%0 Journal Article
%T Severe, Refractory Thrombocytopenia in a Critically Ill Patient Caused by
Vancomycin Induced Antibodies
%J -
%D 2017
%X The differential diagnosis for isolated thrombocytopenia in critically ill patients is broad and includes sepsis, disseminated intravascular coagulation and thrombotic thrombocytopenic purpura and medication effects. Vancomycin, a commonly used antibiotic for hospitalacquired infections, can cause severe, refractory thrombocytopenia due to antibody-mediated platelet destruction. This was first described in 2007 based on 12 case reports of vancomycin-associated thrombocytopenia. The study looked at 29 patients and demonstrated that the thrombocytopenia was immune mediated. We describe a unique case of severe vancomycin induced thrombocytopenia with a lower nadir and longer effect duration than previously described. Our patient is a 70- year-old man who presented with upper respiratory symptoms and was diagnosed with post-influenza pneumonia. Twelve days after completing a course of vancomycin and piperacillin/tazobactam, he developed another episode of sepsis and was resumed on antibiotics. After receiving a dose of vancomycin, the patient¡¯s platelet count decreased from 197,000/¦̀L to 1,000/¦̀L. This case illustrates the importance of awareness of vancomycin induced thrombocytopenia. The platelet destruction is caused by a platelet-specific drugdependent antibody formation. Blood samples should be tested for the antibodies using immunofluorescence by flow cytometry; however, the results may be falsely negative if they were obtained after the patient has received platelet transfusions. This presents a diagnostic challenge and requires maintaining a high index of suspicion as treatment interventions include avoiding drug exposure
%K Van K. Holden
%K Platelets
%K Thrombocytopenia
%K Vancomycin
%K Immunofluorescence
%U https://www.imedpub.com/abstract/severe-refractory-thrombocytopenia-in-a-critically-ill-patient-caused-byrnvancomycin-induced-antibodies-18147.html