Oxaliplatin and Methylprednisolone-induced Thrombocytopenia and Monocytopenia, Owing to Anti-GPIIbIIIa and -CD36 Antibodies in a Patient With Colorectal Cancer

Bevacizumab-induced immune thrombocytopenia in an ovarian cancer patient with mixed connective tissue disease: case report and literature review

Drug-induced immune thrombocytopenia is an adverse reaction marked by accelerated destruction of blood platelets. In cancer therapy, thrombocytopenia has many other causes including bone marrow suppression induced by chemotherapeutic agents, infection, and progression of cancer; drug-induced thrombocytopenia can easily be misdiagnosed or overlooked. Here, we present a case of an ovarian cancer patient with a history of mixed connective tissue disease who underwent surgery followed by treatment with paclitaxel, cisplatin, and bevacizumab. The patient developed acute isolated thrombocytopenia after the sixth cycle. Serum antiplatelet antibody testing revealed antibodies against glycoprotein IIb. After we analyzed the whole therapeutic process of this patient, drug-induced immune thrombocytopenia was assumed, and bevacizumab was conjectured as the most probable drug. Thrombocytopenia was ultimately successfully managed using recombinant human thrombopoietin, prednisone, and recombinant human interleukin-11. We provide a summary of existing literature on immune thrombocytopenia induced by bevacizumab and discuss related mechanisms and triggers for drug-induced immune thrombocytopenia. The present case underscores the potential of bevacizumab to induce immune-mediated thrombocytopenia, emphasizing the need for heightened vigilance towards autoimmune diseases or an autoimmune-activated state as plausible triggers for rare drug-induced immune thrombocytopenia in cancer therapy.

Acute drug-induced immune thrombocytopenia - A work of articaine

Background

Drug‐induced immune thrombocytopenia (DITP) is a rare, but serious complication to a wide range of medications. Upon suspicion, one should do a thorough clinical evaluation following proposed diagnostic criteria and seek laboratory confirmation. If confirmed, it is important to ensure avoidance of the drug in the future.

Study design and methods

Herein, we describe a young adult male who experienced two bouts of severe thrombocytopenia following dental treatment. The thrombocytopenia was acknowledged due to unexpected hemorrhaging during the procedures. On both occasions, he was exposed to four different drugs, none commonly associated with DITP. After the second episode of severe procedural‐related thrombocytopenia, an investigation into the cause was initiated. We describe the clinical approach to elucidate which of the four implicated drugs was responsible for thrombocytopenia and the laboratory work‐up done to confirm that the reaction was antibody‐mediated and identify the antibody's drug: glycoprotein specificity. An alternative drug was tested both in vivo and in vitro, to identify an option for future procedures.

Results

Sequential exposure revealed the local anesthetic substance articaine to induce thrombocytopenia. Laboratory work‐up confirmed drug‐dependent antibodies (DDAbs) with specificity for the glycoprotein Ib/IX complex, swiftly identified by a bead‐based Luminex assay. Further investigations by monoclonal antibody immobilization of platelet antigens assay (MAIPA) revealed a probable GPIb binding site. An alternative local anesthetic, lidocaine, was deemed safe for future procedures.

Conclusion

Articaine can induce rapid‐onset, severe immune‐mediated thrombocytopenia causing bleeding complications. A modified bead‐based Luminex platelet antigen assay proved a useful addition in the DITP‐investigation.

Panitumumab-Associated Drug-Induced Immune Thrombocytopenia in a Patient with Colorectal Cancer

Severe thrombocytopenia is a rare adverse event of panitumumab. Here, we report the first patient with metastatic colorectal cancer who developed severe thrombocytopenia, diagnosed as panitumumab-associated drug-induced immune thrombocytopenia (DITP). A clinical diagnosis of DITP can be obtained by excluding other causes of thrombocytopenia and is confirmed by the recovery of thrombocytopenia after the discontinuation of the suspected drug. Treatment includes permanent discontinuation of the suspected drug. Re-exposure should be avoided. It should be kept in mind that panitumumab can induce DITP in the case of a new, sudden, unexpected, and isolated drop in platelet count after excluding other causes of thrombocytopenia.