Drug-induced immune-mediated thrombocytopenia in the intensive care unit

J Clin Anesth. 2015 Nov;27(7):602-5. doi: 10.1016/j.jclinane.2015.06.021. Epub 2015 Aug 8.


A 62-year-old woman with prosthetic mitral valve was admitted for explant of an infected prosthetic knee. Perioperatively, she was bridged with heparin and started on empiric vancomycin and piperacillin-tazobactam. Platelet counts dropped precipitously within 2 days reaching a nadir of 6000/μL, without any bleeding. Decline persisted despite substituting heparin with bivalirudin. Antiplatelet factor 4 and anti-PLA1 antigen were negative. Schistocytes were absent. Antibiotics were substituted with daptomycin for suspected drug-induced thrombocytopenia. Pulse dose of intravenous immunoglobulin was initiated with rapid normalization of platelet count. She tested positive for IgG antiplatelet antibodies to vancomycin and piperacillin-tazobactam thereby confirming the diagnosis. Drug-induced immune-mediated thrombocytopenia is an underrecognized cause of thrombocytopenia in the intensive care units. Clinicians should be cognizant of this entity, and a definitive diagnosis should be sought if feasible.

Keywords: Drug induced thrombocytopenia; Immune mediated thrombocytopenia; Intensive care unit; Piperacillin; Thrombocytopenia; Vancomycin.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Device Removal
  • Female
  • Humans
  • Immunoglobulin G / immunology
  • Intensive Care Units
  • Middle Aged
  • Penicillanic Acid / administration & dosage
  • Penicillanic Acid / adverse effects
  • Penicillanic Acid / analogs & derivatives*
  • Piperacillin / administration & dosage
  • Piperacillin / adverse effects
  • Piperacillin, Tazobactam Drug Combination
  • Prosthesis-Related Infections / surgery
  • Purpura, Thrombocytopenic, Idiopathic / chemically induced*
  • Purpura, Thrombocytopenic, Idiopathic / diagnosis
  • Purpura, Thrombocytopenic, Idiopathic / immunology
  • Vancomycin / administration & dosage
  • Vancomycin / adverse effects*


  • Immunoglobulin G
  • Piperacillin, Tazobactam Drug Combination
  • Vancomycin
  • Penicillanic Acid
  • Piperacillin