Abstract

RANITIDINE INDUCED THROMBOCYTOPENIA: A CASE REPORT

Ankit Gaur* and Manik Chhabra

Abstract

Introduction: Thrombocytopenia is defined as a platelet count of 100,000/mm3 or >50% drop in the platelet count from baseline. Ranitidine causes thrombocytopenia by an idiosyncratic reaction. Case Report: A 60-year-old female, a case of psoriasis, presented in dermatology department with multiple pustules over lower extremities, associated with fever and vomiting with the history of diabetes mellitus type-2 and hypertension as co-morbidity from the past six years. Initially the platelet count of patient was 1.85 × 109 /dL. Hb was 9 g%. Patient was started on azithromycin 250 mg BD, paracetamol 500 mg BD, IV ranitidine 50 mg BD and IV domperidone. Hematological investigations repeated after 3 days revealed thrombocytopenia with platelet count of 71 × 109/dL and WBC count of 2500 cells/mm3 with neutropenia and Hb 9.2 g%. Repeated blood picture showed further decrease in platelet count to 28,000 × 109/dL and WBC count to 1500 cells/mm3. Important causes of pancytopenia were ruled out. The drug was withdrawn and after 48 hours a considerable improvement in the hemogram was noticed with Hb 9.7 g%, WBC count of 4800 cells/mm3 and platelet count of 80 × 109/dL. The patient had recovery without incident and was discharged ten days later with normal blood counts. Conclusion: In cases of severe thrombocytopenia in critically ill patients, a pharmacological cause must be suspected, including H2-receptor antagonist such as in our case it was ranitidine induced thrombocytopenia. Alternative drugs for prophylaxis of stress ulcer should be considered.

Keywords: Thrombocytopenia, H2-receptor antagonist, Ranitidine, Adverse drug reaction.