Idiopathic Thrombocytopenic Purpura Induced by Synthetic Cannabinoid

Abstract

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder defined as low platelet count with normal bone marrow in the absence of other causes of thrombocytopenia. It is caused by autoantibodies binding to several platelet surface antigens which lead to premature destruction of the platelet by the reticuloendothelial system. ITP can be primary or secondary, and it is known to be associated with various infections and drugs. K2/Spice, or synthetic marijuana, acts on cannabinoid receptors CB1 (cannabinoid type-1) and CB2 (cannabinoid type-2) with increased binding capacity compared to marijuana. A white male was brought to the emergency department with signs of acute drug toxicity. His urine drug test was negative but he admitted to a year long history of synthetic marijuana use. His platelet count was 12,000/mm 3 and he was diagnosed with ITP. After receiving 2 doses of oral dexamethasone his platelets improved. Synthetic cannabinoids are widely available and used psychoactive drugs. Little is known about the complete chemical composition of the synthetic products thus there is relatively little information available on the pharmacodynamic and pharmacokinetic effects. A high index of suspicion is needed to diagnose toxicity to these drugs since there are no readily available on-site lab tests. Currently there exists 1 case report of ITP induced by K2/Spice. Here, we discuss another case of K2/Spice a as a potential cause of immune thrombocytopenia.

Inflammation in Patients with Opiate Use Disorder: Neutrophil/Lymphocyte, Platelet/Lymphocyte, Monocyte/Lymphocyte Ratios and Mean Platelet Volume

“…Kan platelet düzeyleri ve PLO; ucuz, kolay ölçülebilen, kronik inflamasyonun göstergesi olarak kullanılabilen parametrelerdir. Literatürde bu değerler AMKB tanılı hastalarda çok daha kısıtlı çalışmada yer bulmuştur (23,24,(26)(27)(28)(29). Literatürde esrar kullanım bozukluğu ve sentetik kannabinoid kullanım bozukluğu olan hastalarda yürütülen iki ayrı çalışmada; hastaların PLO ve platelet düzeyleri sağlıklı kontrollerden farklı bulunmamıştır (24,26).…”

Inflammation levels in patients with alcohol and substance use disorders

“…Ucuz ve kolay ölçülebilen, kronik düşük dereceli inflamasyon göstergesi olan platelet fonksiyonları ve PLO psikiyatri hastalıklarında daha az çalışmada yer bulmuştur. Alkol/madde kullanım bozukluğu tanılı hastalarda ise çok daha kısıtlı çalışılmıştır 19,20,23,[30][31][32] . Literatürde sentetik kannabinoid kullanım bozukluğu olan hastalarda yapılan bir çalışmada; hastaların PLO sağlıklı kontrollerden farklı bulunmamıştır 23 .…”

“…Benzer şekilde esrar kullanımı olan hastalarda da PLO sağlıklı kontrollerden farklı saptanmamıştır 20 . Başka bir çalışmada ise sentetik kannabinoid kullanımı sonrası idiyopatik trombositopenik purpuranın tetiklendiği olgu sunumu olarak yapılmıştır 30 . Çalışmalarda elde edilen sonuçlardan farklı çeşit kannabinoidlerin farklı sistemler üzerinden etki etmesinin rolü olabileceği düşünülmektedir 23,28 .…”

Anti-Neuronal Autoantibodies (Cell Surface and Onconeural) and Their Association With Natural Autoantibodies in Synthetic Cannabinoid-Induced Psychosis

“…THC exposure during adolescence also resulted in a persistent neuroinflammatory state in adult female rats and mice, characterized by altered microglia morphologic structure, increased proinflammatory mediators, reduced CB1, and increased CB2 ( 21 ). A few case reports show that SCRA users can develop autoimmune disease ( 22 , 23 ). The study by Parajuli et al represents a case about a drug-induced posterior reversible encephalopathy syndrome (PRES) after K2 consumption (a type of SCRAs); besides, the autoimmune mechanism of a toxic origin can be found in the background of PRES ( 24 ).…”