van den Hurk K, Veenstra J, Hendriks H A
OLVG locatie west, Amsterdam.
Ned Tijdschr Geneeskd. 2016;160:D417.
Thrombocytopenia can be caused by many different underlying disorders. The diagnostic approach to this haematological abnormality may, therefore, be challenging for physicians. Causes of thrombocytopenia may be classified according to decreased production, increased peripheral consumption or destruction, or abnormal distribution of platelets. Additionally, it is important to rule out pseudothrombocytopenia, a laboratory artefact caused in vitro by ethylenediaminetetraacetic acid (EDTA) anticoagulants. Here we discuss the clinical and laboratory evaluation of drug-induced thrombocytopenia based on the description of two patients, one with ceftriaxone-induced thrombocytopenia and the other with heparin-induced thrombocytopenia. Drug-induced thrombocytopenia is rare, but it is an important consideration in the differential diagnosis of thrombocytopenic patients. The aetiology is often not recognised or is ascribed to other complications such as disseminated intravascular coagulation (DIC) or immune thrombocytopenia (ITP). Misdiagnosis or late recognition may result in morbidity and mortality due to bleeding or thrombotic complications.
血小板减少症可由许多不同的潜在疾病引起。因此,对于医生来说,对这种血液学异常的诊断方法可能具有挑战性。血小板减少症的病因可根据血小板生成减少、外周消耗或破坏增加、或血小板分布异常进行分类。此外,排除假性血小板减少症很重要,这是一种由乙二胺四乙酸(EDTA)抗凝剂在体外引起的实验室假象。在此,我们基于两名患者的描述讨论药物性血小板减少症的临床和实验室评估,一名患者为头孢曲松引起的血小板减少症,另一名患者为肝素引起的血小板减少症。药物性血小板减少症很罕见,但在血小板减少症患者的鉴别诊断中是一个重要的考虑因素。其病因往往未被认识到,或归因于其他并发症,如弥散性血管内凝血(DIC)或免疫性血小板减少症(ITP)。误诊或延迟诊断可能会因出血或血栓形成并发症导致发病和死亡。