Prednisone thrombocytopenia

Glucocorticoids 40-60 mg oral prednisone equivalents thrombocytopenia Serious infections hypersensitivity icity hepatotoxicity Diabetes osteoporosis infection... 

Fatal cerebral involvement in systemic aspergillosis has been described in a 25-year old woman with severe thrombocytopenia (platelet count 10 x 109/1) and mild intermittent leukopenia (granulocytes 0.375-3 x 109/1) who was taking prednisone 1-1.5 mg/kg/day and azathioprine 100-200 mg/day (344). 

A 72-year-old man with autoimmune thrombocytopenia had taken prednisone (30 mg/day) for 1 year, when he was found to have systemic lupus erythematosus (46). Prednisone was continued and he started to take chloroquine (250 mg/day) and monthly cyclophosphamide (0.75 g/m ). Three weeks after the first bolus of cyclophosphamide, he complained of fever and dyspnea, and chest X-rays showed bilateral pulmonary infiltrates. Despite prompt medical management, he died 5 days after admission with cytomegalovirus-induced interstitial pneumonia. 

In all but one of 26 children with Wilson s disease who were treated with penicillamine 20 mg/kg/day, there were fewer adverse reactions than expected two patients developed a rash, one patient had to stop taking the drug because of a lupus-like syndrome, and another had thrombocytopenia, which resolved after treatment with prednisone (151). 

An asthmatic woman taking theophylline and treated for medulloblastoma with lomustine, prednisone and vincristine, developed severe nose bleeding and thrombocytopenia 3 weeks after the third cycle of chemotherapy. This was attributed to the eoneurrent use of lomustine and theophylline. The suggested explanation for this effect is that theophylline inhibited the activity of phosphodiesterase within the platelets, thereby increasing cyclic AMP levels and disrupting normal platelet function, which seems to be supported by an experimental study while lomustine causes thrombocytopenia. What is known is far too limited to act as more than a warning of the possibility of increased thrombocytopenia during the concurrent use of theophylline and lomustine. 

Haematologic Thrombocytopenia has been reported in a 61-year-old Caucasian hypertensive man who had his losartan increased from 50 to 100 mg per day [16 ]. Platelet count dropped from the baseline value of 280 x lO cells/L to 15 X lO cells/L. Following prednisone taper, his platelet count returned to >200 x 10 cells/L and losartan was replaced with valsartan. Forty-seven days after commencement of valsartan, the platelet count dropped again to 37 X lO cells/L. Valsartan was withheld and prednisolone taper recommenced and the platelet count improved to 214 X IPP cells/L. The authors suggested the possibility of antibody cross-reactivity between losartan and valsartan due to similarity in their molecules. 

Severe thrombocytopenia, with positive Coombs test (3+) and antinuclear antibody test developed in a 63-year-old man after 3 years of treatment with levodopa 4.5 g/day with procyclidine. Withdrawal of therapy and administration of prednisone led to a slow return to a normal platelet count during 6 months when, after further tests, levodopa therapy was restarted. A year later the Coombs test was negative and the antinuclear antibody test was weak positive (75 ). 

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