SHM Converge Scientific Abstract ePoster Gallery-Vancomycin- Induced Immune Thrombocytopenia: A New Offender Other Than the Classic Heparin

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This case report describes vancomycin-induced immune thrombocytopenia, a rare form of drug-induced immune thrombocytopenia (DITP), as an important alternative diagnosis to heparin-induced thrombocytopenia (HIT) in hospitalized patients with rapidly falling platelet counts.<br /><br />The patient, who had alcohol use disorder and multiple traumatic injuries, was treated initially with vancomycin and cefepime, along with subcutaneous heparin for DVT prophylaxis. Platelets began to fall soon after vancomycin was started. Vancomycin was later restarted for Staphylococcus epidermidis bacteremia, after which the platelet count dropped more dramatically, reaching a nadir of 11,000/µL. Despite receiving four units of platelets, there was no meaningful improvement, prompting hematology consultation for transfusion-refractory thrombocytopenia.<br /><br />A workup ruled out other common causes of thrombocytopenia, including HIT (low 4T score and negative anti-heparin PF4 antibody), nutritional deficiencies, splenomegaly, and liver dysfunction. The pattern of thrombocytopenia—especially the abrupt decline after re-exposure to vancomycin—strongly supported vancomycin-induced DITP.<br /><br />Treatment consisted of immediate discontinuation of vancomycin and administration of two doses of IVIG. Platelet counts then rose quickly from 11,000/µL to 84,000/µL over four days and eventually recovered to 386,000/µL by discharge. Steroids were avoided because of active bacteremia.<br /><br />The report emphasizes that DITP typically presents 5–10 days after first exposure or more rapidly after re-exposure, often with severe thrombocytopenia and bleeding risk. Prompt recognition, stopping the offending drug, and using supportive therapies such as platelet transfusion, IVIG, and sometimes glucocorticoids are key to management.

Asset Subtitle

Shivani Shah

Meta Tag

Author List Deep Shah, Maitreyee Rai, Ryan Sweeney, Shivani Shah

Category Clinical Vignettes

Concept Immune Thrombocytopenia

Concept Drug-Induced Immune Thrombocytopenia

Concept Vancomycin

Concept Thrombocytopenia

Concept Platelets

Distinguished Non-Finalist

Presenter Organization Allegheny General Hospital

Presenting Author Shivani Shah

Track Adult

Keywords

vancomycin-induced immune thrombocytopenia

drug-induced immune thrombocytopenia

heparin-induced thrombocytopenia

thrombocytopenia

platelet count decline

IVIG treatment

Staphylococcus epidermidis bacteremia

platelet transfusion refractory

hospitalized patients

adverse drug reaction

Immune Thrombocytopenia

Drug-Induced Immune Thrombocytopenia

Vancomycin

Thrombocytopenia

Platelets