Gold therapy thrombocytopenia with

Penicillamine (29) can be effective in patients with refractory RA and may delay progression of erosions, but adverse effects limit its useflilness. The most common adverse side effects for penicillamine are similar to those of parenteral gold therapy, ie, pmritic rash, protein uria, leukopenia, and thrombocytopenia. Decreased or altered taste sensation is a relatively common adverse effect for penicillamine. A monthly blood count, platelet count, and urinalysis are recommended, and also hepatic and renal function should be periodically monitored. Penicillamine is teratogenic and should not be used during pregnancy. 

Many drugs, especially quinidine and heparin, induce antibodies leading to thrombocytopenia. In most cases the antibodies are drug-dependent however, there are many examples in which the antibodies are autoimmune in nature [42], even for drugs, such as quinidine that are classically associated with drug-dependent antibodies [43], Gold therapy, in particular, is associated with autoimmune-thrombocytopenia [44],... 

Thrombocytosis is another common hematologic finding with active rheumatoid arthritis. Platelet counts rise and fall in direct correlation with disease activity in many patients. Thrombocytopenia may result from toxicity of gold salts, penicillamine, or immunosuppressive therapy. Thrombocytopenia also may be observed in Felty s syndrome or vascuhtis. 

Visentin GP, Wolfmeyer K, Newman PJ, Aster RH (1990) Detection of drag-dependent, platelet-reactive antibodies by antigen-capture ELISA and flow cytometry. Transfusion 30 694—700 von dem Borne AE, Pegels JG, van der Stadt RJ, van der Plas-van Dalen CM, Hehnerhorst FM (1986) Thrombocytopenia associated with gold therapy a drag-induced autoimmune disease ... 

A case is reported of a patient who after 5 months treatment with gold developed anaemia (Hct 26%) and thrombocytopenia (43,000/mm ) (49 ). Upon cessation of gold therapy the anaemia lessened but the platelet count fell to 2000/mm . Intravascular platelet survival appeared to be markedly decreased megakaryocytes were abundant in the bone marrow. 

Levin, H. A., McMillan, R., Tavassoli, M. et al. (1975) Thrombocytopenia associated with gold therapy. Observations on the mechanism of platelet destruction. Amer. J. Med., 59, 274. 

MTX is potentially toxic. Therefore, the nurse observes closely for development of adverse reactions, such as thrombocytopenia (see Nursing Alert in Gold Compounds section) and leukopenia (see discussion of adverse reactions associated with hydroxychloroquine). Hematology, liver, and renal function studies are monitored every 1 to 3 months with MTX therapy. The primary care provider is notified of abnormal hematology, liver function, or kidney function finding. The nurse immediately brings all adverse reactions or suspected adverse reactions to the attention of the primary health care provider. 

Kotsy MP, Hench PK, Tani P, McMillan R (1989) Thrombocytopenia associated with aurofin therapy evidence for a gold-dependent immunologic mechanism. Am J Hematol, 30 236-239. 

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