Piperacillin Induced Acute Severe Thrombocytopenia during VV ECMO in COVID19 Pneumonia: Case Report and Review of the Literature
Asian Hematology Research Journal,
Piperacillin-tazobactam is a frequently used antibiotic that has a broad spectrum of antibacterial activity and a wide safety profile. The development of thrombocytopenia following the use of piperacillin is usually a gradual phenomenon occurring several days following the first exposure, which is usually mild and passed unnoticed However, re-exposure can cause severe rapid thrombocytopenia secondary to pre-existing antibodies. Thrombocytopenia is relatively common during VV ECMO and multifactorial in nature. We present a case of acute severe thrombocytopenia after re-exposure to piperacillin during a prolonged VV ECMO run for COVID 19 respiratory failure leading to diagnostic challenge, after withdrawal of the piperacillin the acute severe thrombocytopenia improved dramatically, also we provide literature review for the similar cases available in the literature. Our case unique in that it had happened in ECMO patient with severe COVID ARDS, and we clinically confirmed that the piperacillin component of TZP is the culprit for the acute severe thrombocytopenia.
- VV ECMO
How to Cite
George JN, Aster RH. Drug-induced thrombocytopenia: pathogenesis, evaluation, and management. Hematology Am Soc Hematol Educ Program. 2009; 153-158.
Aster RH, Curtis BR, McFarland JG, Bougie DW. Drug-induced immune thrombocytopenia: pathogenesis, diagnosis, and management. J Thromb Haemost. 2009;7(6):911-8.
Hackett T, Kelton JG, Powers P. Drug-induced platelet destruction. Semin Thromb Hemost. 1982;8(2):116-37.
Arnold DM, Nazi I, Warkentin TE, et al. Approach to the diagnosis and management of drug-induced immune thrombocytopenia. Transfus Med Rev. 2013;27(3):137-145.
Esteban Olivera, Prabhudas Lakhani & Chatrchai Watanakunakorn Isolated Severe Thrombocytopenia and Bleeding Caused by Piperacillin, Scandinavian Journal of Infectious Diseases. 1992;24 (6):815-817.
Perez-Vazquez A, Pastor JM, Riancho JA. Immune thrombocytopenia caused by piperacillin/tazobactam. Clin Infect Dis. 1998;27(3):650–651.
Yan MT, Chu HY, Chau T, Lin SH. Profound thrombocytopenia associated with piperacillin in a hemodialysis patient. Clin Nephrol. 2009;72(3):240-3.
Rousan TA, Aldoss IT, Cowley BD, Curtis BR, Bougie DW, Aster RH, et al. Recurrent acute thrombocytopenia in the hospitalized patient: Sepsis, DIC, HIT, or antibiotic-induced thrombocytopenia. American Journal of Hematology; 2009.
Anand A, Chauhan HK. Piperacillin and vancomycin induced severe thrombo cytopenia in a hospitalized patient. Platelets. 2011;22(4):294-301.
Lin SY, Huang JC, Shen MC, Chuang SH, Lee MH, Chen HC. Piperacillin-induced thrombocytopenia reversed by high-flux hemodialysis in an uremic patient. Hemodial Int. 2012 Oct;16 Suppl 1:S50-3.
Macwilliam JL, Mistry R, Floyd MS Jr, Baird AD. Piperacillin/tazobactam induced thrombocytopaenia--a delayed response. BMJ Case Rep. 2012;9;bcr0320125981.
Uzun G, Onem Y, Hatipoglu M, Turhan V, Mutluoglu M, Ay H. Piperacillin/ tazobactam-induced neutropenia, thrombocytopenia, and fever during treatment of a diabetic foot infection. Scand J Infect Dis. 2013;45 (1):73-6.
Shaik S, Kazi HA, Ender PT. Rapid-onset piperacillin-tazobactam induced thrombocytopenia. J Pharm Pract. 2015; 28(2):204-6.
Boyce K, Brar H, Stabler SN. Piperacillin/tazobactam-induced immune-mediated thrombocytopenia in the intensive care unit. J Clin Pharm Ther. 2016;41(6):730-732.
Patel S, Levin-Epstein R, Kobashigawa J. Piperacillin-induced Thrombocytopenia in a Dual Heart and Kidney Transplant Patient: A Case Report. Transplant Proc. 2017;49(7):1672-1674.
Alzahrani M, Alrumaih I, Alhamad F, Abdel Warith A. Rapid onset severe thrombocytopenia following reexposure to piperacillin-tazobactam: report of two cases and review of the literature. Platelets. 2018;29(6):628-631.
Masroujeh R, Bonder B, Mandviwala A, Haj Abdulkader A. Internal Medicine, Rapid Near-Fatal Piperacillin/Tazobactm-Induced Thrombocytopenia. American Journal of Respiratory and Critical Care Medicine. 2018;197:A6928.
Beaulieu C, Kurczewski L, Yajnik V. Cefepime challenge after piperacillin/tazobactam-induced thrombocytopenia. J Thromb Thrombolysis. 2019;48(1):167-170.
Minh-Tri H, Nguyen MD, Pavneet Kaur MD, Richard H. Aster, MD, Vidya Krishnan, MD MHS Blood; 2019.
Chen S, Cooper N, Müller M, Bein G, Sachs UJ. Piperacillin-dependent anti-platelet antibodies are a relevant, easy to confirm differential diagnosis in patients with rapid-onset thrombocytopenia. Br J Haematol. 2020;190(5):e320-e321.
Abstract View: 298 times
PDF Download: 70 times