Usman M, Adil S N, Sajid R, Khurshid M.
Fludarabine induced Immune Thrombocytopenia in a patient with CD5 Positive B Cell Chronic Lymphocytic Leukemia.
J Pak Med Assoc Jan ;53(10):496-7.

Fifty years old female presented to the hematology outpatient with a history of low-grade fever, weight loss and painless swellings on both sides of neck since one month. She was a known patient of diabetes mellitus and hypertension. Examination revealed bilateral cervical and axillary lymphadenopathy. Spleen was palpable. Investigations revealed hemoglobin 12.1 gm/dl, white cells count 35,500/cumm and platelets 277,000/cumm. Absolute lymphocyte count was 28,000/cumm. Bone marrow and bone trephine findings were consistent with the diagnosis of lymphoproliferative disorder (chronic lymphocytic leukemia). Immuno-phenotyping revealed positivity against CD5, CD19, CD20 and CD22 and hence consistent with B cell chronic lymphocytic leukemia. Other laboratory investigations were within normal ranges. Serial blood counts subsequently revealed progressive increase in absolute lymphocyte count along with an increase in the percentage of prolymphocytes. nitially she received three cycles of tablet chlorambucil 10mg PO daily for two weeks in a cycle of four weeks with no improvement. She was started on tablet Fludarabine 25mg per meter square for five days every four weeks. She responded well to the treatment. After four cycles of Fludarabine, she developed petechial hemorrhages on both legs, spontaneous epistaxis, bleeding from left ear and malena.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com