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Recurrent Pancytopenia, Coagulopathy, and Renal Failure Associated with Multiple Quinine-dependent Antibodies

Robert B. Maguire, MD; David F. Stroncek, MD; and Allan C. Campbell, MD
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From the University of Illinois College of Medicine at Peoria, St. Francis Medical Center, and Proctor Hospital, Peoria, Illinois; the University of Minnesota Medical School, Minneapolis, Minnesota; the American Red Cross, St. Paul, Minnesota. Requests for Reprints: David Stroncek, MD, University of Minnesota Hospital and Clinic, Department of Laboratory Medicine and Pathology, Blood Bank Laboratory, Box 198 UMHC/D211 Mayo, 420 Delaware Street SE, Minneapolis, MN 55455. Acknowledgments: The authors thank Mary Egging, Gail Eiber, Greg Herr, Jane Swanson, and Shelley Pulkrabek for their technical assistance and Bobbie Gibson for help in manuscript preparation. Grant Support: In part by funds from the Residents' Research Fund, St. Francis Medical Center, and The American Red Cross St. Paul Regional Blood Services.

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;119(3):215-217. doi:10.7326/0003-4819-119-3-199308010-00006
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Immune thrombocytopenia mediated by drug-dependent antibodies to platelets is a well-known adverse reaction to quinine [12]. Recent reports of disseminated intravascular coagulation [3] and the hemolytic uremic syndrome [45] in association with multiple quinine-dependent antibodies suggest the existence of immune-mediated effects on cell lines other than platelets. We describe two patients who were not known to be taking quinine and who had a recurrent febrile illness associated with pancytopenia and renal failure along with serologic evidence of drug-dependent platelet, neutrophil, and erythrocyte antibodies.

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