DRUG-INDUCED IMMUNE THROMBOCYTOPENIA

Dr. Jensen presented a great case of thrombocytopenia at noon report today. An older gentleman with recent STEMI s/p PCI with DES presented with profound thrombocytopenia (platelets 14 —> 1) and was ultimately diagnosed with drug-induced immune thrombocytopenia due to Tirofiban (received at time of PCI). The diagnosis was confirmed with drug-dependent platelet antibody testing. Treatment was challenging given his recent STEMI with DES, concern for risk of myocardial wall rupture with high-dose steroids, and onset of GI bleeding. He was thus treated with the “platelet boiler-maker”.

Platelet Boilermaker…

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What’s that? A 24-hour continuous infusion of IVIG,1 g/kg, and four units of apheresis platelets, each infused over 6 h.

When do I use it? With major hemorrhage or need for rapid hemostasis in patients with ITP

Does it work? In a retrospective review at OHSU (by our very own heme team), 65% of patients showed a response after 24 hours (defined as platelets >30,000/uL and a twofold increase in baseline levels) .