Quinine-Associated Thrombotic Thrombocytopenic Purpura–Hemolytic Uremic Syndrome: Frequency, Clinical Features, and Long-Term Outcomes

Quinine-Associated Thrombotic Thrombocytopenic Purpura–Hemolytic Uremic Syndrome: Frequency, Clinical Features, and Long-Term Outcomes

From University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.

Abstract

Background: Quinine-associated thrombotic thrombocytopenic purpura–hemolytic uremic syndrome (TTP–HUS) is thought to be uncommon and to have a good prognosis.

Objective: To describe the frequency, clinical features, and long-term outcomes of quinine-associated TTP–HUS.

Design: Case series.

Setting: Hospitals in central-western Oklahoma.

Patients: 225 consecutive patients with TTP–HUS, 1989-2000.

Measurements: Presenting features and clinical outcomes.

Results: Thrombotic thrombocytopenic purpura–hemolytic uremic syndrome was associated with quinine in 17 patients. Four patients died, and 7 survivors currently have chronic renal failure. Since 1 July 1995, 132 patients with clinically suspected TTP–HUS were explicitly asked about drug exposure. Fourteen (11%) had taken quinine, and 7 had taken other drugs associated with TTP–HUS. Neurologic abnormalities were as severe in patients with quinine-associated TTP–HUS as in the 118 patients who had not taken quinine.

Conclusions: Quinine is a common cause of drug-associated TTP–HUS and can cause death and chronic renal failure. When the disorder is described as TTP–HUS rather than only as HUS, the severity of neurologic abnormalities and the occasional absence of renal failure are emphasized. If recurrent disease is to be prevented, clinicians must recognize quinine as a possible cause.

Article and Author Information

Acknowledgments: The authors thank Drs. George Dale (University of Oklahoma), Dania Yaskanin (Oklahoma Blood Institute), and Janice McFarland (Blood Center of Southeastern Wisconsin, Milwaukee) for performing the quinine-dependent antiplatelet antibody studies. They also thank the Patients' Services staff of the Oklahoma Blood Institute, the community physicians, and the patients for continuing support and participation.
Requests for Single Reprints: James N. George, MD, Hematology–Oncology Section, Department of Medicine, University of Oklahoma Health Sciences Center, Box 26901, Oklahoma City, OK 73190; e-mail, Jim-George{at}OUHSC.edu.
Current Author Addresses: Drs. Kojouri, Vesely, and George: Hematology–Oncology Section, Department of Medicine, University of Oklahoma Health Sciences Center, Box 26901, Oklahoma City, OK 73190.
Author Contributions: Conception and design: K. Kojouri, S.K. Vesely, J.N. George.
Analysis and interpretation of the data: K. Kojouri, S.K. Vesely, J.N. George.
Drafting of the article: K. Kojouri, S.K. Vesely, J.N. George.
Critical revision of the article for important intellectual content: K. Kojouri, S.K. Vesely, J.N. George.
Final approval of the article: K. Kojouri, S.K. Vesely, J.N. George.
Statistical expertise: K. Kojouri, S.K. Vesely, J.N. George.
Collection and assembly of data: K. Kojouri, S.K. Vesely, J.N. George.