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Chapter 77: Acquired Platelet Disorders

INTRODUCTION

  • The clinical manifestations of bleeding disorders are usually mild but may be severe if there is an accompanying hemostatic abnormality or a local lesion that may be predisposed to bleed.

  • The usual laboratory abnormalities are prolongation of the bleeding time and/or abnormal platelet aggregation, but these results do not necessarily predict the risk of clinical bleeding.

  • Table 77–1 lists the principal causes of acquired qualitative platelet abnormalities.

TABLE 77–1ACQUIRED QUALITATIVE PLATELET DISORDERS
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TABLE 77–1 ACQUIRED QUALITATIVE PLATELET DISORDERS
Drugs that affect platelet function
 Thienopyridines (ticlopidine,clopidogrel, and prasugrel)
 αIIbβ3 receptor antagonists
Drugs that increase platelet cyclic adenosine monophosphate
 Antibiotics
 Anticoagulants and fibrinolytic agents
 Cardiovascular drugs
 Volume expanders
 Psychotropic agents and anesthetics
 Antineoplastic drugs
 Foods and food additives
Hematologic disorders associated with abnormal platelet function
 Chronic myeloproliferative disorders
 Leukemias and myelodysplastic syndromes
 Dysproteinemias
 Acquired von Willebrand disease
Systemic disorders associated with abnormal platelet function
 Uremia
 Antiplatelet antibodies
 Cardiopulmonary bypass
 Liver disease
 Disseminated intravascular coagulation

Source: Williams Hematology, 8th ed, Chap. 122, Table 122–1, p. 1972.

DRUGS THAT AFFECT PLATELET FUNCTION

  • Table 77–2 lists drugs known to interfere with platelet function. Drugs are the most common cause of abnormal platelet function.

  • Some drugs can prolong the bleeding time and cause or exacerbate a bleeding disorder.

  • Some drugs prolong the bleeding time or induce abnormal platelet function tests but do not cause bleeding.

TABLE 77–2DRUGS THAT INHIBIT PLATELET FUNCTION
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TABLE 77–2 DRUGS THAT INHIBIT PLATELET FUNCTION

Nonsteroidal Antiinflammatory Drugs

 Aspirin, sulfinpyrazone, indomethacin, ibuprofen, sulindac, naproxen, phenylbutazone, meclofenamic acid, mefenamic acid, diflunisal, piroxicam, tolmetin, zomepirac

Antibiotics

 Penicillins

  Penicillin G, carbenicillin, ticarcillin, methicillin, ampicillin, piperacillin, azlocillin, mezlocillin, apalcillin, sulbenicillin, temocillin

 Cephalosporins

  Cephalothin, moxalactam, cefoxitin, cefotaxime, cefazolin

 Nitrofurantoin

 Miconazole

Thienopyridines

 Ticlopidine, clopidogrel

GP IIb/IIIa Antagonists

 Abciximab, tirofiban, eptifibatide

Drugs that Affect Platelet cAMP Levels or Function

 Prostacyclin, iloprost, dipyridamole, cilostazol

Anticoagulants, Fibrinolytic Agents, and Antifibrinolytic Agents

 Heparin

 Streptokinase, tissue plasminogen activator, urokinase

 ∊-Aminocaproic acid

Cardiovascular Drugs

 Nitroglycerin, isosorbide dinitrate, propranolol, nitroprusside, nifedipine, verapamil, diltiazem, quinidine

Volume Expanders

 Dextran, hydroxyethyl starch

Psychotropic Drugs and Anesthetics

 Psychotropic drugs

  Imipramine, amitriptyline, nortriptyline, chlorpromazine, promethazine, flufenazine, trifluoperazine, haloperidol

Anesthetics

 Local

  Dibucaine, tetracaine, metycaine, cyclaine, butacaine, nupercaine, procaine, cocaine, plaquenil

 General

 Halothane

Oncologic Drugs

 Mithramycin, daunorubicin, BCNU

Miscellaneous Drugs

 Ketanserin

 Antihistamines

  Diphenhydramine, chlorpheniramine, mepyramine

 Radiographic contrast agent

  Iopamidol, iothalamate, ioxalate, meglumine diatrizoate, sodium diatrizoate

Foods and Food Additives

  Omega-3 Fatty acids, ethanol, Chinese black tree fungus, onion extract, ajoene, cumin, turmeric

Source: Williams Hematology, 8th ed, Chap, 122, Table 122–2, p. 1972.

Aspirin

  • Two isoforms of cyclooxygenase have been identified (COX-1 and COX-2). COX-1 is constitutively expressed by many tissues, including platelets, the gastric mucosa, and endothelial cells. COX-2 is undetectable in most tissues, but its synthesis is rapidly induced in cells such as endothelial cells, ...

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