Severe Thrombocytopenia Associated With Black Seed Oil and Evening Primrose Oil

Abstract

We report the case of a 69-year-old female with stage IIIB endometrial adenocarcinoma who developed an acute thrombocytopenia with greater than 90% decrease from her baseline value in platelets one day after a laparoscopic hysterectomy. Subsequently, the patient was found to have bilateral subsegmental pulmonary emboli and a right atrial thrombus. The thrombocytopenia reached a nadir of 31,000/mL 3 from a baseline of 410,000/mL 3 and resolved without intervention. Prior to the surgery, the patient was taking black seed oil, which is commonly used for its anti-carcinogenic effects, and evening primrose oil daily for approximately one month. A literature review revealed that black seed oil contains thymoquinone, which is a compound related to quinine. Evening primrose oil is also known to reduce platelet aggregation and has anti-thrombotic properties. We believe the patient's thrombocytopenia was caused by a consumptive coagulopathy due to the formation of multiple thrombi and exacerbated by the use of herbal supplements, namely black seed and evening primrose oil.

Thymoquinone Induces Human Platelet Aggregation via Cytochrome P450 and Mitochondria

“…TQ, the main biological active compound of N. sativa, has the capacity to reduce oxidative stress and induce apoptosis in many types of cancer [12,13] . The effect of TQ in platelet physiology is controversial and a number of studies associate TQ to thrombocytopenia, induction of platelets apoptosis or no effect on platelet aggregation [17,18,20] .…”

“…Indeed, oral administration of N. sativa fixed oil in mice and rats during 12 w causes 15 % to 35 % decrease in platelet count [16] . In humans, consumption of black seed oil for 1 mo has been reported to induce thrombocytopenia [17] . Also, TQ poses an apoptotic effect on platelets mediated by G protein-coupled receptors that may explain platelet count decrease [18] .…”

Black Seeds

“…183 As mentioned previously, the adverse effects of NS reported in human studies, such as nausea, anorexia, and dyspepsia, seem to be mild. Case reports of acute contact dermatitis [184][185][186][187][188][189][190] and systematic reactions [191][192][193][194] to NS have been documented. As a principal constituent of NS seed, TQ was evaluated in various toxicological studies.…”

Herb–Drug Interaction in Inflammatory Diseases: Review of Phytomedicine and Herbal Supplements

“…A small randomized clinical trial with RA patients did not find differences in platelet activity between evening primrose oil, omega-3 oil, and fish oil supplementation [ 150 ], but these oils’ effects on platelet aggregation are debated, as well. Recently, thrombocytopenia, after hysterectomy in a patient chronically taking evening primrose oil and black seed oil ( Nigella sativa ), was reported [ 151 ]. Nigella sativa oil contains thymoquionone, which can lead to thrombocytopenia.…”

“…Nigella sativa oil contains thymoquionone, which can lead to thrombocytopenia. The authors discuss the case as multifactorial, with the surgery and both herbal oils contributing to the development of thrombocytopenia [ 151 ]. Overall, the clinical risk of evening primrose oil seems to be low, but cumulative thrombocyte inhibitory effects of prescription drugs and combined herbal treatments should be taken into regard.…”