity and Specificity , Young AdultABSTRACT
This case report describes a case of congenital sideroblastic anaemia, one of the prototype disorders of erythroid haem biosynthesis. In this instance it was not recognised until after the patient had undergone splenectomy and developed refractory thromboembolic disease.
