Vancomycin-induced immune thrombocytopenia
Vancomycin-induced immune thrombocytopenia
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DOI：
10.1056/nejmoa065066
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发表时间：
2007-03-01
影响因子：
158.5
通讯作者：
Aster, Richard H.
中科院分区：
文献类型：
--
作者：
Von Drygalski, Annette;Curtis, Brian R.;Aster, Richard H.
背景：万古霉素很少被认为是导致血小板减少的原因，而且只有有限的证据表明这种并发症是由免疫机制引起的。我们进行了一项研究，以确定在接受万古霉素治疗的患者中，血小板减少是否由万古霉素依赖抗体引起。方法：我们鉴定和表征了5年内因临床怀疑万古霉素引起的血小板减少而转诊进行检测的患者的万古霉素依赖、血小板反应性抗体。结果：在34例患者中发现了药物依赖的、血小板反应性抗体，抗体类型为Ig G类、Ig M类或两者兼有，29例患者获得了临床随访信息。这些患者的平均最低值为13,600个/立方毫米，有10个患者(34%)发生了严重出血。在万古霉素停药后，所有存活的26名患者的血小板水平均恢复到基线水平。在15名患者中，药物持续1-14天，同时调查其他可能导致血小板减少的原因。25例服用万古霉素且未出现血小板减少的患者未发现万古霉素依赖抗体。结论：万古霉素所致免疫性血小板减少患者可发生严重出血。在服用抗生素的患者中检测到依赖万古霉素的抗血小板抗体，在这些患者中出现血小板减少症，而服用该药的患者在血小板计数保持稳定的情况下没有抗体，这表明这些抗体是导致血小板减少症的原因。
BACKGROUND:Vancomycin has only rarely been implicated as a cause of thrombocytopenia, and there is only limited evidence that this complication is caused by immune mechanisms. We conducted a study to determine whether thrombocytopenia is caused by vancomycin-dependent antibodies in patients being treated with vancomycin.METHODS:We identified and characterized vancomycin-dependent, platelet-reactive antibodies in patients who had been referred for testing during a 5-year period because of a clinical suspicion of vancomycin-induced thrombocytopenia. We obtained clinical information about the patients from their referring physicians.RESULTS:Drug-dependent, platelet-reactive antibodies of the IgG class, the IgM class, or both were identified in 34 patients, and clinical follow-up information was obtained from 29 of these patients. The mean nadir platelet count in these patients was 13,600 per cubic millimeter, and severe bleeding occurred in 10 patients (34%). Platelet levels returned to baseline in all 26 surviving patients after vancomycin was stopped. In 15 patients, the drug was continued for 1 to 14 days while other possible causes of thrombocytopenia were investigated. Vancomycin-dependent antibodies were not found in 25 patients who had been given vancomycin and in whom thrombocytopenia did not develop.CONCLUSIONS:Severe bleeding can occur in patients with vancomycin-induced immune thrombocytopenia. The detection of vancomycin-dependent antiplatelet antibodies in patients receiving the antibiotic in whom thrombocytopenia develops, and the absence of antibodies in patients given the drug in whom platelet counts remain stable, indicate that these antibodies are the cause of the thrombocytopenia.