{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T20:29:15Z","timestamp":1772742555730,"version":"3.50.1"},"reference-count":20,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2022,3,19]],"date-time":"2022-03-19T00:00:00Z","timestamp":1647648000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Drug\u2010induced immune thrombocytopenia (DITP) is a rare, but serious complication to a wide range of medications. Upon suspicion, one should do a thorough clinical evaluation following proposed diagnostic criteria and seek laboratory confirmation. If confirmed, it is important to ensure avoidance of the drug in the future.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study design and methods<\/jats:title><jats:p>Herein, we describe a young adult male who experienced two bouts of severe thrombocytopenia following dental treatment. The thrombocytopenia was acknowledged due to unexpected hemorrhaging during the procedures. On both occasions, he was exposed to four different drugs, none commonly associated with DITP. After the second episode of severe procedural\u2010related thrombocytopenia, an investigation into the cause was initiated. We describe the clinical approach to elucidate which of the four implicated drugs was responsible for thrombocytopenia and the laboratory work\u2010up done to confirm that the reaction was antibody\u2010mediated and identify the antibody's drug: glycoprotein specificity. An alternative drug was tested both in vivo and in vitro, to identify an option for future procedures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sequential exposure revealed the local anesthetic substance articaine to induce thrombocytopenia. Laboratory work\u2010up confirmed drug\u2010dependent antibodies (DDAbs) with specificity for the glycoprotein Ib\/IX complex, swiftly identified by a bead\u2010based Luminex assay. Further investigations by monoclonal antibody immobilization of platelet antigens assay (MAIPA) revealed a probable GPIb binding site. An alternative local anesthetic, lidocaine, was deemed safe for future procedures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Articaine can induce rapid\u2010onset, severe immune\u2010mediated thrombocytopenia causing bleeding complications. A modified bead\u2010based Luminex platelet antigen assay proved a useful addition in the DITP\u2010investigation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.16858","type":"journal-article","created":{"date-parts":[[2022,3,19]],"date-time":"2022-03-19T17:03:46Z","timestamp":1647709426000},"page":"1142-1147","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Acute drug\u2010induced immune thrombocytopenia \u2010 A work of articaine"],"prefix":"10.1111","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6379-4018","authenticated-orcid":false,"given":"Ingvild Jenssen","family":"L\u00e6greid","sequence":"first","affiliation":[{"name":"The Norwegian National Unit for Platelet Immunology, Department of Laboratory medicine University Hospital of North Norway  Troms\u00f8 Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mats Irgen","family":"Olsen","sequence":"additional","affiliation":[{"name":"Department of Hematology, Division of Internal Medicine University Hospital of North Norway  Troms\u00f8 Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jon Inge","family":"Harr","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Narvik, Division of Surgical Medicine and Intensive Care University Hospital of North Norway  Narvik Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renathe Henriksen","family":"Gr\u00f8nli","sequence":"additional","affiliation":[{"name":"The Norwegian National Unit for Platelet Immunology, Department of Laboratory medicine University Hospital of North Norway  Troms\u00f8 Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0808-0183","authenticated-orcid":false,"given":"Trude Victoria","family":"M\u00f8rtberg","sequence":"additional","affiliation":[{"name":"The Norwegian National Unit for Platelet Immunology, Department of Laboratory medicine University Hospital of North Norway  Troms\u00f8 Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9515-0922","authenticated-orcid":false,"given":"Siw Leiknes","family":"Ernstsen","sequence":"additional","affiliation":[{"name":"The Norwegian National Unit for Platelet Immunology, Department of Laboratory medicine University Hospital of North Norway  Troms\u00f8 Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3104-3818","authenticated-orcid":false,"given":"Maria Therese","family":"Ahlen","sequence":"additional","affiliation":[{"name":"The Norwegian National Unit for Platelet Immunology, Department of Laboratory medicine University Hospital of North Norway  Troms\u00f8 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