Abstract
Objective
To describe the clinical course of quinine-induced disseminated intravascular coagulation (DIC) and review all previous cases reported in the medical literature.
Design
Case report/literature review.
Setting
University teaching hospital medical ICU.
Patients
One patient in whom thrombocytopenia, coagulopathy, intravascular hemolysis, DIC, and acute renal failure temporally followed the ingestion of quinine.
Data sources
We conducted a computerized free-text MEDLINE database search from 1969 to 2000 using the keywords quinine and thrombocytopenia, quinine and hemolytic-uremic syndrome, and quinine and disseminated intravascular coagulation.
Study selection
All reported cases and reviews of quinine-induced thrombocytopenia, hemolytic-uremic syndrome (HUS), and DIC were reviewed. DIC was distinguished from quinine-induced thrombocytopenia or quinine-induced HUS based on the presence of abnormal clotting times, elevated fibrin degradation products, and/or elevated D-dimer levels.
Data synthesis
Fifteen previous patients were found to meet the criteria for DIC temporally related to the recent ingestion of quinine. The clinical course and laboratory abnormalities documented for each case are reviewed.
Conclusions
Quinine-induced DIC is a distinct clinical entity, which may present as unexplained thrombocytopenia, coagulopathy, or renal failure. In susceptible patients, the immune response to quinine may result in the production of not only anti-platelet antibodies but also antibodies against leukocytes, erythrocytes, and endothelial cells. Furthermore, the varying patterns and specificities of antibody production in an individual patient may result in a spectrum of clinical disease from mild, transient thrombocytopenia to overt intravascular hemolysis, renal failure, coagulopathy, and DIC. Early recognition of quinine-induced DIC is paramount, as this diagnosis affords a better prognosis than other adult forms of HUS or DIC.
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References
Aster RH (1989) The immune thrombocytopenias. In: Kunicki TJ, George JN (eds) Platelet immunobiology: molecular and clinical aspects. Lippincott, Philadelphia, pp 387
Kaufman DW, Kelly JP, Johannes GB, Sandler A, Harmon D, Stolley PD, Shapiro S (1993) Acute thrombocytopenic purpura in relation to the use of drugs. Blood 82:2714–2718
Kedia RK, Wright AJ (1999) Quinine-mediated disseminated intravascular coagulation. Postgrad Med J 75:429–430
McDonald SP, Shanahan EM, Thomas AC, Roxby DJ, Beroukas D, Barbara JAJ (1997) Quinine-induced hemolytic uremic syndrome. Clin Neph 6:397–400
Elliot HL, Trash DB (1979) Intravascular coagulation induced by quinine. Scot Med J 24:244–245
Barr E, Douglas JF, Hill HM (1990) Recurrent acute hypersensitivity to quinine. BMJ 301:323
Spearing RL, Hickton CM, Sizeland P, Hannah A, Bailey RR (1990) Quinine-induced disseminated intravascular coagulation. Lancet 336:1535–1537
Stroncek DF, Vercellotti GM, Hammerschmidt, Christie DJ, Shankar RA, Jacob HS (1992) Characterization of multiple quinine-dependent antibodies in a patient with episodic hemolytic uremic syndrome and immune agranulocytosis. Blood 80:241–248
Hagley MT, Hosney IA, Hulisz DT, Davis HH (1992) Hemolytic-uremic syndrome associated with ingestion of quinine. Am J Nephrol 12:192–195
Blayney DW (1992) Quinine-associated immune thrombopenia, neutropenia, and renal failure in a patient with Kleinfelter's syndrome. (letter) Blood 80:2686
Maguire RB, Stroncek DF, Campbell AC (1993) Recurrent pancytopenia, coagulopathy, and renal failure associated with multiple quinine-dependent antibodies. Ann Intern Med 119:215–217
Gottschall JL, Neahring B, McFarland JG, Wu G, Weitekamp LA, Aster RH (1994) Quinine-induced immune thrombocytopenia with hemolytic uremic syndrome: clinical and serological findings in nine patients and review of literature. Am J Hematol 47:283–289
Story D, Hall A, Older P (1994) Quinine-induced haemolytic uraemic syndrome. (letter) Anaesth Intens Care 22:114–115
Schattner A (1998) Quinine hypersensitivity simulating sepsis. Am J Med 104:488–500
Aster RH (1999) Drug-induced immune thrombocytopenia: an overview of pathogenesis. Semin Hematol 36:2–6
Hou M, Horney E, Stockelberg D, Jacobsson S, Kutti J, Waddenvik H (1997) Multiple quinine-dependent antibodies in a patient with episodic thrombocytopenia, neutropenia, lymphocytopenia, and granulomatous hepatitis. Blood 90:4806–4811
Glynne P, Salama A, Chaudhry A, Swirsky D, Lightstone L (1999) Quinine-induced immune thrombocytopenic purpura followed by hemolytic uremic syndrome. Am J Kidney Dis 33:133–137
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Knower, M.T., Bowton, D.L., Owen, J. et al. Quinine-induced disseminated intravascular coagulation: case report and review of the literature. Intensive Care Med 29, 1007–1011 (2003). https://doi.org/10.1007/s00134-003-1732-0
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DOI: https://doi.org/10.1007/s00134-003-1732-0