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Quinidine‐induced thrombocytopenic purpura: clinical presentation in relation to drug‐dependent and drug‐independent platelet antibodies

Summary. We have studied the clinical course of quinidineinduced thrombocytopenia in relation to the presence of drug‐dependent (dd‐ab:s) and drug‐independent antibodies in 14 patients. Thrombocytopenia was reversible in 9 d after discontinuation of quinidine treatment in 10 patients. In four it lasted more than 1 month. Drug‐dependent antibodies of IgG class were detectable in seven patients: in six by an immunofluorescence test applying flow cytometry and in one patient by a monoclonal antibody‐immobilized platelet protein assay (MAIPA) only. The dd‐ab:s of this patient had glycoprotein (GP) IIIb/IIIa specificity. Five of the six patients with dd‐ab:s by immunofluorescence test had GPIb/IX‐specific dd‐ab:s by MAIPA. They recovered within 5 d after discontinuation of the drug. All four patients with prolonged thrombocytopenia had elevated platelet‐associated IgG (PAIgG) in the acute phase as studied by a direct platelet immunofluorescence test. The remaining five patients displayed a relatively rapid clinical recovery but less uniform pattern of immunological findings. The results suggest that patients with GPIb/IX‐specific dd‐ab:s recover promptly despite an acute and profound thrombocytopenia. Another sub‐group with prolonged thrombocytopenia had persistently elevated PAIgG during the convalescent phase.