Drug-induced immune thrombocytopenia: pathogenesis, diagnosis, and management.
Drug-induced immune thrombocytopenia: pathogenesis, diagnosis, and management.
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DOI：
10.1111/j.1538-7836.2009.03360.x
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发表时间：
2009-06
期刊：
影响因子：
--
通讯作者：
Bougie DW
中科院分区：
文献类型：
--
作者：
Aster RH;Curtis BR;McFarland JG;Bougie DW
药物诱导的免疫性血小板减少症（DITP）可由多种药物引发。虽然许多DITP病例是轻度的，但有些病例的特征是危及生命的出血症状。DITP的发病机制是复杂的，因为已经提出了至少六种不同的机制，通过这些机制药物诱导的抗体可以促进血小板破坏。在许多情况下，有可能在致敏药物存在的情况下识别与血小板反应的抗体，但所需的测试在技术上要求很高，而且不能广泛使用。因此，必须根据临床情况决定是否在疑似患有DITP的患者中停用相关药物。有一种算法可以帮助评估特定药物引起血小板减少症的可能性，但管理患者的最重要的单一决定因素是高度怀疑指数和患有病因不明的急性（通常为重度）血小板减少症的个体的药物暴露史。药物如何诱导血小板反应性抗体，以及一旦形成，抗体如何在暴露于药物后引起血小板破坏，目前还知之甚少。需要进一步研究来解决这些问题，并更全面地描述可能导致DITP的药物和药物代谢产物的范围。
Drug-induced immune thrombocytopenia (DITP) can be triggered by a wide range of medications. Although many cases of DITP are mild, some are characterized by life-threatening bleeding symptoms. The pathogenesis of DITP is complex in that at least six different mechanisms have been proposed by which drug-induced antibodies can promote platelet destruction. It is possible in many cases to identify antibodies that react with platelets in the presence of the sensitizing drug, but the required testing is technically demanding and not widely available. Therefore, a decision on whether to discontinue an implicated medication in a patient suspected of having DITP must be made on clinical grounds. An algorithms is available that can be helpful in assessing the likelihood that a particular drug caused thrombocytopenia, but the most important single determinant in managing a patient is a high index of suspicion and a careful history of drug exposure in an individual who presents with acute, often severe thrombocytopenia of unknown etiology. How drugs induce platelet-reactive antibodies and how, once formed, the antibodies cause platelet destruction following exposure to the drug is poorly understood. Further studies to address these issues and characterize more completely the range of drugs and drug metabolites that can cause DITP are needed.
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影响因子：
20.3
作者：
Burgess, JK;Lopez, JA;Chong, BH
通讯作者：
Chong, BH
DOI：
10.1073/pnas.0404201101
发表时间：
2004-09-07
影响因子：
11.1
作者：
Artoni, A;Li, JH;Coller, BS
通讯作者：
Coller, BS
影响因子：
20.3
作者：
Bougie, DW;Wilker, PR;Aster, RH
通讯作者：
Aster, RH
影响因子：
20.3
作者：
Curtis, BR;Swyers, J;Aster, RH
通讯作者：
Aster, RH
影响因子：
15.9
作者：
CHRISTIE, DJ;ASTER, RH
通讯作者：
ASTER, RH