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Published on: October 27, 2014
SEVERE IMMUNE-MEDIATED THROMBOCYTOPENIA AFTER INTRAVITREAL BEVACIZUMAB INJECTION
Tianyi Li1, Derek T Witteman2, Eric D Weber3
1Department of Internal Medicine, William Beaumont Army Medical Center, El Paso, TX.
Purpose:
To report a case of severe immune-mediated thrombocytopenia after intravitreal bevacizumab administration.
Methods:
A 77-year-old man with right-sided macular degeneration received intravitreal bevacizumab. After his third treatment dose, he was hospitalized for symptomatic thrombocytopenia (platelet count of 3 k/μL) and underwent testing to determine the etiology.
Results:
Initial platelet counts on admission were 3 k/μL, down from 238 k/μL 3 months before. A peripheral smear, coagulation studies, and an abdominal CT were unremarkable. A bone marrow biopsy revealed hypercellular marrow with megakaryocytic hyperplasia. Serum antiplatelet antibody testing identified antibodies against glycoprotein IV and human leukocyte antigens. A total of 13 units of platelets were administered and resulted in no significant response. Treatment with rituximab, romiplostim, and human leukocyte antigen-matched platelets resulted in slow recovery and normalization of platelet counts.
Conclusion:
The case presented shows apparent severe immune-mediated thrombocytopenia after intravitreal bevacizumab administration.
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