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Drug-induced Thrombocytopenia
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Slides BleedingDisorders QuantitativePlateletAbnormalities.pdf
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00:01 Drug-induced thrombocytopenia. 00:02 If you missed our discussion on heparin, please make sure that you refer to our hematology hemodynamic pharmacology where I talked about in great detail the possibility when given heparin at the site of injection where there's a possibility in sub-set of population in which may then activate the platelet via platelet factor IV. 00:21 And by doing so, you may then form a thrombi formation and result in thrombocytopenia. 00:25 Other causes, quinidine class 1A sodium-channel blocker, sulphas, methyldopa. 00:32 That'll be in alpha 2 agonist that you may then give a pregnant lady who has hypertension prior, was on ACE inhibitor, obviously, needs to remove that, right? Because ACE inhibitor will kill the kidneys of the fetus or teratogen. 00:45 And unfortunate the patient may then develop thrombocytopenia. 00:50 Also penicillins and also thiazide diuretics. 00:55 HIV-associated thrombocytopenia. 01:00 This is important. 01:01 So now you have antibodies formed against HIV antigen. 01:05 The gp120 cross-react with the platelet surface antigen. 01:11 In other words, we have example of molecular mimicry of IIb/IIIa. 01:15 Unbelievable. 01:16 And now what happens is the antibodies bind to the platelet which are then cleared by the spleen. 01:23 The particular antigen or chemokine receptor that you wanna know that allows for entry of HIV in the platelet, if you remember from microbiology it's called CXCR4. 01:32 Keep that in mind please. 01:34 But at this point, in pathology with HIV, take a look at molecular mimicry with gp120 if you remember that from your HIV discussion.
About the Lecture
The lecture Drug-induced Thrombocytopenia by Carlo Raj, MD is from the course Hemostasis: Basic Principles with Carlo Raj.
Included Quiz Questions
Which of the following best describes the pathogenesis of heparin induced thrombocytopenia?
- Binding of antibodies to complexes of heparin and platelet factor 4, causing platelet activation and promoting a prothrombotic state
- Immunoglobulin G antibodies against platelet membrane glycoproteins IIb-IIIa or Ib-IX, causing platelet destruction
- Massive systemic intravascular activation of coagulation, leading to widespread deposition of fibrin in the circulation
- Systemic deposition of platelet thrombi with abundance of von Willebrand factor (vWF) due to autoimmune destruction of ADAMTS13
- Infiltration and replacement of normal marrow space by nonhematopoietic or abnormal cells
Infection with which of the following pathogens is most likely to cause immune thrombocytopenia as a result of cross-reactive antibodies between the pathogen-gp120 and platelet gpIIIa?
- Human immunodeficiency virus
- Plasmodium falciparum
- Neisseria meningitidis
- Hepatitis C virus
- Mycobacterium tuberculosis
Author of lecture Drug-induced Thrombocytopenia
Carlo Raj, MD
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