Acute Severe Thrombocytopenia Following Non-Ionic Low-Osmolarity Intravenous Contrast Medium Injection

Bata, Pal; Tárnoki, Ádám Domonkos; Tárnoki, Dávid László; Horváth, E; Bérczi, Viktor; Szalay, Ferenç

doi:10.3348/kjr.2012.13.4.505

Cited by 17 publications

(15 citation statements)

References 9 publications

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“…The use of ICM is generally regarded to be safe. However, acute adverse reactions to current non-ionic ICM occur in 0.7–3.1% of patients and, although most reactions are confined to mild urticaria, they can be life-threatening (23). To manage adverse reactions to ICM, several clinical guidelines have been published based on recent studies and consensus statements by relevant expert committees such as the American College of Radiology (ACR), European Society of Urogenital Radiology (ESUR) (45), and Korean Network of Allergists & Radiologists for Research on Radiocontrast media-associated Adverse reactions (6).…”

Section: Introductionmentioning

confidence: 99%

Management of Adverse Reactions to Iodinated Contrast Media for Computed Tomography in Korean Referral Hospitals: A Survey Investigation

et al. 2019

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ObjectiveTo evaluate the current status of managing adverse reactions to iodinated contrast media (ICM) for computed tomography in referral hospitals in South Korea compared with hospitals in other countries.Materials and MethodsThis survey investigation involved 59 Korean and 15 overseas hospitals using guideline-based questionnaires consisting of 24 items in 7 main categories related to managing adverse reactions to ICM.ResultsInformed written consent with risk factor evaluation was appropriately performed in most of the Korean hospitals. There was considerable variability in assessing renal function across the hospitals; serum creatinine level was used as a reference in 76.4% of Korean hospitals. The Korean hospitals preferred a more stringent approach to determining normal renal function (p = 0.01), withholding metformin (p = 0.01), and fasting before ICM exposure (p < 0.001) compared with overseas hospitals. All the Korean hospitals had an emergency protocol and in-hospital system for adverse reactions to ICM. The Korean (87.7%) and overseas hospitals (100%) were similarly equipped with epinephrine (p = 0.332), but only 38.6% of Korean hospitals were equipped with a bronchodilator (p = 0.004). For patients with a previous hypersensitivity reaction to ICM, 62.3% of Korean hospitals pre-medicated with anti-histamine and corticosteroid according to the severity of the previous reaction, and changed the culprit ICM in 52.8%, while skin test was performed in 17%.ConclusionIn general, Korean referral hospitals were well-prepared regarding informed consent, protocol, and an in-hospital system for managing adverse reactions to ICM. Nevertheless, there was considerable variability in details and management, thus requiring standardization by reflecting current guidelines.

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Section: Introductionmentioning

confidence: 99%

Management of Adverse Reactions to Iodinated Contrast Media for Computed Tomography in Korean Referral Hospitals: A Survey Investigation

et al. 2019

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“…Three cases of non-ionic contrast-induced acute severe thrombocytopenia have been reported so far: Two cases demonstrated acute thrombocytopenia following symptoms of immediate allergic reaction after contrast infusion ( Table 2 ). 4 5 The other case did not describe whether any signs or symptoms of allergic reaction were observed after contrast infusion or not. 7…”

Section: Discussionmentioning

confidence: 97%

“… 1 2 3 Non-ionic contrast-induced acute thrombocytopenia is far more rare and has been usually accompanied by signs or symptoms of immediate allergic reaction, including respiratory distress, chest discomfort, facial flushing, or skin rash. 4 5 …”

Section: Introductionmentioning

confidence: 99%

Life-Threatening Thrombocytopenia Following Intravenous Contrast Media Infusion

et al. 2018

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Radiocontrast media-induced acute severe thrombocytopenia is a very rare complication and potentially life-threatening. Here, we report the case of a 63-year-old male patient with severe acute thrombocytopenia following first exposure to intravenous non-ionic contrast media without immediate allergic reactions. His platelet count dropped from 107000/µL to 2000/µL after six hours of radiocontrast infusion. After administration of corticosteroid and transfusion of platelet concentrates, the platelet count returned gradually to normal within 5 days. To the best of our knowledge, non-ionic contrast media-induced isolated acute severe thrombocytopenia following no signs or symptoms of immediate allergic reaction has never been described.

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“…Acute severe thrombocytopenia is an extremely rare and severe adverse complication induced by contrast media. To the best of our knowledge, 16 cases of this serious adverse reaction have been reported with different types of contrast media since the early 1980s (Table 3) [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. In most patients, any symptoms, including bleeding, fever, chills, dyspnea, wheezing, abdominal pain, and blood pressure variability, were observed within 24 h after contrast administration and the platelet count was decreased to below 10,000/ μl.…”

Section: Discussionmentioning

confidence: 99%

“…The lowest reported value of the platelet count was 0/ μl [16]. With regard to treatment, high-dose intravenous corticosteroids, which are widely used in management of anaphylaxis, were used in nine patients [2,4,6,7,10,12,13,16,17]. Eight patients received platelet transfusions [3, 5-8, 10, 12, 17].…”

Section: Discussionmentioning

confidence: 99%

Contrast medium-induced severe thrombocytopenia in patient on maintenance hemodialysis: a case report and literature review

et al. 2020

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A 43-year-old male patient on maintenance hemodialysis had an enhanced computed tomography scan examination with iohexol for the first time 10 min before regular hemodialysis therapy. At the start of hemodialysis, no symptoms were observed, and the platelet count was 148,000/μl. Approximately 1 h after starting hemodialysis, dyspnea and chest discomfort appeared. Since oxygen saturation of the peripheral artery decreased to 87%, oxygen administration was immediately started while continuing hemodialysis therapy. Furthermore, gingival hemorrhage was observed, and the platelet count decreased to 5000/μl. We were carefully monitoring his conditions while continuing hemodialysis and oxygen administration, but no further deterioration was observed. Thereafter, these symptoms and severe thrombocytopenia gradually improved without additional treatment. At the end of hemodialysis, these symptoms completely disappeared. As well, the platelet count recovered to 35,000/μl at the end of hemodialysis and increased to 92,000/μl the next morning. From the clinical course, we diagnosed with contrast medium-induced thrombocytopenia. Acute thrombocytopenia is a rare complication induced by the contrast medium. Until now, 16 cases on contrast medium-induced thrombocytopenia have been reported. Our case spontaneously recovered from severe thrombocytopenia relatively earlier than previous reports. Our patient started hemodialysis therapy 10 min after an enhanced computed tomography examination. Early removal of contrast medium by hemodialysis might be associated with early improvement. We should acknowledge that contrast media have potential to induce severe thrombocytopenia, even in patients on maintenance hemodialysis.

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Acute Severe Thrombocytopenia Following Non-Ionic Low-Osmolarity Intravenous Contrast Medium Injection

Cited by 17 publications

References 9 publications

Management of Adverse Reactions to Iodinated Contrast Media for Computed Tomography in Korean Referral Hospitals: A Survey Investigation

Management of Adverse Reactions to Iodinated Contrast Media for Computed Tomography in Korean Referral Hospitals: A Survey Investigation

Life-Threatening Thrombocytopenia Following Intravenous Contrast Media Infusion

Contrast medium-induced severe thrombocytopenia in patient on maintenance hemodialysis: a case report and literature review

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