Pharmaceutical care of severe thrombocytopenia caused by cefoperazone sodi-um/sulbactam sodium combined with montelukast sodium

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Author: Qiang YANG ¹ Yu YAO ² Peng ZHANG ¹ Xiao-Fen YE ³  Xun-Yan ZHANG ¹

Affiliation: 1. Department of Pharmacy, Suining Central Hospital, Suining 629000, Sichuan Province, China 2. Department of Respiratory and Critical Care Medicine, Suining Central Hospital, Suinning 629000, Sichuan Province, China 3. Department of Pharmacy, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China

Keywords: Cefoperazone sodium/sulbactam sodium Montelukast sodium Thrombo-cytopenia Pharmaceutical care

DOI: 10.19960/j.issn.1005-0698.202306014

Reference: Qiang YANG, Yu YAO, Peng ZHANG, Xiao-Fen YE, Xun-Yan ZHANG.Pharmaceutical care of severe thrombocytopenia caused by cefoperazone sodium/sulbactam sodium combined with montelukast sodium[J].Yaowu Liuxingbingxue Zazhi,2023, 32(6):710-714.DOI: 10.19960/j.issn.1005-0698.202306014.[Article in Chinese]  Copied

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Abstract

A patient with acute exacerbation of chronic obstructive pulmonary disease developed severe thrombocytopenia (Plt 22×10⁹·L^-1) during hospitalization. Considering it as an adverse drug reaction, the most likely cefoperazone sodium/sulbactam sodium was discontinued and the patient was treated with platelet-raising therapy. However, the patient's platelets continued to decrease (Plt 4×10⁹·L^-1), and bleeding occurred. Then, the patient was treated with platelet transfusion. Bone marrow biopsy could not identify cause. The pharmacist considered that there may be other causes of thrombocytopenia. By medication analysis and literature reviewing, montelukast sodium was considered as another factor leading to thrombocytopenia. After discontinuation of montelukast sodium, the patient's platelets increased and the bleeding symptoms disappeared. After discharging from the hospital, the patient took montelukast sodium again and the thrombocytopenia was still existed (minimum Plt 7×10⁹·L^-1). Despite aggressive treatment, it was still in-effective. The pharmacist followed up the patient and advised the patient to stop using montelukast sodium. After 2 weeks of montelukast discontinuing, the platelets returned to normal (Plt 163×10⁹·L^-1).

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