Reactions Weekly | 2021
Octreotide
Abstract
Drug-induced thrombocytopenia: case report A 76-year-old man developed drug-induced thrombocytopenia during treatment with octreotide for variceal bleeding. The man, who had a history of cirrhosis due to hepatitis C virus infection, chronic obstructive pulmonary disease, familial Mediterranean fever, prostate adenocarcinoma and hypertension, was admitted to hospital with melena. He had a Child-Pugh class B cirrhosis and a prior episode of variceal bleeding. Physical examination revealed only mild ascites. Laboratory tests revealed the followings: haemoglobin 4.5 g/dL, platelets 156 × 103 /μL and INR 1.5. He was treated with sodium chloride [saline], RBC transfusion, pantoprazole and IV octreotide bolus injection 50μg, followed by continuous infusion of octreotide at a rate of 50 μg/hour. Upper gastrointestinal endoscopy showed nonbleeding oesophageal varices, which were treated with band ligation, without any complications. Shortly after the initiation of treatment with octreotide , platelet counts dropped to 108 × 103 /μL on the first day, 84 × 103 /μL on the second day and 63 × 103 /μL on the third day. He was referred to the haematology department with laboratory tests, including a coagulation panel and a peripheral blood smear, which revealed no abnormalities. The man’s treatment with octreotide was stopped on the third day due to suspected drug-induced thrombocytopenia. Following the discontinuation of octreotide, the man showed markedly improved platelet counts. On the first day of the withdrawal, platelet counts reached 84 × 103 /μL, 109 × 103 /μL on the second day and 146 × 103 /μL on the third day. Subsequently, he was discharged. Naranjo adverse drug reaction probability scale score of six revealed a probable link between octreotide and thrombocytopenia.