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Chapter 76: 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 focus on abnormal platelet aggregation tests, but these results do not necessarily predict the risk of clinical bleeding.

  • Table 76–1 lists the principal types and causes of acquired qualitative platelet abnormalities.

TABLE 76–1ACQUIRED QUALITATIVE PLATELET DISORDERS
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TABLE 76–1ACQUIRED QUALITATIVE PLATELET DISORDERS

Drugs that affect platelet function

 Aspirin and other nonsteroidal anti-inflammatory drugs

 P2Y12 antagonists (clopidogrel, prasugrel, ticagrelor)

 PAR1 thrombin receptor antagonist (vorapaxar)

 Integrin αIIbβ3 receptor antagonists (abciximab, eptifibatide, tirofiban)

Drugs that increase platelet cyclic adenosine monophosphate

 Antibiotics

 Anticoagulants and fibrinolytic agents

 Cardiovascular drugs

 Volume expanders

 Psychotropic agents and anesthetics

 Oncologic drugs

 Foods and food additives

Hematologic disorders associated with abnormal platelet function

 Chronic myeloproliferative neoplasms

 Leukemias and myelodysplastic syndromes

 Dysproteinemias

 Acquired von Willebrand syndrome

Systemic disorders associated with abnormal platelet function

 Uremia

 Antiplatelet antibodies

 Cardiopulmonary bypass

 Liver disease

 Disseminated intravascular coagulation

 Infection with HIV

Source: Williams Hematology, 9th ed, Chap. 121, Table 121–1.

DRUGS THAT AFFECT PLATELET FUNCTION

  • Table 76–2 lists drugs known to interfere with platelet function. Drugs are the most common cause of abnormal platelet function.

  • Some drugs can prolong platelet function tests and cause or exacerbate a bleeding disorder.

  • Some drugs induce abnormal platelet function tests but do not cause bleeding.

TABLE 76–2DRUGS THAT AFFECT PLATELET FUNCTION
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TABLE 76–2DRUGS THAT AFFECT PLATELET FUNCTION

Nonsteroidal anti-inflammatory drugs

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

P2Y12 antagonists

 Clopidogrel, prasugrel, ticagrelor

PAR1 receptor antagonist

 Vorapaxar

Integrin αIIbβ3 antagonists

 Abciximab, eptifibatide, tirofiban

Drugs that affect platelet cyclic adenosine monophosphate levels or function

 Prostacyclin, iloprost, dipyridamole, cilostazol

Antibiotics

 Penicillins

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

 Cephalosporins

 Cephalothin, moxalactam, cefoxitin, cefotaxime, cefazolin

 Nitrofurantoin

 Miconazole

Anticoagulants, fibrinolytic agents, and antifibrinolytic agents

 Heparin

 Streptokinase, tissue plasminogen activator, urokinase

 ε-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, fluphenazine, trifluoperazine, haloperidol

 Anesthetics

 Local: dibucaine, tetracaine, Cyclaine, butacaine, nupercaine, procaine, cocaine

 General: halothane

Oncologic drugs

 Mithramycin, daunorubicin, BCNU, ibrutinib

Miscellaneous drugs

 Ketanserin

Antihistamines

 Diphenhydramine, chlorpheniramine, mepyramine

Radiographic contrast agent

 Iopamidol, iothalamate, ioxaglate, meglumine diatrizoate, sodium diatrizoate

Foods and food additives

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

Source: Williams Hematology, 9th ed, Chap. 121, Table 121–2.

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 ...

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