Ticlopidine-induced aplastic anemia and quick recovery with G-CSF: Case report and literature review

We report here a case of ticlopidine-induced aplastic anemia that responded to G-CSF and review the literature. An 83-year-old woman was started on ti clopidine for coronary artery disease after an episode of upper gastrointes tinal bleeding secondary to aspirin. She developed aplastic anemia seven we eks after initiation of ticlopidine, She was hospitalised and received empi ric antibiotic therapy and granulocyte colony stimulating factor (G-CSF), H er bone marrow started to recover quickly, and white blood cell and platele t counts returned to normal within three weeks. A review of medical literat ure revealed 20 similar cases of ticlopidine-induced aplastic anemia result ing in death in seven cases. G-CSF has been used previously with variable s uccess. Ticlopidine is associated with serious, sometimes fatal hematologic al side effects. This risk should be seriously taken into consideration whe n prescribing ticlopidine, G-CSF may be helpful in the treatment of ticlopi dine-induced aplastic anemia. Am. J, Hematol, 63:90-93, 2000. (C) 2000 Wile y-Liss, Inc.