heroin and Thrombocytopenia

A variety of drugs and other agents have been reported to cause immune-mediated platelet destruction. The cardinal features of this syndrome are acute, often alarming, purpura, closely related to drug exposure, which remits in one to two weeks after discontinuation of all suspect drugs. Quinidine and quinine have been most commonly implicated but, recently, both heparin and heroin have been the subject of numerous reports. Platelets are removed rapidly from the circulation, apparently as a result of the attachment of drug-antibody immune complexes. In vitro documentation of platelet injury by these complexes has inspired the development of many in vitro tests of differing sophistication. While valuable in confirming the clinical suspicion, none is sufficiently sensitive to exclude the diagnosis.

Topics: Antibody Specificity; Heparin; Heroin; Humans; Immune Complex Diseases; Immune System Diseases; Quinidine; Quinine; Thrombocytopenia

Topics: Adult; AIDS-Related Complex; Female; Heroin; Humans; Male; Splenectomy; Substance-Related Disorders; Thrombocytopenia

Topics: Adult; Heroin; Heroin Dependence; Humans; Male; Purpura, Thrombocytopenic; Thrombocytopenia

Topics: Heroin; Heroin Dependence; Humans; Thrombocytopenia

Profound thrombocytopenia developed in a 22-year-old man after intravenous use of heroin. A high-titer, quinine-dependent, platelet-specific antibody was detected in his serum using lysis of normal platelets labeled with chromium 51 and an electroimmunoassay for measurement of platelet-associated IgG. The antibody was specific for quinine and failed to react with platelets in the presence of quinidine hydrochloride or two structural analogues of heroin. Quinine, a common adulterant found in heroin, was detected in the patient's blood and urine. On the basis of these observations, the patient was judged to have quinine-induced immunologic thrombocytopenia. To our knowledge, this report is the first to confirm that quinine used as an adulterant can induce immunologic thrombocytopenia following an injection of heroin.

Topics: Adult; Blood Platelets; Chromium Radioisotopes; Drug Contamination; Heroin; Humans; Immunoassay; Immunoglobulin G; Injections, Intravenous; Male; Quinine; Thrombocytopenia

Topics: Antibodies; Heroin; Humans; Injections, Intravenous; Male; Thrombocytopenia

Topics: Adult; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male; Thrombocytopenia