Thrombocytopenia

A 34 year-old Turkish man with PMHx of testicular CA (stage III and s/p BEP chemotherapy regimen and surgical excision),  presents to BMC with a rash on arms and legs and bleeding m0uth. He was recently started on an H2 blocker for GERD-like symptoms. In a 5 day span, his platelet count dropped from > 200k to 13k.

What is on the differential diagnosis for his thrombocytopenia? The most likely causes appear to be drug-related vs. ITP. His testicular cancer was an unlikely source given his remission and lack of other symptoms. He failed to respond to platelet transfusion and discontinuing the H2-blocker (ranitidine). This indicates a process that is consuming platelets rather than a production problem. Therefore, the team speculated that this may be an ITP-like reaction to the medication. Steroids were began and we await further improvements in his cell counts.

Thrombocytopenia in adults: A practical approach to evaluation and management – South Med J. 2006 May;99(5):491-8; quiz 499-500, 533.

Ranitidine-induced thrombocytopenia: A rare drug reaction – Indian J Pharmacol. 2011 Feb;43(1):76-7.
A case report from India