{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T23:18:32Z","timestamp":1782602312577,"version":"3.54.5"},"reference-count":26,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2009,2,2]],"date-time":"2009-02-02T00:00:00Z","timestamp":1233532800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["American J Hematol"],"published-print":{"date-parts":[[2009,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Acute infusion reactions are the most common documented adverse reactions reported with rituximab, with overt cytokine release syndrome, and hematological adverse events being much rarer. The clinical course of a patient with mantle cell lymphoma, who developed acute thrombocytopenia and leukopenia following rituximab administration, is described and the literature reviewed. Serum complement and the levels of three cytokines\u2014TNF\u2010\u03b1, IL\u20106, and IL\u20101, were measured 2 days after the infusion of rituximab by using ELISA assay. Drug\u2010dependent antibodies against platelets were evaluated by two procedures as follows: an immunofluorescence test applying flow cytometry and Monoclonal Antibody Immobilization of Platelet Antigen (MAIPA). Serum levels of TNF\u2010a were significantly increased compared with normal, whereas those of IL\u20106 and IL\u20101 were not increased significantly. Flow cytometry assay and the MAIPA assay failed to detect rituximab\u2010dependent antibodies against platelets. Complement levels were decreased compared with normal. Literature search yielded 10 publications reporting on another 15 patients. The most common type of lymphoma was mantle cell lymphoma, six patients had bone marrow involvement, and 10 patients had splenomegaly. In 10 patients, acute cytopenia was preceded by cytokine release syndrome or infusion\u2010related symptoms. Usually, thrombocytopenia was not associated with bleeding manifestations. Thrombocytopenia was the most commonly acute cytopenia reported. The postulated pathogenesis is associated with cytokine release syndrome and complement activation. Patients with potential risk factors like splenomegaly and bone marrow involvement, who develop clinical manifestations compatible with cytokine release syndrome, should be closely monitored for rituximab\u2010associated cytopenia. Am. J. Hematol., 2009. \u00a9 2009 Wiley\u2010Liss, Inc.<\/jats:p>","DOI":"10.1002\/ajh.21372","type":"journal-article","created":{"date-parts":[[2009,2,2]],"date-time":"2009-02-02T18:58:10Z","timestamp":1233601090000},"page":"247-250","source":"Crossref","is-referenced-by-count":50,"title":["Rituximab\u2010associated acute thrombocytopenia: An under\u2010diagnosed phenomenon"],"prefix":"10.1002","volume":"84","author":[{"given":"Ron","family":"Ram","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilach","family":"Bonstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anat","family":"Gafter\u2010Gvili","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac","family":"Ben\u2010Bassat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ofer","family":"Shpilberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pia","family":"Raanani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2009,3,3]]},"reference":[{"key":"e_1_2_1_2_2","doi-asserted-by":"publisher","DOI":"10.1053\/sonc.2003.50025"},{"key":"e_1_2_1_3_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1998.16.8.2825"},{"key":"e_1_2_1_4_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2001.19.8.2153"},{"key":"e_1_2_1_5_2","doi-asserted-by":"crossref","first-page":"2217","DOI":"10.1182\/blood.V94.7.2217.419k02_2217_2224","article-title":"Cytokine\u2010release syndrome in patients with B\u2010cell chronic lymphocytic leukemia and high lymphocyte counts after treatment with an anti\u2010CD20 monoclonal antibody","volume":"94","author":"Winkler U","year":"1999","journal-title":"Blood"},{"key":"e_1_2_1_6_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2003.09.027"},{"key":"e_1_2_1_7_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2001.19.8.2165"},{"key":"e_1_2_1_8_2","doi-asserted-by":"publisher","DOI":"10.1080\/10428190802475329"},{"key":"e_1_2_1_9_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2004-04-1323"},{"key":"e_1_2_1_10_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.leu.2401987"},{"key":"e_1_2_1_11_2","doi-asserted-by":"publisher","DOI":"10.1080\/10428190701625099"},{"key":"e_1_2_1_12_2","first-page":"ECR23","article-title":"Rituximab\u2010induced acute thrombocytopenia: A report of two cases","volume":"90","author":"Otrock ZK","year":"2005","journal-title":"Hematologica"},{"key":"e_1_2_1_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.20218"},{"key":"e_1_2_1_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.20028"},{"key":"e_1_2_1_15_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1997.15.10.3266"},{"issue":"3","key":"e_1_2_1_16_2","first-page":"128","article-title":"Rituximab induced thrombocytopenia in marginal lymphoma and hairy cell leukemia: A rare, but possible complication","volume":"92","author":"Farina G","year":"2007","journal-title":"Hematologica"},{"key":"e_1_2_1_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2006.06299.x"},{"key":"e_1_2_1_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12032-008-9079-6"},{"key":"e_1_2_1_19_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V83.2.435.435"},{"key":"e_1_2_1_20_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.leu.2402424"},{"key":"e_1_2_1_21_2","doi-asserted-by":"publisher","DOI":"10.1080\/10428190500254752"},{"key":"e_1_2_1_22_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-119-8-199310150-00013"},{"key":"e_1_2_1_23_2","doi-asserted-by":"publisher","DOI":"10.1128\/IAI.67.10.5186-5191.1999"},{"key":"e_1_2_1_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/s002770050279"},{"key":"e_1_2_1_25_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2002-06-1639"},{"key":"e_1_2_1_26_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000441-199612000-00009"},{"key":"e_1_2_1_27_2","first-page":"727","article-title":"Experimental evaluation of serum C3 and C4 assay by laser\u2010nephelometry. 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