Physician Should Think Have Thrombocytopenia before Using Antibiotic Vancomycin
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The blood that flows through this network of veins and arteries is called whole blood. Whole blood contains three types of blood cells, including:
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- red blood cells
- white blood cells
- platelets
These three types of blood cells are mostly manufactured in the bone marrow (the soft tissue inside our bones), especially in the bone marrow of the vertebrae (the bones that make up the spine), ribs, pelvis, skull, and sternum (breastbone). These cells travel through the circulatory system suspended in a yellowish fluid called plasma (pronounced: plaz-muh). Plasma is 90% water and contains nutrients, proteins, hormones, and waste products. Whole blood is a mixture of blood cells and plasma.
Among them platelet help in the clotting process. Platelets are indicated for the prevention or control of bleeding due to thrombocytopenia or platelet dysfunction. Platelets may be provided as pooled whole-blood derived platelet concentrates ("random donor" platelets) and as apheresis platelet concentrates ("single donor" platelets).When a blood vessel breaks, platelets gather in the area and help seal off the leak. Platelets survive only about 9 days in the bloodstream and are constantly being replaced by new cells.Blood also contains important proteins called clotting factors, which are critical to the clotting process. Although platelets alone can plug small blood vessel leaks and temporarily stop or slow bleeding, the action of clotting factors is needed to produce a strong, stable clot.
Thrombocytopenia is any disorder in which there are not enough platelets. Platelets are cells in the blood that help blood to clot. This condition is sometimes associated with abnormal bleeding.Thrombocytopenia with significant risk of hemorrhage. Randomized trials indicate that a threshold transfusion for prophylactic platelet transfusion of 10,000/ml is appropriate for many patients with chemotherapy induced thrombocytopenia.
Thrombocytopenia often occurs as a result of a separate disease or disorder. For example, a bone marrow disorder such as leukemia can interfere with platelet production and reduce the number of platelets in your blood. Or sometimes, thrombocytopenia occurs because of an immune system malfunction that develops for unknown reasons. In addition, thrombocytopenia may occur as a reaction to a medication.
An antibiotic often used in hospital intensive care units to treat serious staph infections resistant to other medicines may cause a sometimes-fatal bleeding condition, researchers said .
A study in the New England Journal of Medicine linked the antibiotic vancomycin to a disorder called thrombocytopenia. It is associated with abnormal bleeding and marked by a decrease in blood platelets -- cells that help the blood to clot.
Vancomycin is a glycopeptide antibiotic used in the prophylaxis and treatment of infections caused by Gram-positive bacteria. It has traditionally been reserved as a drug of "last resort", used only after treatment with other antibiotics had failed.Vancomycin is indicated for the treatment of serious, life-threatening infections by Gram-positive bacteria which are unresponsive to other less toxic antibiotics.
Vancomycin, in use for about three decades, can be used to treat infections in many parts of the body, and is seen as the drug of choice for serious staphylococci infections that are resistant to most other antibiotics. It can have other serious side effects, including hearing and kidney damage.
The study's senior researcher, Dr. Richard Aster of the Medical College of Wisconsin in Milwaukee and the BloodCenter of Wisconsin's Blood Research Institute, said the findings should not reduce use of vancomycin, which he said remains an important life-saving drug for certain patients.
"Only a small fraction who get vancomycin develop this complication," Aster said in a telephone interview. "But it's common enough so that we think physicians be aware of it and be prepared to stop the vancomycin if the platelet count goes down and substitute another antibiotic."
Antibiotics are used to treat infections caused by bacteria.
Patients who doctors think have thrombocytopenia can be tested for a special type of antibody -- an immune system protein that helps seek and destroy invaders like viruses and bacteria -- to see if it is related to medications.
The researchers examined data on 29 patients treated at major U.S. hospitals who tested positive for antibodies related to vancomycin. Three of the patients died after experiencing serious bleeding.
None of 29 had a rise in their platelet counts until use of vancomycin was stopped and use of another antibiotic was started.
The researchers suggested that doctors should have patients seen by a hematology consultant if they experience a low platelet count while being treated with vancomycin.
The increasing emergence of vancomycin-resistant enterococci has resulted in the development of guidelines for use by the Centers for Disease Control (CDC) Hospital Infection Control Practices Advisory Committee. These guidelines restrict use of vancomycin to the following indications:
treatment of serious infections caused by susceptible organisms resistant to penicillins (methicillin-resistant Staphylococcus aureus and multi-resistant Staphylococcus epidermidis (MRSE)) or in individuals with serious allergy to penicillins
pseudomembranous colitis (relapse or unresponsive to metronidazole treatment)
For treatment of infections caused by gram-positive microorganisms in patients who have serious allergies to beta-lactam antimicrobials.
antibacterial prophylaxis for endocarditis following certain procedures in penicillin-hypersensitive individuals at high risk
surgical prophylaxis for major procedures involving implantation of prostheses in institutions with a high rate of MRSA or MRSE.
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