Reactions 1281 - 5 Dec 2009

SImipramine

Immune thrombocytopenia in a child: case reportA 5-year-old boy developed antiglobulin-positive

immune thrombocytopenia after receiving imipramine forattention-deficit hyperactivity disorder.

The boy had been receiving imipramine 10 mg/day for1 week when he was admitted to hospital for petechiae onhis legs. Platelet count on admission was 18 000/µL, downfrom 288 000/µL measured several weeks before.Haemoglobin was normal, reticulocyte count was 1% andWBC count was 11 400/µL, with 70% neutrophils and30% lymphocytes. Coagulation parameters were normal.Peripheral blood smear showed rare, normal-lookingplatelets with no evidence of haemolysis. Direct andindirect antiglobulin tests were +3 and +1 positive,respectively. ESR was 5 mm/h. Bone marrow aspirationsmear demonstrated increased megakaryocytes.Autoimmunity and serology tests were negative. A throatswab culture was negative for pathologic organisms.

Imipramine was discontinued and the boy receivedmega-dose methylprednisolone. His platelet countincreased to 391 000/µL by the 7th day of treatment. Thesteroid dose was tapered and eventually discontinuedfive weeks after it was started. Five weeks later, indirectantiglobulin test was negative, and four months after mega-dose methylprednisolone initiation, direct antiglobulin testwas negative. He was followed up for seven months withno recurrence of thrombocytopenia.Aksoy A, et al. A case of imipramine-associated immune thrombocytopenia.Turkish Journal of Pediatrics 51: 275-278, No. 3, May 2009 - Turkey 801154786

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Reactions 5 Dec 2009 No. 12810114-9954/10/1281-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved