A Case of Thrombocytosis Associated with Enoxaparin Therapy in an Adolescent

Abstract

Secondary thrombocytosis, often referred to as a reactive thrombocytosis, is more common than primary thrombocytosis and has many potential etiologies including anemia, infection, inflammation, medications, and post-splenectomy. When considering the critically ill patient in the ICU setting potential medication-related etiologies of thrombocytosis should be included in the differential diagnosis. We present a 15-year-old adolescent with a traumatic brain injury who developed thrombocytosis that was temporally related to the administration of enoxaparin. There was a prompt return of the platelet count to normal following the discontinuation of enoxaparin therapy which led to the probable diagnosis of enoxaparin-induced thrombocytosis.

Thrombocytosis in children

“…Clemens Stockklausner et al reported that the most common causes were infections (49.5%), postsplenectomy (7.8%), Kawasaki disease (6.4%), tissue damage (4.5%), blood diseases (3.7%), malignancies (3.7%), renal diseases (3.2%), chronic inflammation (1.8%), essential thrombocythemia (0.5%), and other causes (3.7%) 10 . In some other studies, the frequencies of infections in secondary thrombocytosis were 39, 53, 30, and 63%, respectively 11 – 14 . In our study, infections (37.9%) were also the most common cause of secondary thrombocytosis in accordance with the previously published studies.…”

Thromboembolic complications in newborns – diagnostic value of D-dimers concentration and proposed outline of enoxaparin use

“…The use of EX both in prophylactic and therapeutic management is slowly becoming the procedure of choice in paediatric patients, and is increasingly recommended in newborns due to its easy dosing, low number of complications and rare interactions with other drugs and nutrients [29,30].…”

“…The use of EX, like other LMWHs, is slowly becoming the treatment of choice in paediatric patients and is increasingly recommended in newborns. LMWHs have an advantage over non-fractionated heparin (NFH) due to easier monitoring, fewer complications and less frequent interactions with other drugs and nutrients [29,30].…”

“…EX metabolism occurs mainly in the liver by breaking disulphide bonds and depolymerization [28]. Due to the ease of use and favourable pharmacokinetic parameters, among LMWH it is EX that is recommended in TECs therapy in newborns [29,30].…”