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Blood, 6 August 2009, Vol. 114, No. 6, pp. 1250-1253. Prepublished online as a Blood First Edition Paper on May 8, 2009; DOI 10.1182/blood-2009-02-203034. This Article Full Text Full Text (PDF) All Versions of this Article: blood-2009-02-203034v1 114/6/1250    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Google Scholar Articles by Greinacher, A. Articles by Schwertz, H. PubMed PubMed Citation Articles by Greinacher, A. Articles by Schwertz, H. Related Collections Platelets and Thrombopoiesis Thrombosis and Hemostasis Brief Reports Related Article in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  PLATELETS AND THROMBOPOIESIS Brief report Megakaryocyte impairment by eptifibatide-induced antibodies causes prolonged thrombocytopenia Andreas Greinacher1, Birgitt Fuerll1, Heike Zinke2, Bernd Müllejans3, William Krüger4, Noemi Michetti5, Wolfgang Motz6, and Hansjörg Schwertz5,7 1 Institut für Immunologie und Transfusionsmedizin and 2 Klinik für Anästhesie und Intensivmedizin, Ernst-Moritz-Arndt Universität, Greifswald, Germany; 3 Klinik für Anästhesiologie und Intensivmedizin, Klinikum Karlsburg, Karlsburg, Germany; 4 Klinik für Innere Medizin, Hämatologie und Onkologie, Ernst-Moritz-Arndt Universität, Greifswald, Germany; 5 Program in Human Molecular Biology and Genetics, University of Utah, Salt Lake City; 6 Klinik für Kardiologie, Klinikum Karlsburg, Karlsburg, Germany; and 7 Department of Surgery, University of Utah, Salt Lake City Glycoprotein (GP) IIbIIIa inhibitors are used in the treatment of acute coronary syndromes. Transient immune-mediated acute thrombocytopenia is a recognized side effect of GPIIbIIIa inhibitors. We provide evidence that GPIIbIIIa inhibitor-induced antibodies can affect megakaryocytes in the presence of eptifibatide. In a patient with acute coronary syndrome, acute thrombocytopenia occurred after a second exposure to eptifibatide 20 days after the initial treatment. Despite the short half-life of eptifibatide (t1/2 = 2 hours), thrombocytopenia less than 5 x 109/L and gastrointestinal and skin hemorrhage persisted for 4 days. Glycoprotein-specific enzyme-linked immunosorbent assay showed eptifibatide-dependent, GPIIbIIIa-specific antibodies. Bone marrow examination showed predominance of early megakaryocyte stages, and platelet transfusion resulted in an abrupt platelet count increase. Viability of cultured cord blood–derived megakaryocytes was reduced in the presence of eptifibatide and patient IgG fraction. These findings can be explained by impaired megakaryocytopoiesis complicating anti-GPIIbIIIa antibody-mediated immune thrombocytopenia. This mechanism may also apply to some patients with autoimmune thrombocytopenia. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Article in Blood Online: Double jeopardy Richard H. Aster Blood 2009 114: 1135-1136. [Full Text] [PDF] This article has been cited by other articles: R. H. Aster Double jeopardy Blood, August 6, 2009; 114(6): 1135 - 1136. [Full Text] [PDF]

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