SHM Converge Scientific Abstract ePoster Gallery-A Not So Routine Scan: Immune Thrombocytopenia Following Contrast Administration

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A 70-year-old male veteran with COPD, depression, prior MALT lymphoma in remission, and recently diagnosed lung adenocarcinoma developed an acute reaction after receiving iodinated contrast media (ICM) for a staging CT scan. Within 5 minutes, he experienced nausea, diaphoresis, and shortness of breath, which resolved within 30 minutes. He had had a similar reaction during a previous CT scan but had not reported it.<br /><br />Although his initial symptoms suggested a physiologic contrast reaction rather than a classic allergic-like reaction, overnight observation revealed a new petechial rash. Laboratory testing showed a dramatic platelet drop from 259,000/µL five months earlier to 28,000/µL two hours after contrast, then to 6,000/µL the next day. Peripheral smear showed rare platelets without schistocytes, and workup for DIC, hemolysis, hepatitis B/C, HIV, and other causes was negative.<br /><br />Hematology diagnosed ICM-induced immune thrombocytopenia (ITP), a rare but important complication that can occur with or after contrast reactions. The patient had no active bleeding, so platelet transfusion was avoided. He was treated with dexamethasone 40 mg daily and responded well, with platelet recovery over several days and normalization within 10 days to 2 weeks.<br /><br />The case emphasizes the importance of distinguishing physiologic from allergic-like contrast reactions, recognizing that both may occur together, and monitoring patients carefully after contrast exposure. It also highlights the need to ask about prior undocumented reactions to ICM, document them clearly, and educate patients to avoid future contrast exposure because recurrence of ITP may occur even with steroid pre-treatment.

Asset Subtitle

Cory D. Ritter

Meta Tag

Author List Amira Dalmazio, Cory D. Ritter, Daniel Bajwa, Renee P. Chu, Tanvi Gupta

Category Clinical Vignettes

Concept Iodinated Contrast

Concept Immune Thrombocytopenia

Concept Allergic-like Reaction

Concept Hypersensitivity Reaction

Concept Contrast Avoidance

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine, Michael E DeBakey Veterans Affairs Medical Center

Presenting Author Cory D. Ritter

Track Adult

Keywords

iodinated contrast media

immune thrombocytopenia

contrast reaction

platelet drop

petechial rash

lung adenocarcinoma

dexamethasone treatment

physiologic reaction

allergic-like reaction

veteran patient

Iodinated Contrast

Immune Thrombocytopenia

Allergic-like Reaction

Hypersensitivity Reaction

Contrast Avoidance