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Adalimumab-induced platelet antibodies resulting in severe thrombocytopenia
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  • Henk-Jan Boiten,
  • Sufia Amini,
  • Frank Wolfhagen,
  • Peter Westerweel
Henk-Jan Boiten
Albert Schweitzer Hospital Location Dordwijk
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Sufia Amini
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Frank Wolfhagen
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Peter Westerweel
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Abstract

Anti-tumor necrosis factor alpha (TNFα) agents are effective in diseases including Crohn’s disease (CD) but may cause cytopenias. The mechanisms involved in anti-TNFα agents induced thrombocytopenia are scarce. We report a 73-year-old male with Crohn’s disease for which he currently used adalimumab, an anti-TNFα agent. He had received mesalazine and infliximab before the treatment of adalimumab. No comorbidities were present. Routine laboratory tests revealed a deep thrombocytopenia (thrombocytes 24x10*9/L) after which adalimumab was discontinued. Bleeding symptoms included cutaneous hematomas and mild epistaxis. Direct monoclonal antibody-specific immobilization of platelet antigens (MAIPA assay) revealed autoantibodies specific to glycoprotein IIb/IIIa (GPIIb/IIIa) and glycoprotein V (GPV) platelet receptors. There was no bone marrow suppression. Other causes of the thrombocytopenia were ruled out. The platelet count normalized after adalimumab discontinuation. No further interventions were required. Monitoring thrombocyte levels after initiating anti-TNFα agents is recommended, which could lead to prevention of this potential fatal phenomenon.

Peer review status:ACCEPTED

06 Jan 2021Submitted to British Journal of Clinical Pharmacology
07 Jan 2021Submission Checks Completed
07 Jan 2021Assigned to Editor
10 Jan 2021Reviewer(s) Assigned
31 Jan 2021Review(s) Completed, Editorial Evaluation Pending
01 Feb 2021Editorial Decision: Revise Minor
03 Feb 20211st Revision Received
04 Feb 2021Submission Checks Completed
04 Feb 2021Assigned to Editor
04 Feb 2021Review(s) Completed, Editorial Evaluation Pending
04 Feb 2021Editorial Decision: Accept