Vancomycin Induced Thrombocytopenia – Protracted Course in a Hemodialysis Patient

Abstract

Vancomycin induced thrombocytopenia (VIT) is an uncommon side effect of vancomycin which can manifest from mild petechiae to life-threatening bleed. Decreased renal clearance of vancomycin results in prolonged thrombocytopenia by antibody-mediated platelet destruction in the presence of vancomycin. Improvement in thrombocytopenia is achieved with the elimination of vancomycin. We describe a patient with end stage renal disease who experienced a protracted course of thrombocytopenia from vancomycin. We illustrate the mechanism of thrombocytopenia and the treatment modalities used by us and those described in literature. VIT is an important differential in patients with thrombocytopenia admitted to the hospital.

Drug-Induced Thrombocytopenia: A Case Involving Vancomycin

“…Although platelet transfusions and steroids were given to the patient in this case, significant improvement in platelet count was not seen until the discontinuation of vancomycin. This finding was compared to other case reports of vancomycin-induced thrombocytopenia, and it was consistently discovered that significant platelet recovery began following vancomycin discontinuation [2,[5][6][7][8][9][10][11][12][13][14]. The normal time frame for platelet counts to return to levels greater than 150x10 3 /μL occurred between 5 and 7 days after vancomycin discontinuation.…”

“…This case involves an interesting adverse effect that is a rare occurrence with the use of vancomycin, with a reported occurrence of 7.1% in individuals being treated with vancomycin [5]. Using this case and other case reports from similar presentations, we are able to discuss and educate on the typical presentations of this adverse effect and the treatment course with the best outcomes [1,2,[6][7][8][9][10][11].…”

Re-exposure causing rapid onset of vancomycin induced thrombocytopenia

“…Patients who have renal insufficiency may have prolonged courses with up to 32 days of thrombocytopenia given the decreased rate of clearance. In these patients, hemodialysis can be considered if there are worsening of symptoms in order to eliminate vancomycin from the blood [10] . Once vancomycin was held on day 15 in this case, the platelet count returned to the normal range on day 18.…”