How does pepcid affect platelets

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Blood smear. May consider also: Heparin-PF4 antibody only if 4T-score is Ultrasonography to evaluate for DVT. Ferritin if concern for HLH. TEG may be helpful in more complex cases. Consider platelet transfusion. It is often a poor prognostic sign that is associated with systemic inflammation. Most cases of thrombocytopenia will resolve in parallel with the patient's overall recovery. Most ICU patients with mild thrombocytopenia don't require an exhaustive evaluation.

Potential indications to evaluate further might include: Severe thrombocytopenia e. Features of HIT e. Clinical thrombosis. The underlying disease process is unclear, raising a possibility of an underlying hematologic disorder e. Alcoholism direct marrow toxicity; can be suggested by macrocytosis; platelets should rise within days of cessation. Thrombotic microangiopathies e. Catastrophic antiphospholipid antibody syndrome CAPS.

Sepsis: Can occur with any pathogen. Especially occurs with specific pathogens ehrlichiosis, babesiosis, anaplasmosis, rocky mountain spotted fever, hantavirus, dengue.

Surgery, trauma. Hemophagocytic lymphohistiocytosis HLH. Devices: intra-aortic balloon pump, hemodialysis, ECMO. Drug-induced immune thrombocytopenia D-ITP. Post-transfusion purpura. Passive alloimmune thrombocytopenia. Idiopathic thrombocytopenic purpura ITP diagnosis of exclusion. Pseudothrombocytopenia: This refers to artificially low platelet count due to in vitro aggregation induced by EDTA in blood tubes.

Pseudothrombocytopenia may be suggested by finding clumped platelets on blood smear. Platelets may also coat the surface of neutrophils platelet satellitism. Pseudothrombocytopenia is usually meaningless, but can be associated with lupus, vasculitis, or lymphoma. Disseminated intravascular coagulation DIC of a pro-thrombotic type e. Severe marrow failure e. Will usually see neutropenia here as well. Usually not due solely to sepsis or DIC thrombocytopenia in septic-appearing patient Disseminated intravascular coagulation DIC due to the infection.

Specific infections ehrlichiosis, babeosis, anaplasmosis, rocky mountain spotted fever, hantavirus, dengue. Thrombotic thrombocytopenic purpura TTP related to clopidogrel. Acute fatty liver of pregnancy. Idiopathic thrombocytopenia ITP. Gestational thrombocytopenia. Obtaining baseline CBC from prior admissions or from other hospitals may be extremely helpful. Medication review? Many drugs can cause thrombocytopenia, not all of which are listed above. Calculate the 4T score for HIT. Recent events known to cause thrombocytopenia e.

Blood smear: Platelet clumps or satellitism platelets clumped around neutrophils suggests pseudothrombocytopenia. She endorsed severe abdominal pain and a pound weight loss over the last year, but denied any hematemesis, melena, or hematochezia.

Laboratory evaluation revealed white blood cell count of No other laboratory tests had been obtained until this recent emergency department visit. Therefore, the effect of PPI on the platelet count for the next 6 months after initiation of therapy was not available to us.

CT imaging of the abdomen and pelvis showed diffuse steatosis but was otherwise normal. Gastroenterology was consulted and due to refractory abdominal pain, weight loss, and NSAID use, an upper endoscope was recommended.

Additionally, intravenous esomeprazole twice daily was started. Hematology was consulted for the rapid drop in platelet count and the etiology was thought to be secondary to drug-induced thrombocytopenia, infection, or idiopathic thrombocytopenic purpura. Of note, the patient did not have any history of bleeding or clotting disorders. Additionally, there was no evidence of hemolysis on the peripheral blood smear and the patient was not coagulopathic.

On review of medications, since there were no other drugs except for one prophylactic dose of heparin that could be attributed to thrombocytopenia, it was recommended to hold the PPI.

Upper endoscope performed at that time revealed nonspecific gastritis. Biopsies were found to be negative for Helicobacter pylori infection. Due to the spontaneously improved platelet count, antibodies to heparin-platelet factor 4 complex were not checked to rule out heparin-induced thrombocytopenia.

Our patient was subsequently discharged home, but continued to have persistent epigastric pain. She tried a H2 histamine 2 receptor antagonist with minimal symptom relief. She was next seen in the Gastroenterology Clinic.

Since a PPI was warranted due to her persistent symptoms, the decision was made to restart dexlansoprazole with close follow-up. She ultimately got readmitted to the hospital 7 days later for persistent epigastric pain while on PPI. On this admission, our patient did not receive any heparin products and peripheral blood smear was not consistent with hemolysis. She did not receive any medications known to cause thrombocytopenia. She was seen in the Gastroenterology Clinic after hospital discharge and it was noted that her symptoms were partially controlled on H2 antagonist, sucralfate, and scopolamine which she received from her home country for control of nausea.

They are also important for the treatment of peptic ulcers, especially in acute settings when patients present with upper gastrointestinal bleeding [ 12 ]. Generally, PPIs are very safe medications, but a few case reports have implicated their role in causing thrombocytopenia [ 28 , 33 ].

This side effect of PPIs should be taken seriously, as the drop in the platelet count in our patient was very severe, and this side effect poses significant consequences such as life-threatening bleeding.

In our patient, the temporal relationship of the drop in platelet count with the introduction of PPI, along with the subsequent revival of the count upon its withdrawal, was sufficient to implicate PPI use as the reason for the thrombocytopenia. A reasonable first step in the evaluation and diagnosis of drug-induced thrombocytopenia is to discontinue the offending drug and look for the normalization of platelet counts.

However, in vitro testing for the detection of drug-dependent antibodies provides a direct analytical method to diagnose this condition. This test can be used as an adjunct to clinical findings in making a diagnosis of drug-induced thrombocytopenia and also for drug surveillance [ 40 ].

In all cases, platelet count dropped the very next day after starting PPI. The first case of pantoprazole-induced thrombocytopenia was reported by Watson et al. Subsequently, other authors have also documented a similar effect after pantoprazole administration [ 29 — 31 , 34 ].

However, Dotan et al. A small number of case reports have demonstrated thrombocytopenia with different types of PPI. While Zlabek and Anderson and Ogoshi et al. Finally, Ranzino et al. In our case, both esomeprazole and dexlansoprazole caused thrombocytopenia, so it is likely that this effect is not drug-specific, but is rather a class effect.

Hematology work-up including examination of a peripheral smear was also done, excluding other causes of thrombocytopenia. Based on the findings from these case reports and from our observation, it appears that PPIs can cause thrombocytopenia.

However, the mechanism of action is unknown. Future research should be focused on discovering how this class of drugs, which primarily works by inhibiting hydrogen potassium ATPase, can cause thrombocytopenia. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors.

Read the winning articles. Journal overview. Academic Editor: Chia-Tung Shun. Received 10 Dec Accepted 22 Mar Published 30 Apr Abstract Proton pump inhibitors PPIs are the most effective and preferred class of drugs used to treat peptic ulcer disease, gastroesophageal reflux disease, and other diseases associated with increased production of gastric acid.

Introduction Proton pump inhibitors PPIs are the most commonly used class of drugs for the treatment of gastric acid-related disorders [ 1 ]. Case A year-old Hispanic female was admitted for worsening upper abdominal pain, nausea, and vomiting. Figure 1. Platelet count trend of the patient. Thrombocytopenia developed after starting PPI for the first time and later on when it was restarted. References M.

Wolfe and G. S9—S31, View at: Google Scholar M. Wolfe, L. Welage, and G. Holt and C. Poynard, M. Lemaire, and H. It is created by eHealthMe based on reports of 42, people who have side effects when taking Pepcid from the FDA, and is updated regularly. You can use the study as a second opinion to make health care decisions. With medical big data and AI algorithms, eHealthMe enables everyone to run phase IV clinical trial to detect adverse drug outcomes and monitor effectiveness. Among them, 1, people 3.

Pepcid has active ingredients of famotidine. It is often used in gastroesophageal reflux disease. Low platelet count is found to be associated with 3, drugs and 3, conditions by eHealthMe. You can discuss the study with your doctor, to ensure that all drug risks and benefits are fully discussed and understood.

The study uses data from the FDA. It is based on famotidine the active ingredients of Pepcid and Pepcid the brand name. Other drugs that have the same active ingredients e.