Platelet count reactions

Other adverse reactions associated with penicillin are hematopoietic changes such as anemia, thrombocytopenia (low platelet count), leukopenia (low white blood cell count), and bone marrow depression. When penicillin is given orally, glossitis (inflammation of the tongue), stomatitis (inflammation of die mouth), dry mouth, gastritis, nausea, vomiting, and abdominal pain occur. When penicillin is given intramuscularly (IM), there may be pain at die injection site Irritation of the vein and phlebitis (inflammation of a vein) may occur witii intravenous (IV) administration. 

More than half of the patients receiving this drug by the parenteral route experience some adverse reaction. Severe and sometimes life-threatening reactions include leukopenia (low white blood cell count), hypoglycemia (low blood sugar), thrombocytopenia (low platelet count), and hypotension (low blood pressure). Moderate or less severe reactions include changes in some laboratory tests, such as the serum creatinine and liver function tests. Other adverse reactions include anxiety, headache, hypotension, chills, nausea, and anorexia Aerosol administration may result in fatigue a metallic taste in the mouth, shortness of breath, and anorexia... 

Monitoring Monitor for hematologic reactions common to sulfonamides. Obtain baseline CBC and platelet counts before therapy and at regular intervals during therapy. 

Clarithromycin Adverse reactions occurring in at least 3% of patients include abdominal pain, abnormal taste, diarrhea, increased BUN, nausea, and rash. Dirithromycin Adverse reactions occurring in at least 3% of patients include abdominal pain/discomfort, diarrhea/loose stools, headache, increased platelet counts, nausea, and vomiting. 

Erythromycin Adverse reactions occurring in at least 3% of patients include abdominal pain/discomfort, diarrhea/loose stools, headache, increased platelet count, and nausea. 

Thrombopoietin is a cytokine that selectively stimulates megakaryocytopoiesis. Thrombopoeitin is not used therapeutically. Theoretical uses include the procurement of platelets for donation and recovery of platelet counts after myelosuppressive chemotherapy. Flowever, a modified recombinant form caused paradoxical reactions, delaying the development of therapeutic thrombopoietin. 

The bleeding potential is similar among the agents. However, thrombocytopenia, particularly profound thrombocytopenia (platelet count <50,000 mrrT3) occurs with a two-to four-fold higher frequency with abciximab (0.4— 1.0%) compared with eptifibatide (0-0.2%) or tirofiban (0,1 —0.3%) (6), The exact mechanism of this difference is not clear, However, immune complex-mediated reaction (due to an anamnestic response to the humanized chimeric antibody) may contribute to rapid precipitation of thrombocytopenia with abciximab (6), Platelet counts should, therefore, be measured early (within the first one to four hours) after administration of these agents and followed for the duration of therapy. Platelet transfusion should be considered for profound thrombocytopenia with or without serious bleeding (6). 

Re-administration might be an issue for abciximab, due to its inherent immunogenicity. Human antichimeric antibody is detectable in about 5% to 6% patients receiving abciximab therapy, but no antibodies have been observed in response to the small molecules. In practice, re-administration registry of 500 patients showed similar safety and efficacy for repeat administration when compared with first time administration (80). No reports of hypersensitivity or anaphylactic reactions were reported with abciximab re-administration. Thus, these agents can be safely re-administered with careful monitoring of platelet counts, especially with abciximab therapy. 

The side effects observed in the clinic with the early 100% and 90% w/v concentrated PFOB formula-tions and with Oxyfluor consisted of early effects, during or shortly after infusion, including headache and occasional lower backache, and delayed effects (2-12 h), referred to as flu-like symptoms e.g., fever, occasional chills and nausea.These reactions, generally categorized as mild, were transient and fully reversible within 4-12 h. A transient, moderate drop (about 15%) in platelet count was seen about 3 days after dosing. Similar effects have been documented for parenteral fat emulsions and liposomes, indicating that these effects were likely related to the particulate nature of the emulsion. 

Because of its antigenic potential, there are theoretical concerns about the readministration of abciximab, and this has been studied in 1342 patients, who underwent percutaneous coronary interventions and received abciximab at least twice (25). There were no cases of anaphylaxis, and there were only five minor allergic reactions, none of which required termination of the infusion. There was clinically significant bleeding in 31 patients, including one with intracranial hemorrhage. There was thrombocytopenia (platelet count below 100 X 10 /1) in 5% and profound thrombocytopenia (platelet count below 20 x 10 /1) in 2%. In patients who received abciximab within 1 month of a previous treatment (n = 115), the risks of thrombocytopenia and profound thrombocytopenia were 17 and 12% respectively. Human chimeric antibody titers before... 

Type I heparin-induced thrombocytopenia is common and is characterized by a mild transient thrombocytopenia (with platelet counts that usually do not fall below 50 X 10 /1) the thrombocytopenia occurs on the first few days of heparin administration (usually 1-5 days) and requires careful monitoring but not usually withdrawal of heparin. Type I thrombocytopenia is generally harmless and very probably results from direct heparin-induced platelet aggregation. Thrombocjdopenia is most common when large doses of heparin are used, or in some particular circumstances, such as after thrombolytic therapy (35) or in the early orthopedic postoperative period (36) it can abate in spite of continued therapy. Tjrpe I thrombocytopenia is a non-immune reaction, probably due to a direct activating effect of heparin on platelets. 

Phenylbutazone brings about a number of changes in the blood. In rabbits it decreases total protein albumin, but increases globulin.1500 There is frequently a drop in the platelet count, mild anemia, occasionally hemorrhage from the gastrointestinal tract and sometimes granulocytopenia. The most serious blood reaction is the occurrence of 6+c.h.c. 20... 

Heparin can cause at least two types of thrombocytopenia. The first is a mild, reversible, non-immune-mediated reaction that occurs 2 to 4 days after the initiation of therapy. The platelet count slowly returns to normal following an initial decline, despite continued heparin therapy. This benign condition is thought to result from weak activation of platelets, leading to sequestration. No major sequelae develop from this type of heparin-induced thrombocytopenia. 

The second type of heparin-induced thrombocytopenia is severe and may be associated with a platelet count below 100,000/mm and thrombosis. ° ° The platelet count generally begins to decline 5 to 10 days after the start of heparin therapy (sooner in patients previously treated with heparin). Thrombocytopenia and thrombosis may develop with low-dose heparin, heparin-coated catheters, or even heparin flushes. Historically, the reaction was thought to be mediated by the formation of antibodies to the platelet-heparin complex. However, evidence suggests a complex interaction between heparin, platelet factor 4 (PF4), platelet membrane Fc receptors, and possibly heparin-like molecules on the surface of endothehal cells (Fig. 102-6). Circulating heparin reacts with PF4 to produce a... 

Heparin-induced thrombocytopenia (platelet count <150,000/ml or a 50% decrease from the pretreatment value) occurs in about 0.5% of medical patients 5 to 10 days after initiation of therapy with standard heparin. The incidence of thrombocytopenia is lower with low-molecular-weight heparin. Thrombotic complications that can be life threatening or lead to amputation occur in about one-half of the affected heparin-treated patients and may precede the onset of thrombocytopenia. The incidence of heparin-induced thrombocytopenia and thrombosis is higher in surgical patients. Venous thromboembolism occurs most commonly, but arterial thromboses causing limb ischemia, myocardial infarction, and stroke also occur. Bilateral adrenal hemorrhage, skin lesions at the site of subcutaneous heparin injection, and a variety of systemic reactions may accompany heparin-induced thrombocytopenia. The development of IgG antibodies against complexes of heparin with... 

Complete blood counts often reveal leukocytosis with a left shift. Leukemoid reactions with up to 100,000 white blood cells per microliter may be seen, especially in children. Platelet counts may be normal or low, and partial thromboplastin times are often increased. When DIC is present, fibrin degradation products will be elevated. Because of liver involvement, alanine aminotransferase, aspartate aminotransferase, and bilirubin levels are often increased. 

The compound quinine has been reported to cause thrombotic thrombocytopenic purpura (a disorder that causes blood clots to form in small blood vessels and leads to a low platelet count) in sensitive individuals. This condition has been associated with use of quinine tablets and tonic water containing quinine. Individuals can become sensitized to cinchona alkaloids and develop sudden reactions after long-term use (Belkin 1967 Brasic and Baltimore 2001 Howard et al. 2003). 

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