Sahoo Swapnajeet, Singla Himanshu, Spoorty M, Malhotra Pankaj, Grover Sandeep
Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Psychiatry. 2016 Jul-Sep;58(3):339-341. doi: 10.4103/0019-5545.192005.
There is limited literature on olanzapine-associated thrombocytopenia. In this report, we present a case of a 32-year-old female, suffering from persistent delusional disorder who had thrombocytopenia (46,000/mm) with the use of olanzapine 25 mg/day, 6 weeks after starting medication. Blood film did not reveal any evidence of any dysplastic cells, disturbance in the count of other cell lines, and autoimmune workup including antinuclear antibodies and anti-neutrophil cytoplasmic antibodies were found to be negative. Given no other etiology, olanzapine was gradually tapered, and platelet counts were monitored. Reduction in the dose of olanzapine led to an improvement in platelet counts which reached the normal range after complete stoppage of olanzapine. In view of continued psychotic symptoms, she was started on clozapine and which was gradually increased to 200 mg/day with biweekly monitoring of total platelet counts before each increment in the dose of clozapine. Thrombocytopenia did not recur with use of clozapine. With clozapine, her psychosis improved by nearly 60%. A review of literature revealed only eight case reports supporting the association of olanzapine and thrombocytopenia.
关于奥氮平相关血小板减少症的文献有限。在本报告中，我们介绍了一例32岁女性病例，该患者患有持续性妄想障碍，在开始服用奥氮平25毫克/天6周后出现血小板减少（46,000/mm）。血涂片未发现任何发育异常细胞的证据、其他细胞系计数异常，且包括抗核抗体和抗中性粒细胞胞浆抗体在内的自身免疫检查均为阴性。由于没有其他病因，奥氮平逐渐减量，并监测血小板计数。奥氮平剂量的减少导致血小板计数改善，在完全停用奥氮平后血小板计数达到正常范围。鉴于持续存在的精神病症状，她开始服用氯氮平，并逐渐增加至200毫克/天，在每次增加氯氮平剂量前每两周监测一次血小板总数。使用氯氮平时血小板减少症未复发。使用氯氮平后，她的精神病症状改善了近60%。文献综述显示，仅有八篇病例报告支持奥氮平与血小板减少症的关联。
