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DRUG-INDUCED PLATELET ANTIBODIES

Hypersensitivity to drugs may lead to the development of drug-induced platelet antibodies and consequently thrombocytopenia and bleeding, usually in the form of purpura. The association of drug and purpura was reported by Vipan(1) as early as 1883, even before the role of platelets in haemostasis was recognised. The relationship between drug ingestion and thrombocytopenia was demonstrated by Rosenthal(2) in 1928 when he rechallenged a patient who had just recovered from quinine-induced thrombocytopenia with the drug and showed that thrombocytopenia promptly recurred. The immune nature of drug-induced thrombocytopenia was confirmed by Ackroyd in 1951.(3) In a series of pioneering experiments, he demonstrated the presence of drug-induced antibodies in the plasma of patients with serdomid-induced thrombocytopenia. He showed that incubation of normal platelets with patient plasma and the drug resulted in platelet lysis in the presence of complement and platelet agglutination in its absence. Since then a large number of drugs (> 50) have been reported to cause immune thrombocytopenia.(4) Some of the commonly implicated drugs include quinine, quinidine, heparin, co-trimoxazole, sulphonamide, ampicillin, cephalosporin, sodium valproate, carbamazepine, gold and cimetidine. Of these drugs, only antibodies induced by quinine/quinidine and heparin have been extensively studied.