Sir,
I read with interest, the letter to editor published in Lung India Jan-March issue on thrombocytopenia due to rifampicin by Dixit et al.[1] The authors claim that only few cases of thrombocytopenia due to rifampicin in daily doses have been reported. Perhaps the authors have not searched the literature well. The disorder is not so rare.
Way back in 1985, I along with others (Sharma et al.[2] ) have reported such a case of thrombocytopenia due to rifampicin in daily dose, with severe bleeding diathesis. Other reports of more than 20 cases are available on “PubMed.” Many more may not have been reported since its occurrence is known for so many years. Most such cases have occurred in situations, where patients have been irregular on therapy or there are interruptions in rifampicin therapy, for one or the other reason.
Need not to emphasize that a high index of suspicion is warranted to unravel the disorder early and managed by prompt withdrawal of the drug. Patients who are irregular on therapy must be warned of reporting immediately, if they notice bleeding from any site.
Although Bhasin et al.[3] have suggested that resumption of the drug is possible in these patients; in my opinion, it is best avoided looking to the serious nature of the reaction.
REFERENCES
- 1.Dixit R, George J, Sharma AK. Thronbocytopenia due to rifampicin. Lung India. 2012;29:90–2. doi: 10.4103/0970-2113.92380. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Sharma TN, Gupta PR, Purohit SD, Jain BL, Durlabhji P, Koolwal S. Thronbocytopenic purpura induced by daily administration of rifampicin. Ind J Tuberc. 1985;32:199–200. [Google Scholar]
- 3.Bhasin DK, Sarode R, Puri S, Murwaha N, Singh K. Can rifampicin be restarted in patients with rifampicin induced thrombocytopenia. Tubercle. 1991;72:306–7. doi: 10.1016/0041-3879(91)90063-x. [DOI] [PubMed] [Google Scholar]