View Full Version : Drug-induced thrombocitopeny?

10-07-2015, 03:52 PM
Sorry, for long post, but I would like to explain in details my doubt.

My general/gastrintestinal surgeon request a complete blood test as a pre-surgery exam in order to perform a fundoplication, to solve a gastroesophagical reflux disease (GERD) that I've had for three years. My condition is not responding to high-dose proton pump inhibitors, diet or lifestyle changes, because I have a hypotensive lower esophageal shpincter and my esophagus peristaltic rhythm is lower than normal.

I've been taking 80 mg (2x40 mg) of esomeprazole + 20 mg (2x10 mg) of domperidone daily for about a month, and during the day before the blood exam, 900 mg (3x300 mg) of ibuprofen in 8 hours interval, as I was having a muscle pain on thighs due to heavy exercise on weekend without warming up properly. The pain has since completely gone.

I did the blood exam yesterday, on Tuesday at 8:30 (I took the last pill of ibuprofen on Monday at 22:30), and receive the results today. I explained to the nurse who drew my blood that I took these medicines. My platelet count was low (thrombocitopeny), and I suspect due to either the PPI drug or ibuprofen.

As you might know, the platelets are essential in blood coagulation process after a an injury (such as a surgery), which is something the surgeon needs to be sure that I don't have coagulation problems and will have a hemorragy during the procedure.

The normal platelet value is between 150,000 and 450,000, but in my result was 143,000. The Platelet Distribution Index was 72,7%, when the normal values should be between 25 to 65% according to the parameters in the result. Mean Platelet Volume is 10,1 fL (fentolitre), which is within the normal range (7,2-11,1) fL. Every other coagulation parameter is normal, along with HDL, tryglicerides (in optimal or normal range), etc.

All my previous blood tests resulted in normal values of platelets amount, but I wasn't taking any medication when I underwent the complete blood test. I read the package inserts for esomeprazole and ibuprofen (or any other NSAID), and thrombocitopeny was among the possible adverse effects. I think that the ibuprofen is the main culprit, I only took it because I had a major muscle pain (due to extreme fatigue) that really hurt, but I didn't know it could interfere with the platelet production. As I said, I told the nurse i took these medicines.

I don't know if the surgeon will think that I have some blood or vascular disease (which I don't believe, as all my previous blood exams were normal and I don't have any symptoms) and will not do the precedue on me. Should I ask him for a 2nd blood test to see if platelets levels will get back to normal? Or he will take the fact that I've been taking 3 medicines into account? and consider this a pretty much normal or expected result? Thanks in advance.

10-07-2015, 04:41 PM
I forgot to mention:

-before 80 mg of esomeprazole daily, I was taking 40 mg of pantoprazole, along with 20 mg of domperidone daily for 28 days;

-complete blood test fastening period was 12-hour (12 hours and a half the moment my blood was drawn);

-I have no other systemic diseases, such as in kidneys or liver;

-I'm 1,90 m (about 6"3') and I weight 84,5 kg, so it's clear I'm not obese;

-glucose level was 78 mg/dL (normal range 70-99 mg/dL) after a 12-hour fastening period;

-cholesterol was 128 mg/dL (being optimal < 200 mg/dL)

-tryglicerydes: 39 mg/dL (optimal values < 150 mg/dL)

-HDL was 55 mg/dL (optimal > 60 mg/dL) , even though I eat lots of fruits (except citric), vegetables, oatmeal and linseed almost daily, along with other sources of soluble fiber that lower LDL. I suspect the high dose of PPI might be involved in this;

-I'm not usually sedentary, usually 2 hours of moderate-intensive jogging weekly when I have time from college;

-bleeding time was 2 min (reference levels are between 1 and 6 minutes);

-prothrombin partial activity time, thromboplastine time, INR (1,09, normal being < 1,26) and every other blood clotting parameter was among normal values.

-I've already undergone 3 surgeries that required geral anesthesia, the last three years ago, and never had any issue with excessive bleeding. Never had any spontaneous or easy bleeding, the other way around actually.

Basically, what I'm saying is that I will try to convince my surgeon that it the the abnormal parameters, platelet value and PDW, were caused by these drugs and not by a blood or bone marrow disease, which could exclude me from undergoing the surgery and solving my GERD once and for all.

10-11-2015, 12:59 PM
I agree that the ibuprofen is the likeliest culprit for your below norm platelet count.
A count of 143K will not present a bleeding risk. Surgeons' opinions on the matter vary, but I very much doubt yours would have any kind of apprehension about operating with your count well above 100K.

10-15-2015, 01:31 PM
I showed him the test results, and fortunately, there was no reason for concern. He considered it normal, probably because I'm already taking a very high dose of PPI drug for about two months, along with the ibuprofen. Previously, I've also told him I had already undergone three major surgeries and din't have any excessive bleeding, and all my previous clotting testes were normal.

I guess I've learnt the lesson now, I'll never take any other drug, especially a NSAID, right before a blood test anymore. Thanks for your reply, I'll undergo fundoplication next Monday as planned, and I'm sure everything will go alright.

10-15-2015, 02:01 PM
I'm sure it will. Good luck with it!