Propofol and/or etomidate-induced immune thrombocytopenia: A case report

OBJECTIVE: To report a case of severe immune-mediated thrombocytopenia highly suspected to be induced by propofol and/or etomidate. CLINICAL FEATURES: A 62-year-old female patient developed acute, severe thrombocytopenia following two separate general anesthesia events in 2025. The first episode occurred 14 days after laparoscopic renal cyst unroofing, with a platelet nadir of 1 × 10⁹/L. The second episode occurred 11 days after painless gastroscopy and colonoscopy, with a platelet nadir of 2 × 10⁹/L. Platelet counts normalized after treatment with glucocorticoids, thrombopoietin receptor agonists, and platelet transfusions on both occasions. We suspect that propofol and/or etomidate, common drugs used in both anesthesia procedures, induced immune-mediated thrombocytopenia. CONCLUSION: Propofol and/or etomidate may induce immune-mediated thrombocytopenia. Anesthesiologists should enhance their awareness of this rare adverse reaction. When unexplained thrombocytopenia occurs post-anesthesia, besides common causes like sepsis, DIC, or heparin-induced thrombocytopenia, propofol and/or etomidate induced thrombocytopenia must be considered as an important differential diagnosis.