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

Abstract

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.

Thrombocytopenia Induced by Iodinated Contrast Media: A Systematic Review

“…We found no patient profile or comorbidity pattern allowing to predict severe symptomatology. Case reports by Takeda et al 18 and Cubero et al 16 are both potentially comparable as they refer to patients with similar comorbidities on hemodialysis. Despite this, presentation outcomes differed widely -the former case had moderate symptoms (gingival bleeding, desaturation) that required no specific treatment; recovery was complete at day three.…”

“…3 Contrast-induced thrombocytopenia is a very rare condition, with case reports being exceptional since early use during the 1980s to this day. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Iodinated contrast-induced thrombocytopenia Contrast-induced thrombocytopenia is one of the so-called drug-induced immune thrombocytopenias, which cause a decrease in platelet count (< 30 x 10 9 /L) because of destruction in peripheral blood or reduced production in the bone marrow. 19 Multiple drugs may induce this effect, including those used for chemotherapy, heparins, quinidine, tirofiban, abciximab, procainamide, protamine, and a number of monoclonal antibodies, among others.…”