Yamanouchi Jun, Hato Takaaki, Shiraishi Sanshiro, Takeuchi Kazuto, Yakushijin Yoshihiro, Yasukawa Masaki
Departments of Hematology, Clinical Immunology and Infectious Diseases, Ehime University Graduate School of Medicine, Japan.
Intern Med. 2016;55(20):3035-3038. doi: 10.2169/internalmedicine.55.6902. Epub 2016 Oct 15.
Vancomycin-induced thrombocytopenia is a rare adverse reaction that may be overlooked because no specific diagnostic test is currently available. We herein report a patient with vancomycin-induced immune thrombocytopenia who was diagnosed by the detection of vancomycin-dependent anti-platelet antibody with flow cytometry. An IgG antibody in the patient's serum reacted with platelets only in the presence of vancomycin. Severe thrombocytopenia gave rise to life-threatening gastrointestinal bleeding, which was quickly resolved after effective platelet transfusion following the cessation of vancomycin administration. This report suggests that the flow cytometric test is useful for the differential diagnosis of thrombocytopenia and platelet transfusion should be performed after the cessation of vancomycin administration.
万古霉素诱导的血小板减少是一种罕见的不良反应,由于目前尚无特异性诊断试验,可能会被忽视。我们在此报告一例万古霉素诱导的免疫性血小板减少患者,该患者通过流式细胞术检测万古霉素依赖性抗血小板抗体得以确诊。患者血清中的IgG抗体仅在有万古霉素存在的情况下与血小板发生反应。严重的血小板减少导致危及生命的胃肠道出血,在停用万古霉素后进行有效的血小板输注后,出血迅速得到缓解。本报告表明,流式细胞术检测对于血小板减少的鉴别诊断有用,且应在停用万古霉素后进行血小板输注。