DRUG-INDUCED THROMBOCYTOPENIA - TCPEHA药物引起的血小板减少症- tcpeha.pptVIP

DRUG-INDUCED THROMBOCYTOPENIA James N. George, M.D. EHA Working Group on Thrombocytopenias June 10, 2004 Drug-Induced Thrombocytopenia Frequency is uncertain Frequency of medication use increases with age Frequency of alternative medicine use is increasing at all ages Drug-Induced Thrombocytopenia Often initially diagnosed as ITP Correct diagnosis is essential to: avoid inappropriate treatment prevent recurrence Frequency of Drug-Induced Thrombocytopenia Sweden (1966-1970) 1.0/100,000/year Denmark (1968-1991) 1.0/100,000/year U.S. (1972-1991) 0.6/100,000/year U.S. (1983-1991) 1.8/100,000/year Frequency of Drug Use in Adults Ages 65 Years or Older 1 medication/week 90% 5 or more different medications/week 40% 10 or more different medications/week 12% JAMA 2002; 287:337 Frequency of Complementary and Alternative Medicine Use in the U.S. 1997:12.1% of U.S. adults had used an herbal medicine in the previous 12 months, compared to 2.5% in 1990 (JAMA 1998; 280:1569) 2001 in U.S.: $4.2 billion spent on herbs and botanical remedies (NEJM 2002; 347:2073) 443 Web sites market herbal products (JAMA 2003; 290:1505) Drug-Induced Thrombocytopenia Initial Diagnosis as ITP 343 patients registered as ITP, 1993-1999 28 (8%) excluded because of subsequent diagnosis of drug-induced thrombocytopenia Quinine most common cause (13 of 28, 46%) Neylon, Br J Haem 2003; 122:966 Recurrent Acute ITP 68 yo man, ITP diagnosed in 1992, required splenectomy, complete response. January 1999: MI, CABG. 12-20-99: extensive purpura, severe epistaxis, plt 2000. DC all meds: glucotrol, clonidine, HCTZ, aspirin, cayenne pepper pills, arthrx, quinine. Treat with IV steriod, IVIG. Plt → 44,000 on 12-23; 379,000 on 12-27. Home on prednisone, insulin J Okla State Med Assoc 2000; 93:519 Calvin’s story. /jgeorge Recurrent Acute ITP 12-28-99: recurrent severe bleeding, plt 5000, IVIG. Plt → 302,000 on 1-3. 1-6-00: recurrent severe bleeding, plt 2000, IVIG, cytoxan. Plt →