Entecavir-Associated Thrombocytopenia: A Case Report and Review of the Pathophysiology, Diagnosis, and Treatment of a Rare but Reversible Cause of Thrombocytopenia

Drug-associated thrombocytopenia is often unrecognized. We report a 76-year-old female with lymphoma who presented with easy bruising and oral bleeding. She had undergone screening for hepatitis B virus (HBV) prior to starting rituximab and was found to have hepatitis B core serum antibody (IgG anti...

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Bibliographic Details
Published in:Case reports in hematology 2019-01, Vol.2019 (2019), p.1-4
Main Authors: Yohannan, Binoy, Feldman, Mark, Luu, Dai Chu N.
Format: Article
Language:English
Subjects:
Adefovir dipivoxil
Analgesics
Antiviral drugs
Bendamustine
Biopsy
Blood
Blood platelets
Bone marrow
Care and treatment
Case Report
Case reports
Chemotherapy
Drugs
Entecavir
Glycoproteins
Health aspects
Hepatitis
Hepatitis B
Hydrochlorothiazide
Immunoglobulin G
Immunoglobulins
Infections
Internal medicine
Lymphoma
Mammography
Medicine
Monoclonal antibodies
Oncology
Pantoprazole
Pathogenesis
Patients
Targeted cancer therapy
Thrombocytopenia
Tirofiban
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Summary:Drug-associated thrombocytopenia is often unrecognized. We report a 76-year-old female with lymphoma who presented with easy bruising and oral bleeding. She had undergone screening for hepatitis B virus (HBV) prior to starting rituximab and was found to have hepatitis B core serum antibody (IgG anti-HBc). She was therefore treated with prophylactic entecavir 0.5 mg daily to prevent reactivation of HBV. Her initial platelet count was 136,000/mm3. Five days after starting entecavir, she presented with bruising and oral bleeding and was found to have a platelet count of 7,000/mm3. A coagulation profile and the rest of the blood parameters (RBC and WBC counts) were normal. Entecavir was stopped, and she was given 3 units of apheresed platelets followed by intravenous immunoglobulin (1 g/kg) for 5 consecutive days. Her platelet counts improved and normalized in one week. She was diagnosed with entecavir-induced thrombocytopenia based on the temporal relationship and after carefully excluding alternate causes of thrombocytopenia. This case highlights the importance of recognizing drug-induced thrombocytopenia (DITP) as a reversible cause of thrombocytopenia.
ISSN:2090-6560
2090-6579
DOI:10.1155/2019/4319148