Case Study Thrombocytopenia

Clinical Pharmacy Semester 10th
Thrombocytopenia
 Thrombocytopenia is a condition in which you have a low blood platelet count.

Platelets (thrombocytes) are colorless blood cells that help blood clot.
Platelets stop bleeding by clumping and forming plugs in blood vessel
injuries.
 Thrombocytopenia might occur as a result of a bone marrow disorder such as
leukemia or an immune system problem. Or it can be a side effect of taking
certain medications. It affects both children and adults.
 Thrombocytopenia can be mild and cause few signs or symptoms. In rare
cases, the number of platelets can be so low that dangerous internal bleeding
occurs. Treatment options are available.
Symptoms
 Easy or excessive bruising (purpura)
 Superficial bleeding into the skin that appears as a rash of pinpoint-sized

reddish-purple spots (petechiae), usually on the lower legs
 Prolonged bleeding from cuts
 Bleeding from your gums or nose
 Blood in urine or stools
 Unusually heavy menstrual flows
 Fatigue
 Enlarged spleen
1
Diagnosis
The following can be used to determine whether you have thrombocytopenia:
 Blood test. A complete blood count determines the number of blood cells,
including platelets, in a sample of your blood.
 Physical exam, including a complete medical history. Your doctor will look

for signs of bleeding under your skin and feel your abdomen to see if your
spleen is enlarged. He or she will also ask you about illnesses you've had and the
types of medications and supplements you've recently taken.
.Treatment
 Blood or platelet transfusions. If your platelet level becomes too low, your
doctor can replace lost blood with transfusions of packed red blood cells or
platelets.
 Medications. If your condition is related to an immune system problem, your

doctor might prescribe drugs to boost your platelet count. The first-choice drug
might be a corticosteroid. If that doesn't work, stronger medications can be used
to suppress your immune system.
 Surgery. If other treatments don't help, your doctor might recommend surgery
to remove your spleen (splenectomy).
 Plasma exchange. Thrombotic thrombocytopenic purpura can result in a

medical emergency requiring plasma exchange.
2
RIPHAH INTERNATIONAL UNIVERSITY

Riphah Institute of Pharmaceutical Sciences
PHARMACOTHERAPY REVIEW (Patient Case)
Student Name: Date: 4/26/2021
Patient Demographics:
Name: XYZ Age: 55 years Gender: male Ht/Wt: 75 kg

Chief Complaint:
A 55-year-old man presented with a scalp laceration and T3 and T12 compression fractures
after falling down an escalator. He had a prolonged stay complicated by confusion, pain and
methicillin-sensitive Staphylococcus aureus bacteremia.
Past Medical History;

The patient’s medical history was significant for hepatitis C, hypertension and bilateral knee
replacements requiring red cell transfusions, but no prior thrombocytopenia.
Heavy alcohol use, but had been sober for two years.
Diagnosis:
Drug induced thrombocytopenia
VITAL SIGNS
SIGNS 1 Normal Comment

BP 160/80 120/80 Slightly raised
Temp 970F 960F afibrile
RR
PR 102 Raised
LAB TEST INTERPRETATION
3
Lab Tests value Normal range INTERPRETATION

RBC 4.41 4.0-5.5*10^6/ul Normal
Hb 10 g/dL 11.5-16.0g/dl Low
HCT 26 36-46% decrease
Platelet 200,000 k/mcL 150-450 *10^3/ul normal
WBCS 13 g/dL 4-11.0*10^3/ul
MCH 19 27-32pg decrease
MCV 92 mcm3 76-96fl decrease
K+
Ca
d-dimer: 7,900
200 to 400
Fibrinogen: 600mg/dl Normal
mg/dL
Bilirubin 3.4 U/L
ALP
ALT 25 U/L
Albumin 2.2 g/dL
Heparin-induced
thrombocytopenia Positive
(HIT) antibody
Rx
Nafcillin Furosemide
Quinine (Quinine, AR Holding) Haloperidol
Enoxaparin (Lovenox) Metoprolol
Heparin flushes Morphine
Omeprazole Aspirin
After this therapy lab findings were

 Peripheral smear revealed normochromic and normocytic anemia with increased red
cell regeneration,
 Mild leukocytosis with left-shift,
 Mild absolute eosinophilia,
 Hemophagocytosis and marked
 Thrombocytopenia with large hypergranular platelets
Labs were drawn. Enoxaparin and quinine were discontinued, and nafcillin was
switched to clindamycin. The patient was started on dexamethasone 40 mg orally
daily for four days.
By day three he had minimal response to dexamethasone. He was started on IV

immunoglobulin 0.4 g/kg for five days. He was also given IV methylprednisone
(Medrol, Pfizer) 500 mg daily for three days.
4
The platelet antibody to human platelet alloantigen-5a (HPA–5a) was identified. The
diagnosis of post transfusion purpura was made.
The patient received transfusions with 5a negative platelets on three separate

occasions with a platelet bump from 3,000 k/mcL to 21,000 k/mcL.
By hospital day 40 the patient’s platelet count gradually increased, returning to levels
of 70,000 k/mcL
5
Clinical Pharmacy Manual Semester 9th
RIPHAH INTERNATIONAL UNIVERSITY

Riphah Institute of Pharmaceutical Sciences
PRESCRIPTION ANALYSIS FORM
Dr. Name XYZ
Specialization MBBS, FCPS
Patient Name XYZ
Age 55 years
Weight 75kg
Diagnosis Drug induced thrombocytopenia
Other Details (If any) NO
Suggested Corrections in Duration was not mentioned.

Prescription (Missing Name,
Brands was not mentioned
Age, Wrong strength, dose,
frequency, etc..)
Dosage Brand Generic Strength Class Frequency Duration th Instructions
Rx Form Clinical Pharmacy Manual Semester 9
Not Not β-lactam Not 3 days Not

Nafcillin mentioned Nafcillin mentioned antibiotic mentioned (after that mentioned in
in the case in the case in the case r) the case
Quinine Quinine Antimalarials 3 days

(Quinine, AR (after that
Holding) –
withrawn)
Enoxaparin Lovenox Enoxaparin - low molecular

(Lovenox) weight heparins
Heparin flushes Heparin - anticoagulant

flushes
Omeprazole Omeprazole Proton-pump

inhibitors
Furosemide Furosemide Loop diuretic
Haloperidol Haloperidol Typical

Antipsychotics
Metoprolol Metoprolol selective β1

receptor blocker
Morphine Morphine Opioid analgesic
Aspirin Aspirin Analgesic,

antiplatelet
Clinical Pharmacy Manual Semester 9th
DRUG INTERACTIONS ANALYSIS FORM

Software Drug Interactions Effects
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Clinical Pharmacy Semester 10th

 Thrombocytopenia is a condition in which you have a low blood platelet count.

 Easy or excessive bruising (purpura)

 Superficial bleeding into the skin that appears as a rash of pinpoint-sized

 Prolonged bleeding from cuts

 Bleeding from your gums or nose

 Blood in urine or stools

 Unusually heavy menstrual flows

The following can be used to determine whether you have thrombocytopenia:

 Physical exam, including a complete medical history. Your doctor will look

 Medications. If your condition is related to an immune system problem, your

 Plasma exchange. Thrombotic thrombocytopenic purpura can result in a

RIPHAH INTERNATIONAL UNIVERSITY

Student Name: Date: 4/26/2021

Name: XYZ Age: 55 years Gender: male Ht/Wt: 75 kg

Past Medical History;

Drug induced thrombocytopenia

SIGNS 1 Normal Comment

LAB TEST INTERPRETATION

Lab Tests value Normal range INTERPRETATION

After this therapy lab findings were

By day three he had minimal response to dexamethasone. He was started on IV

The patient received transfusions with 5a negative platelets on three separate

RIPHAH INTERNATIONAL UNIVERSITY

Specialization MBBS, FCPS

Patient Name XYZ

Diagnosis Drug induced thrombocytopenia

Other Details (If any) NO

Suggested Corrections in Duration was not mentioned.

Not Not β-lactam Not 3 days Not

Quinine Quinine Antimalarials 3 days

Enoxaparin Lovenox Enoxaparin - low molecular

Heparin flushes Heparin - anticoagulant

Omeprazole Omeprazole Proton-pump

Furosemide Furosemide Loop diuretic

Haloperidol Haloperidol Typical

Metoprolol Metoprolol selective β1

Morphine Morphine Opioid analgesic

Aspirin Aspirin Analgesic,

DRUG INTERACTIONS ANALYSIS FORM

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