{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T22:06:02Z","timestamp":1769810762233,"version":"3.49.0"},"reference-count":15,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2006,7,11]],"date-time":"2006-07-11T00:00:00Z","timestamp":1152576000000},"content-version":"vor","delay-in-days":4240,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["American J Hematol"],"published-print":{"date-parts":[[1994,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Quinine\u2010induced immune thrombocytopenia with hemolytic uremic syndrome (HUS) is a recently defined clinical entity. In this paper we have attempted to characterize the natural history and laboratory abnormalities typical of quinine\u2010induced immune thrombocytopenia associated with hemolytic uremic syndrome in nine patients experiencing ten episodes of the disease. In addition, review of other reported cases of probable quinine\u2010induced HUS is presented. The disease was characterized by the onset of chills, diapheresis, nausea and vomiting, abdominal pain, decreased urine output, and petechiae following quinine exposure. All patients experience significant anemia, severe thrombocytopenia, increased lactate dehydrogenase, elevated serum creatinine, and oliguria. Quinine\u2010dependent platelet\u2010reactive antibodies were identified in eight of nine using flow cytometry. Unexpectedly, drug\u2010dependent antibodies reactive with red cells and granulocytes were identified in four and eight patients, respectively. All patients were treated with plasma exchange (range 1\u201312 procedures), and seven required hemodialysis. All survive without residual abnormality. Our experience with nine patients with quinine\u2010induced HUS and the nine additional cases reported by others and reviewed in this paper establishes this condition as a distinct clinical entity. Adult patients presenting with HUS should routinely be asked about exposure to quinine in the form of medication or beverages. The mechanism by which quinine\u2010dependent antibodies produce renal failure is uncertain, but preliminary studies (described elsewhere) suggest that drug\u2010induced antibodies reactive with endothelial cells and possibly margination of granulocytes in renal glomeruli may be responsible for this complication. The prognosis in quinine\u2010induced HUS is better than in other forms of adult HUS. \u00a9 1994 Wiley\u2010Liss, Inc.<\/jats:p>","DOI":"10.1002\/ajh.2830470407","type":"journal-article","created":{"date-parts":[[2007,2,21]],"date-time":"2007-02-21T13:58:10Z","timestamp":1172066290000},"page":"283-289","source":"Crossref","is-referenced-by-count":91,"title":["Quinine\u2010induced immune thrombocytopenia with hemolytic uremic syndrome: Clinical and serological findings in nine patients and review of literature"],"prefix":"10.1002","volume":"47","author":[{"given":"Jerome L.","family":"Gottschall","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Betsy","family":"Neahring","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janice G.","family":"McFarland","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guo\u2010Guang","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lee Ann","family":"Weitekamp","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard H.","family":"Aster","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2006,7,11]]},"reference":[{"key":"e_1_2_1_2_2","first-page":"387","volume-title":"Platelet Immunobiology: Molecular and Clinical Aspects","author":"Aster RH","year":"1989"},{"key":"e_1_2_1_3_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V77.2.306.306"},{"key":"e_1_2_1_4_2","doi-asserted-by":"publisher","DOI":"10.1159\/000168444"},{"key":"e_1_2_1_5_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1537-2995.1990.30891020326.x"},{"key":"e_1_2_1_6_2","first-page":"77","article-title":"Separation of leukocytes from blood and bone marrow","volume":"21","author":"Boyum A","year":"1968","journal-title":"Scand J Clin Lab Invest"},{"key":"e_1_2_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/0022-1759(74)90109-4"},{"key":"e_1_2_1_8_2","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1177\/003693307902400314","article-title":"Intravascular coagulation induced by quinine: Unexpected hazard of \u201cbitter lemon.\u201d","volume":"24","author":"Elliot HL","year":"1979","journal-title":"Scott Med J"},{"key":"e_1_2_1_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.301.6747.323"},{"key":"e_1_2_1_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(90)93309-D"},{"key":"e_1_2_1_11_2","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1182\/blood.V80.1.241.241","article-title":"Characterization of multiple quinine\u2010dependent antibodies in a patient with episodic hemolytic uremic syndrome and immune agranulocytosis","volume":"80","author":"Stroncek DF","year":"1992","journal-title":"Blood"},{"key":"e_1_2_1_12_2","doi-asserted-by":"crossref","first-page":"2686","DOI":"10.1182\/blood.V80.10.2686.2686","article-title":"Quinine\u2010associated immune thrombocytopenia, granulocytopenia, and renal failure in a patient with Klinefelter's syndrome [Letter]","volume":"80","author":"Blayney DW","year":"1992","journal-title":"Blood"},{"key":"e_1_2_1_13_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-119-3-199308010-00006"},{"key":"e_1_2_1_14_2","first-page":"641","article-title":"Quinine\u2010dependent anti\u2010endothelial cell antibodies in plasma of patients with hemolytic\u2010uremic syndrome (HUS)","volume":"69","author":"Neahring BJ","year":"1983","journal-title":"Thromb Haemost"},{"key":"e_1_2_1_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/1060028089023007-810"},{"key":"e_1_2_1_16_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-101-1-41"}],"container-title":["American Journal of Hematology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fajh.2830470407","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ajh.2830470407","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,24]],"date-time":"2023-10-24T01:49:10Z","timestamp":1698112150000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ajh.2830470407"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1994,12]]},"references-count":15,"journal-issue":{"issue":"4","published-print":{"date-parts":[[1994,12]]}},"alternative-id":["10.1002\/ajh.2830470407"],"URL":"https:\/\/doi.org\/10.1002\/ajh.2830470407","archive":["Portico"],"relation":{},"ISSN":["0361-8609","1096-8652"],"issn-type":[{"value":"0361-8609","type":"print"},{"value":"1096-8652","type":"electronic"}],"subject":[],"published":{"date-parts":[[1994,12]]}}}