DIGITOXIN-INDUCED THROMBOCYTOPENIA - A CA SE-REPORT

A 82-year-old woman was admitted to hospital because of heart failure, vomiting, and pain in the right upper abdomen. During the past three months she had received treatment with 0.07 mg digitoxin twice daily. The ECG showed sinus bradycardia with intermittent complete sinoatrial block. On the basis of the history, clinical presentation and ECG fin dings digitalis intoxication was suspected. Digitoxin level was 65.23 ng/ml - far beyond the therapeutic range. Laboratory examinations reve aled a marked thrombocytopenia (25,000/mul). The patient was placed on cholestyramine (4 g three times daily) to accelerate intestinal excre tion of digitoxin. As there were no life-threatening complications the re was no indication for treatment with digitalis-specific antibodies. On the 6th day after discontinuation of digitoxin treatment the plate let count showed a marked rise and returned to normal values as from t he 12th day.