The patient was diagnosed with severe thrombocytopenia after administration of iodinated contrast media.Ī basophil activation test (CD69 expression on CD4+ lymphocytes) was negative for Hexabrix. After six hours, blood tests showed a platelet count of zero with no clinical manifestations methylprednisolone was then administered gradually, and the platelet count recovered to 181×10 9/l after six days. Using 213 ml of ioxaglate sodium/ioxaglate meglumine ionic iodinated contrast (Hexabrix) and bivalirudin as an anticoagulant, percutaneous intervention was performed to implant seven zotarolimus-eluting stents ( Figure 1B and E). Prasugrel was then administered for three days without affecting the platelet count. The patient's platelet count returned to normal four days after the procedure. Possible explanations were that the episode was related to aspirin or was a hematologic reaction to catheterization contrast. Tests for heparin-induced thrombocytopenia were negative, and blood parameters and clotting times were normal. After 24 hours, the patient's platelet count dropped from 242×10 9/l to 75×10 9/l with a nadir of 25×10 9/l after 48 hours aspirin was then suspended and pseudothrombocytopenia was ruled out. Multivessel disease ( Figure 1A and D) was diagnosed. Exercise testing was positive and a new coronary angiography was performed via the right femoral artery, without clopidogrel but still using aspirin (the patient had previously taken aspirin, but it had to be discontinued due to an episode of epistaxis) and 2000 IU of unfractionated heparin as pretreatment. The patient remained asymptomatic until 2014, when he presented angina symptoms. At that time, severe thrombocytopenia was detected (7×10 9/l), which was attributed to the pretreatment with clopidogrel. After pretreatment with 100 mg aspirin and a 300-mg loading dose of clopidogrel, coronary angiography was performed, which revealed no significant coronary lesions. In 2007, the patient complained of typical chest pain. We present the case of a 47-year-old man, hypertensive, an ex-smoker, who received a kidney transplant in 1993 and restarted hemodialysis in 1999 due to recurrent focal segmental glomerulonephritis. Here, we present a case of a male patient with acute severe thrombocytopenia induced by iodinated contrast media, who underwent percutaneous coronary revascularization under both intravascular ultrasound (IVUS) and gadolinium contrast guidance. Gadolinium is a contrast medium used as an alternative in cases of intolerance or contraindication to iodinated contrast.
The mechanism behind contrast-induced thrombocytopenia remains unclear, but an immunoallergic or idiosyncratic reaction and direct toxicity have been postulated. Acute contrast-induced thrombocytopenia is an unusual event with the use of modern low osmolarity iodinated contrast media. Iodinated contrast media, used in coronary angiography, can occasionally produce serious reactions including respiratory failure or anaphylactic shock.
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