Key Learning Point  In an inpatient who has received vancomyc | Daily Medical Info 4 Medics

Key Learning Point 

In an inpatient who has received vancomycin and ceftriaxone, the most likely cause of a new thrombocytopenia that develops during or shortly after hospitalization is drug-induced thrombocytopenia.


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Thrombocytopenia is a common laboratory abnormality in hospitalized patients. Perhaps the most common etiology is drug-induced thrombocytopenia.
More than 100 agents have been implicated in drug-induced thrombocytopenia; among those most frequently cited are heparin, quinine, and some antibiotics.

In a large case series of vancomycin-treated patients who then developed thrombocytopenia, vancomycin-dependent platelet-reactive antibodies were identified.

Immune thrombocytopenia is unlikely to develop this acutely during or shortly after hospitalization in a patient who presents with a normal platelet count.
Disseminated intravascular coagulation is possible but unlikely in a patient who is improving clinically.

Folate deficiency is a cause of thrombocytopenia but would not cause thrombocytopenia that developed acutely.

Thrombotic thrombocytopenic purpura has a classic pentad: fever, acute kidney failure, thrombocytopenia, microangiopathic hemolytic anemia, and altered mental status.

Source: NEJM, Dec 2020.