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Linezolid-associated thrombocytopenia.

¹Department of Clinical Pharmacy Practice, St. John's University, Queens, NY, USA. Lams1@stjohns.edu

The Consultant Pharmacist : the Journal of the American Society of Consultant Pharmacists

|August 23, 2012

Summary

Elderly patients with end-stage renal disease on linezolid may develop severe thrombocytopenia (low platelets). Discontinuation of linezolid led to platelet count recovery, highlighting the need for vigilant monitoring.

Area of Science:

Pharmacology
Hematology
Nephrology

Background:

Linezolid is an antibiotic used for serious infections.
Thrombocytopenia is a potential adverse effect of linezolid therapy.

Observation:

A 76-year-old male patient with end-stage renal disease (ESRD) and comorbidities developed progressive thrombocytopenia during linezolid treatment.
Platelet count decreased by over 50% within a week, leading to gastrointestinal bleeding and transfusion.
Despite linezolid discontinuation, platelet counts continued to fall before eventually recovering.

Findings:

The patient's thrombocytopenia resolved nine days after stopping linezolid.
Risk factors for linezolid-associated thrombocytopenia included advanced age, ESRD, and potential drug metabolite accumulation due to impaired renal clearance.

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This case highlights a severe hematologic adverse drug reaction potentially linked to linezolid in a high-risk patient population.

Implications:

Clinicians must monitor platelet counts closely in elderly patients receiving linezolid, particularly those with ESRD.
Vigilance is crucial for patients at increased risk of bleeding events while on linezolid therapy.
This case underscores the importance of considering drug-induced thrombocytopenia in patients with declining platelet counts and risk factors.