Knower Mark T, Bowton David L, Owen John, Dunagan Donnie P
Section on Pulmonary and Critical Care, Ochsner Clinic North Shore, 804 Heavens Drive, Suite 105, Mandeville, LA 70471, USA.
Section on Pulmonary and Critical Care, Wake Forest University School of Medicine, Winston-Salem, WC, USA.
Intensive Care Med. 2003 Jun;29(6):1007-1011. doi: 10.1007/s00134-003-1732-0. Epub 2003 Apr 8.
To describe the clinical course of quinine-induced disseminated intravascular coagulation (DIC) and review all previous cases reported in the medical literature.
Case report/literature review.
University teaching hospital medical ICU.
One patient in whom thrombocytopenia, coagulopathy, intravascular hemolysis, DIC, and acute renal failure temporally followed the ingestion of quinine.
We conducted a computerized free-text MEDLINE database search from 1969 to 2000 using the keywords quinine and thrombocytopenia, quinine and hemolytic-uremic syndrome, and quinine and disseminated intravascular coagulation.
All reported cases and reviews of quinine-induced thrombocytopenia, hemolytic-uremic syndrome (HUS), and DIC were reviewed. DIC was distinguished from quinine-induced thrombocytopenia or quinine-induced HUS based on the presence of abnormal clotting times, elevated fibrin degradation products, and/or elevated D-dimer levels.
Fifteen previous patients were found to meet the criteria for DIC temporally related to the recent ingestion of quinine. The clinical course and laboratory abnormalities documented for each case are reviewed.
Quinine-induced DIC is a distinct clinical entity, which may present as unexplained thrombocytopenia, coagulopathy, or renal failure. In susceptible patients, the immune response to quinine may result in the production of not only anti-platelet antibodies but also antibodies against leukocytes, erythrocytes, and endothelial cells. Furthermore, the varying patterns and specificities of antibody production in an individual patient may result in a spectrum of clinical disease from mild, transient thrombocytopenia to overt intravascular hemolysis, renal failure, coagulopathy, and DIC. Early recognition of quinine-induced DIC is paramount, as this diagnosis affords a better prognosis than other adult forms of HUS or DIC.
描述奎宁诱发的弥散性血管内凝血（DIC）的临床病程，并回顾医学文献中既往报道的所有病例。
病例报告/文献综述。
大学教学医院的医疗重症监护病房。
1例患者在摄入奎宁后出现血小板减少、凝血病、血管内溶血、DIC和急性肾衰竭。
我们使用关键词“奎宁”和“血小板减少症”、“奎宁”和“溶血尿毒综合征”以及“奎宁”和“弥散性血管内凝血”，对1969年至2000年的计算机化自由文本MEDLINE数据库进行了检索。
对所有报道的奎宁诱发的血小板减少症、溶血尿毒综合征（HUS）和DIC的病例及综述进行了回顾。根据凝血时间异常、纤维蛋白降解产物升高和/或D-二聚体水平升高，将DIC与奎宁诱发的血小板减少症或奎宁诱发的HUS区分开来。
发现15例既往患者符合与近期摄入奎宁时间相关的DIC标准。对每个病例记录的临床病程和实验室异常情况进行了回顾。
奎宁诱发的DIC是一种独特的临床实体，可能表现为不明原因的血小板减少症、凝血病或肾衰竭。在易感患者中，对奎宁的免疫反应可能不仅导致抗血小板抗体的产生，还导致针对白细胞、红细胞和内皮细胞的抗体产生。此外，个体患者抗体产生的不同模式和特异性可能导致一系列临床疾病，从轻度、短暂的血小板减少症到明显的血管内溶血、肾衰竭、凝血病和DIC。早期识别奎宁诱发的DIC至关重要，因为与其他成人形式的HUS或DIC相比，这一诊断的预后更好。
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