Introduction
The medicines taken to cure certain disease conditions may sometimes precipitate another condition. There is not even a single medicine that offers absolutely zero side effects. Drug-induced thrombocytopenia is one such disease condition elicited as a side effect of some other medicines.
What Is Drug-Induced Thrombocytopenia?
Drug-induced thrombocytopenia (DITP) is a specific form of thrombocytopenia where the patients elicit an exaggerated inclination toward bleeding. This inclination develops as a consequence of particular medicine intake. Not all medicines bring about this condition. However, certain specific medications are capable of projecting bleeding tendencies. These medicines intervene and mess up the body's expertise in producing cells that check to bleed - platelets. As the condition is purely drug-driven, it is medically coined as drug-induced thrombocytopenia to distinguish the triggering factor's involvement clearly. It also includes thrombocytopenia that is triggered by certain foodstuffs and beverages.
What Is Thrombocytopenia?
Thrombocytopenia encompasses a spectrum of diseases where the platelet cell count diminishes tremendously. This decline in platelet number is reflected in the form of various bleeding issues. The patient elicits tiny dots, almost the size of a pin head, all over the body surface. The person experiences dramatic bleeding even for minor skin abrasions. In severe stages, the urine, vomitus, and feces even turn out blood color, indicating the presence of blood in the urine, vomitus, and feces. Many known and unknown reasons could lead to this medical disorder. It can be the reaction of the body's immune system, impaired platelet production, inflated platelet elimination, detrimental effects of certain medicines, and many more. Considering the underlying factors, it is categorized into different subclasses, and accordingly, the treatment strategies are designed.
What Are the Different Types of Drug-Induced Thrombocytopenia?
Drug-induced thrombocytopenia can be categorized into two groups based on the mechanism by which that specific drug precipitates thrombocytopenia.
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Immune-Mediated Drug-Induced Thrombocytopenia: Intake of certain medicines triggers the body to produce specific, drug-dependent antibodies. These antibodies target the platelet and attach to the platelet's surface, remarkably impairing the platelet function and eventually wrecking the platelet cells. It can result in a drastic platelet drop, and the patient elicits various signs and symptoms indicating the dip.
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Nonimmune-Mediated Drug-Induced Thrombocytopenia: In this class of drug-induced thrombocytopenia, platelet depletion occurs due to the noxious effect of the medicine on the platelet cells. At times, it develops by influencing the megakaryocytes (giving rise to platelet cells). The toxic effect of the medication hampers the megakaryocytes from forming into platelets, which eventually reflects in the form of a depleted platelet count. The active bloodstream's platelet-forming process and enhanced platelet eradication will be entirely disrupted.
What Leads to the Development of Drug-Induced Thrombocytopenia?
Just as the name indicates, drug-induced thrombocytopenia develops as an after-effect of certain known medications. The drug's harmful effect or the drug-dependent antibodies facilitate the development of drug-induced thrombocytopenia. There are a wide variety of drugs that are capable of bringing in thrombocytopenia. Heparin is the widely reported triggering agent; however, it is considered a separate entity - Heparin-induced thrombocytopenia. Some of the drugs that are extensively reported to elicit thrombocytopenia include the following:
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Chemotherapy Drugs: Chemotherapy medicines are routinely solid and toxic, aimed at killing cancer cells. The toxicity of the drugs often impacts the platelet cells, which eventually end up in DITP. Tamoxifen advised for cancer involving the breast can give rise to DITP.
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Antiepileptic Drugs: Drugs that are advised to control the seizure activity, like Phenytoin, Valproic acid, and Carbamazepine, are capable of causing DIPT when administered for a significant period.
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Antimalarial Drugs: Medicines that deal with malarial infections, like Quinine and Quinidine, are also reported to be associated with DITP.
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Antibiotics: Commonly prescribed antibiotics in classes like Penicillins, cephalosporins, and sulphonamides are known to cause DITP. In addition, glycopeptide antibiotics like Vancomycin, antifolate antibiotics like Trimethoprim, and oxazolidinones like Linezolid are potential triggers for DITP.
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Non-steroidal Anti-inflammatory Drugs(NSAIDs): Naproxen and Ibuprofen are the NSAIDs that tend to evoke immune-mediated drug-induced thrombocytopenia.
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Cardiovascular Drugs: Medicines advised for heart-related abnormalities like Abciximab, Furosemide, Thiazides, Amiodarone, Tirofiban, and Eptifibatide often bring about thrombocytopenia as a potential side effect.
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Antimycobacterials: Rifampicin and Ethambutol are known antimycobacterial medications that stimulate platelet death.
Besides medicines, certain vaccines like the mumps-measles-rubella vaccine and diphtheria-tetanus-pertussis vaccine also bring about thrombocytopenia. Gold, when used to tackle arthritis (bone pain), is reported to precipitate thrombocytopenia, which also comes under DITP. Jue herbal tea, beans (Lupinus termis), and sesame seeds are the foodstuffs capable of evoking thrombocytopenia, just like other drugs.
What Are the Symptoms Associated With Drug-Induced Thrombocytopenia?
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Drug-induced thrombocytopenia manifests symptoms in the form of bleeding issues. The patient encounters bleeding while tooth brushing. The slightest provocation by the toothbrush on the gums evokes bleeding.
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The patient develops innumerable tiny blood-tinted dots over the skin surface, technically known as petechiae.
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Routinely, the patient encounters bleeding in one way or the other. Even minor skin abrasions tend to elicit unrealistic bleeding, which projects the suspicion of platelet disorder.
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The symptomatic manifestations become evident within a week after the start of medicine. The severity of the bleeding tends to progress day by day.
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If left untreated, it could potentially threaten a person's life. The advanced stage is depicted as blooded vomit, reddish urine, and feces with blood streaks.
What Are the Treatment Interventions Available for Drug-Induced Thrombocytopenia?
The treatment strategy for drug-induced thrombocytopenia entails the withdrawal of the culprit drug. The patient will be strictly advised to stop that drug, and an equivalent substitute drug will be prescribed to deal with the underlying condition for which the medicine was earlier given. In the presence of lethal symptoms like severe thrombocytopenia, immunoglobulin therapy is advised, in which antibodies are administered in high doses through the vein into the body to tackle declining platelet count. Platelet transfusion also aids in dealing with the thrombocytopenic condition, thereby impeding unusual bleeding. With the initiation of treatment following the stoppage of triggering drugs, platelet levels rise to their normal range in a week.
Conclusion
Drug-induced thrombocytopenia is quite an unfamiliar condition in which the patient develops thrombocytopenic symptoms following the initiation of treatment for other disease conditions. Proper identification of the causative factor is challenging when multiple drug involvement exists. It can precipitate fatal symptoms; however, when treated promptly at the right time, the patient recovers within a couple of weeks.
