Journal of

Case Reports and Images in Oncology

 
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Case Report
 
Morphine induced thrombocytopenia: A case report
Ayman Rasmy1,3, Mohammed Rahal1, Masood Kisana2, Shakeel Ahmad2, Ahmed Salah2
1Adult Oncology Department- King Fahad Specialist Hospital - Dammam-KSA.
2Pallitive Department - King Fahad Specialist Hospital - Dammam-KSA.
3Medical Oncology Department- Zagazig University Egypt.

Article ID: 100004Z10AR2015
doi:10.5348/Z10-2015-4-CR-4

Address correspondence to:
Dr. Ayman Ahmed Rasmy
Adult Oncology Department, Oncology Center
King Fahad Specialist Hospital (KFSH-D), Al Murekbat Area
Omar Bin Thabet Street, Dammam
Saudi Arabia; Postal Code Box: 15215, ZIP Code: 31444
Phone: 00966541899333
Fax: 0096638442222 (Ext. 6854)

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How to cite this article:
Rasmy A, Rahal M, Kisana M, Ahmad S, Salah A. Morphine induced thrombocytopenia: A case report. J Case Rep Images Oncology 2015;1:15–19.


Abstract
Introduction: Thrombocytopenia is defined as a platelet count below the 2.5th lower percentile of the normal platelet count distribution. The results of the third US National Health and Nutrition Examination Survey support the traditional value of 150 µL as the lower limit of normal. However, platelet counts between 100 µL and 150 µL, do not necessarily indicate disease if they have been stable for more than six months, and the adoption of a cut-off value of 100 µL may be more appropriate to identify a pathologic condition.
Case Report: A 57-year-old male patient known diabetic and hypertensive who has metastatic rectosigmoid cancer to the liver that was treated with chemotherapy FOLOFX for 12 cycles with disease progression and uncontrolled severe lower abdominal pain that was not controlled on oral morphine, so started to receive morphine infusion by PCA pump with development of severe thrombocytopenia, which reach Less than 5000 µL. Urgent platelet transfusion was given for life-saving and by investigations, there was no definite primary pathological cause for this unexplained severe thrombocytopenia, and it was most probably drug -induced secondary to morphine because the depth of thrombocytopenia was increased with the increasing dose of morphine. The diagnosis of morphine induced thrombocytopenia in this case was confirmed by positive anti-platelet antibody and increasing the platelet to 76000 µL one week after stopping the morphine.
Conclusion: Although it is very rare worldwide, morphine induced thrombocytopenia can happen and may be life threatening if not diagnosed and treated probably.

Keywords: Chemotherapy, Metastatic rectosigmoid cancer, Morphine, Thrombocytopenia


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Author Contributions
Ayman Rasmy – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Mohammed Rahal – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Masood Kisana – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Shakeel Ahmad – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Ahmed Salah – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Ayman Rasmy et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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