Pedersen-Bjergaard U, Andersen M, Hansen P B
Department of Haematology and Internal Medicine, Herlev Hospital, University of Copenhagen, Denmark.
Eur J Clin Pharmacol. 1997;52(3):183-9. doi: 10.1007/s002280050272.
To analyse the clinical picture and the course of thrombocytopenia induced by non-cytotoxic drugs, and to evaluate a possible therapeutic effect of corticosteroids.
A retrospective analysis of 309 well-documented cases of drug-induced thrombocytopenia was performed. Data sources were reports from the files of the Danish Committee on Adverse Drug Reactions and discharge summaries.
The median length of exposure to the offending drug, before development of thrombocytopenia, was 21 days. The median nadir platelet count was 11 x 10(9).l-1, and 74% of the patients had clinical haemorrhage. Bone marrow examination generally showed hyperplastic reactive changes and a variable number of megakaryocytes. Slight leucopenia was present in 6% of the patients and 16% were anaemic. Complete recovery was seen in 87% of cases, with a median recovery rate of 8 days. The standard treatment was corticosteroids, which were administered in 53% of the cases. No difference in recovery between corticosteroid-treated and untreated patients was observed. No other clinical parameter affected the recovery rate. The mortality rate due to haemorrhage was 3.6%.
Thrombocytopenia induced by non-cytotoxic drugs is characterised by heterogeneous clinical picture and recovery is generally rapid. Although corticosteroids seem inefficient, we still recommend that severe symptomatic cases of drug-induced thrombocytopenia are treated as idiopathic thrombocytopenic purpura due to the difficult initial differentiation between the two conditions.
分析非细胞毒性药物所致血小板减少症的临床表现及病程，并评估皮质类固醇可能的治疗效果。
对309例记录完整的药物性血小板减少症病例进行回顾性分析。数据来源为丹麦药物不良反应委员会档案报告及出院小结。
血小板减少症发生前接触致病药物的中位时长为21天。血小板计数最低点的中位数为11×10⁹/L，74%的患者有临床出血表现。骨髓检查通常显示增生性反应性改变及数量不等的巨核细胞。6%的患者有轻度白细胞减少，16%的患者贫血。87%的病例完全恢复，中位恢复时间为8天。标准治疗为皮质类固醇，53%的病例使用了该药物。未观察到皮质类固醇治疗组与未治疗组在恢复情况上的差异。无其他临床参数影响恢复率。出血所致死亡率为3.6%。
非细胞毒性药物所致血小板减少症临床表现各异，恢复通常较快。尽管皮质类固醇似乎无效，但鉴于这两种情况在初期难以鉴别，我们仍建议将严重的药物性血小板减少症症状性病例按特发性血小板减少性紫癜进行治疗。
