Drug-induced Thrombocytopenia: Pediatric Cases from the Medical Literature

Marcia L. Buck, Pharm.D., FCCP, FPPAG

Disclosures

Pediatr Pharm. 2010;16(11) 

In This Article

Pantoprazole

Several case reports of proton pump inhibitor-associated thrombocytopenia in adults have been published, but Miller and colleagues have recently reported the first pediatric case.[16] They describe a 9-day-old female born at 38 weeks gestation. She was diagnosed with hypoplastic left heart and underwent a Norwood procedure. Her postoperative course was complicated by sepsis and disseminated intravascular coagulation. During her recovery, she was placed on pantoprazole for stress ulcer prophylaxis. Following a bi-directional Glenn procedure on hospital day 75, the dose of pantoprazole was doubled to 1 mg/kg every 12 hours. Six days later, her platelet count dropped to 37,000/mm3. No other laboratory values were abnormal. Other potential drug causes were ruled out. Pantoprazole was discontinued and replaced with omeprazole 1 mg/kg/day. Her platelet count began to rise within 4 days. Although a causal relationship could not be firmly established, the authors suggest that clinicians be aware of the potential for thrombocytopenia in patients receiving pantoprazole.

Management of DITP

Patients with mild petechial hemorrhages and bruising rarely require any treatment beyond discontinuation of the causative agent. Those with severe thrombocytopenia may require transfusion to avoid progression to intracranial or pulmonary hemorrhage. Corticosteroids, intravenous immune globulin, and exchange transfusions have been used in the management of DITP, but there are no adequate studies to demonstrate clear benefit from these therapies. Once the causative drug has been identified, the patient and/or family should be aware of the need to avoid this drug in the future. Information about the drug reaction should be included in the patient's medical record and reported through the Food and Drug Administration's MedWatch Adverse Event Reporting System at www.accessdata.fda.gov/scripts/medwatch/ (accessed 8/14/10).[1–4]

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