Pantoprazole
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Thrombocytopenia in an infant: case report An infant girl [age not clearly stated] developed thrombocytopenia during treatment with pantoprazole for prevention of stress ulcer. The girl, born at 38 weeks’ gestation, underwent Norwood stage 1 repair of her hypoplastic left heart and was admitted to the ICU afterwards. She developed Staphylococcus epidermidis sepsis on hospital day 24 and disseminated intravascular coagulation on day 54. She was started on IV pantoprazole (1 mg/kg/day) on day 26 for stress ulcer prophylaxis. On day 75, she underwent the second stage repair of her hypoplastic heart. Prior to surgery, she had platelet transfusions and also received recombinant factor VIIa. After the surgery, the dosage of pantoprazole was increased to 1 mg/kg every 12 hours. On day 81, her platelet count decreased to 37 × 103/mm3. She had received milrinone and was also receiving heparin but further investigations revealed that thrombocytopenia was not induced by either drug. Pantoprazole was discontinued. The girl received platelets and then received omeprazole via nasogastric tube. Her platelet count increased 4 days later and stabilised at 260 × 103/mm3. She was discharged on day 107. Author comment: "It is difficult to establish a true cause and effect relationship between the dose increase of pantoprazole and the development of thrombocytopenia. The Naranjo probability scale indicates a "possible" relationship in this infant." Miller JL, et al. Pantoprazole-induced thrombocytopenia. Indian Journal of Pediatrics 76: 1278-1279, No. 12, Dec 2009. Available from: URL: http:// 803013567 dx.doi.org/10.1007/s12098-009-0224-9 - USA
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Reactions 8 May 2010 No. 1300
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