Yohannan Binoy, Luu Dai Chu N, Feldman Mark
Department of Internal Medicine, Texas Health Presbyterian Hospital, Dallas, Texas 75231, USA.
Department of Internal Medicine, Division of Hematology and Oncology, Texas Health Presbyterian Hospital, Dallas, Texas 75231, USA.
Case Rep Hematol. 2019 Mar 12;2019:4319148. doi: 10.1155/2019/4319148. eCollection 2019.
Drug-associated thrombocytopenia is often unrecognized. We report a 76-year-old female with lymphoma who presented with easy bruising and oral bleeding. She had undergone screening for hepatitis B virus (HBV) prior to starting rituximab and was found to have hepatitis B core serum antibody (IgG anti-HBc). She was therefore treated with prophylactic entecavir 0.5 mg daily to prevent reactivation of HBV. Her initial platelet count was 136,000/mm. Five days after starting entecavir, she presented with bruising and oral bleeding and was found to have a platelet count of 7,000/mm. A coagulation profile and the rest of the blood parameters (RBC and WBC counts) were normal. Entecavir was stopped, and she was given 3 units of apheresed platelets followed by intravenous immunoglobulin (1 g/kg) for 5 consecutive days. Her platelet counts improved and normalized in one week. She was diagnosed with entecavir-induced thrombocytopenia based on the temporal relationship and after carefully excluding alternate causes of thrombocytopenia. This case highlights the importance of recognizing drug-induced thrombocytopenia (DITP) as a reversible cause of thrombocytopenia.
药物相关性血小板减少症常常未被识别。我们报告一例76岁患有淋巴瘤的女性，她出现了易瘀斑和口腔出血症状。在开始使用利妥昔单抗之前，她接受了乙肝病毒（HBV）筛查，发现有乙肝核心血清抗体（IgG抗-HBc）。因此，她接受了每天0.5毫克恩替卡韦的预防性治疗，以防止HBV再激活。她最初的血小板计数为136,000/mm³。开始使用恩替卡韦五天后，她出现了瘀斑和口腔出血，血小板计数为7,000/mm³。凝血指标以及其余血液参数（红细胞和白细胞计数）均正常。停用恩替卡韦，并给她输注了3个治疗量的单采血小板，随后连续5天静脉注射免疫球蛋白（1克/千克）。她的血小板计数在一周内得到改善并恢复正常。基于时间关系并在仔细排除血小板减少的其他原因后，她被诊断为恩替卡韦诱导的血小板减少症。该病例凸显了将药物性血小板减少症（DITP）识别为血小板减少症可逆病因的重要性。
