Quinine‐induced immune thrombocytopenia with hemolytic uremic syndrome: Clinical and serological findings in nine patients and review of literature

American Journal of Hematology - Tập 47 Số 4 - Trang 283-289 - 1994
Jerome L. Gottschall1, Betsy Neahring2, Janice G. McFarland2, Guo‐Guang Wu2, Lee Ann Weitekamp2, R. C. Aster2
1Blood Center of Southeastern Wisconsin, Inc., Milwaukee 53201-2178.
2The Blood Center of Southeastern Wisconsin, Inc., and the Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin

Tóm tắt

AbstractQuinine‐induced immune thrombocytopenia with hemolytic uremic syndrome (HUS) is a recently defined clinical entity. In this paper we have attempted to characterize the natural history and laboratory abnormalities typical of quinine‐induced immune thrombocytopenia associated with hemolytic uremic syndrome in nine patients experiencing ten episodes of the disease. In addition, review of other reported cases of probable quinine‐induced HUS is presented. The disease was characterized by the onset of chills, diapheresis, nausea and vomiting, abdominal pain, decreased urine output, and petechiae following quinine exposure. All patients experience significant anemia, severe thrombocytopenia, increased lactate dehydrogenase, elevated serum creatinine, and oliguria. Quinine‐dependent platelet‐reactive antibodies were identified in eight of nine using flow cytometry. Unexpectedly, drug‐dependent antibodies reactive with red cells and granulocytes were identified in four and eight patients, respectively. All patients were treated with plasma exchange (range 1–12 procedures), and seven required hemodialysis. All survive without residual abnormality. Our experience with nine patients with quinine‐induced HUS and the nine additional cases reported by others and reviewed in this paper establishes this condition as a distinct clinical entity. Adult patients presenting with HUS should routinely be asked about exposure to quinine in the form of medication or beverages. The mechanism by which quinine‐dependent antibodies produce renal failure is uncertain, but preliminary studies (described elsewhere) suggest that drug‐induced antibodies reactive with endothelial cells and possibly margination of granulocytes in renal glomeruli may be responsible for this complication. The prognosis in quinine‐induced HUS is better than in other forms of adult HUS. © 1994 Wiley‐Liss, Inc.

Từ khóa


Tài liệu tham khảo

Aster RH, 1989, Platelet Immunobiology: Molecular and Clinical Aspects, 387

10.1182/blood.V77.2.306.306

10.1159/000168444

10.1046/j.1537-2995.1990.30891020326.x

Boyum A, 1968, Separation of leukocytes from blood and bone marrow, Scand J Clin Lab Invest, 21, 77

10.1016/0022-1759(74)90109-4

Elliot HL, 1979, Intravascular coagulation induced by quinine: Unexpected hazard of “bitter lemon.”, Scott Med J, 24, 244, 10.1177/003693307902400314

10.1136/bmj.301.6747.323

10.1016/0140-6736(90)93309-D

Stroncek DF, 1992, Characterization of multiple quinine‐dependent antibodies in a patient with episodic hemolytic uremic syndrome and immune agranulocytosis, Blood, 80, 241, 10.1182/blood.V80.1.241.241

Blayney DW, 1992, Quinine‐associated immune thrombocytopenia, granulocytopenia, and renal failure in a patient with Klinefelter's syndrome [Letter], Blood, 80, 2686, 10.1182/blood.V80.10.2686.2686

10.7326/0003-4819-119-3-199308010-00006

Neahring BJ, 1983, Quinine‐dependent anti‐endothelial cell antibodies in plasma of patients with hemolytic‐uremic syndrome (HUS), Thromb Haemost, 69, 641

10.1177/1060028089023007-810

10.7326/0003-4819-101-1-41

Thông tin
Thông tin xuất bản

American Journal of Hematology

Tập 47 Số 4

283-289

Thông tin tác giả