Vancomycin-induced immune thrombocytopenia: a review based on a clinical case
Thrombocytopenia is a common condition, particularly in a critical care setting. It can result from multiple conditions, including drug-related adverse effects. The link between vancomycin and thrombocytopenia was first described in 1985, with several case reports published ever since. The main goal of this article is to summarize the available knowledge about this condition.
We performed a review of available literature in PubMed and ISI Web of Knowledge, from which pertinent information on prevalence, natural history, clinical presentation, diagnosis and management was extracted.Vancomycin-induced immune thrombocytopenia occurs after at least six days of exposure and platelet levels return to normal eight days after vancomycin discontinuation. The mechanism behind this phenomenon seems to be an immune mediated reaction involving vancomycin-directed antibody. Patients might present with no or mild symptoms, but one third have severe haemorrhagic manifestations requiring urgent management. The correct diagnosis of this condition is essential, since the most important therapeutic measure is stopping the culprit drug. Some other treatments have been proposed, namely steroids, but with no proven benefit.
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