Is the drop in platelets really caused by drugs?

[Case process]On the evening of February 17th, I contacted myself clinically and asked whether a patient's platelet results were accurate and whether there were any suggestions for continuous platelet decline.

[Case process] [Case process] On the evening of February 17th, I contacted clinically and asked a patient whether the platelet results were accurate and whether there were any suggestions for the continuous decline of platelets

figure 1

figure 1

I still have an impression of this patient, because the film was stained at the time, and platelets are indeed rare under the oil microscope, which is in line with the results of the instrument

I still have an impression of this patient, because the film was stained at the time, and platelets are indeed rare under the oil microscope, which is in line with the results of the instrument

At this time, I made a preconceived mistake.

On February 18, the clinical round showed that the continued decline of platelets was considered a serious infection, and the possibility of drug causes could not be ruled out

【Case Tracking】

After stopping cefoperazone sodium and sulbactam sodium and aspirin, the patient's platelets still did not rise.

After stopping cefoperazone sodium and sulbactam sodium and aspirin, the patient's platelets still did not rise.

Looking back at the entire case, I was too obsessive about the drop in platelets, but did not consider the patient's condition as a whole

Table 1

 

figure 2

figure 2

Combined with the high CRP, it indicates that there is indeed an infection in the patient's body, and infection is one of the main causes of diffuse intravascular coagulation (DIC), so it may trigger the process of DIC, which can be corroborated by the increase of DD dimer.

Combined with the high CRP, it indicates that there is indeed an infection in the patient's body, and infection is one of the main causes of diffuse intravascular coagulation (DIC), so it may trigger the process of DIC, which can be corroborated by the increase of DD dimer.

Is it possible that the patient has DIC? According to the Chinese DIC Diagnostic Scoring System (CDSS), it is found that the patient can only score 4 points, which is less than the 7-point standard for diagnosis (non-hematological diseases)

Some teachers will ask, how can other factors (such as drugs) be eliminated? First of all, we must know that the reduction of platelets can generally be considered from these four aspects: platelet production disorder or ineffective production, increased platelet destruction or excessive consumption, abnormal platelet distribution, and pseudothrombocytopenia

If the drug causes bone marrow suppression, which in turn leads to reduced platelet production, then whole blood cells such as red blood cells should also be reduced, but this patient does not

Therefore, a comprehensive analysis considers that the patient's increased platelet consumption led to a progressive decline in PLT, and the "culprit" of the increased consumption is the infection that has not been completely controlled

【Summarize】

The case of continuous platelet decline also told me that I should not just look at a certain index for more truth, but should combine all the patients' examinations and symptoms, and conduct a comprehensive analysis and consideration from the overall situation

The case of continuous platelet decline also told me that I should not just look at a certain index for more truth, but should combine all the patients' examinations and symptoms, and conduct a comprehensive analysis and consideration from the overall situation
.
It cannot be ruled out that although there are some cases of drug-induced thrombocytopenia, such as "Gentamicin-induced thrombocytopenia 1 case" reported by Teacher Ma Xiaolong, drug-induced thrombocytopenia is still relatively rare after all.
Exclusionary diagnosis should be done carefully at work
.

【references】

【references】

[1] Ge Junbo , Xu Yongjian, Wang Chen.
Internal Medicine 9th Edition [M].
Beijing: People's Medical Publishing House, 2018: 625

[1] Ge Junbo , Xu Yongjian, Wang Chen.
Internal Medicine 9th Edition [M].
Beijing: People's Medical Publishing House, 2018: 625 Ge Junbo

[2] Lin Guowei, Wang Jiyao, Ge Junbo.
Practical Internal Medicine 15th Edition [M].
Beijing: People's Medical Publishing House, 2017: 1853-1854

[2] Lin Guowei, Wang Jiyao, Ge Junbo.
Practical Internal Medicine 15th Edition [M].
Beijing: People's Medical Publishing House, 2017: 1853-1854

[3] Ma Xiaolong, Wang Xiaodan, Zhang Jiyan, Wang Fengjin.
A case of drug-induced thrombocytopenia caused by gentamicin[J].
Chinese Journal of Drug Application and Monitoring, 2018, 18(2): 137-139

[3] Ma snapdragon, Wang Xiaodan, Zhangji Yan, Jin Wang gentamicin drug-induced thrombocytopenia in 1 case [J] Chinese Journal of Drug Application and Monitoring, 2018,18 (2): 137-139

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