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DJ Christie, N van Buren, SS Lennon and JL Putnam
Department of Laboratory Medicine and Pathology, University of Minnesota,
Minneapolis.
Two patients with leukemia experienced profound thrombocytopenia and
refractoriness to platelet transfusion during vancomycin treatment. In one
patient, withdrawal of drug and administration of platelet transfusions
restored platelet counts to near normal levels (approximately 100 x
10(9)/L), however, subsequent challenge with vancomycin due to recurring
infection again precipitated severe thrombocytopenia (platelets less than
10 x 10(9)/L) and life- threatening hemorrhagic symptoms. Potent
vancomycin-dependent antiplatelet antibodies were detected in the serum of
both patients during the refractory period using staphylococcal protein A
rosette formation. Employing a monoclonal antibody-antigen capture enzyme-
linked immunosorbent assay (ELISA), the patients were found to have
vancomycin-dependent IgG antibodies that bound specifically to platelet
glycoproteins (GP) IIb and/or IIIa. One of these antibodies failed to react
with platelets deficient in GPIIb/IIIa obtained from an individual with
Glanzmann's thrombasthenia. These findings provide the first major evidence
for drug-dependent antibodies in association with severe thrombocytopenia
and refractoriness to platelet transfusion in alloimmunized leukemia
patients and, further, provide the first demonstration of
vancomycin-dependent antibodies reactive with platelets.
This article has been cited by other articles:
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| Copyright © 1990 by American Society of Hematology Online ISSN: 1528-0020 | |||||||||
