Haemolytic anaemia and thrombocytopenia following phenobarbital therapy for alcohol withdrawal.
Sera Whitelaw, Sumedha Arya, Nicola Goldberg et al.
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Case in brief
A man in his 50s was admitted for alcohol withdrawal and developed acute anaemia and thrombocytopenia shortly after starting phenobarbital. Laboratory tests indicated haemolysis, evidenced by undetectable haptoglobin and indirect hyperbilirubinaemia, despite a negative direct antiglobulin test. After stopping phenobarbital, his haematologic parameters improved rapidly, suggesting a drug-induced immune haemolytic anaemia.
Diagnostic / clinical pearl
Clinicians should consider drug-induced immune haemolytic anaemia in patients presenting with anaemia and thrombocytopenia, even when the direct antiglobulin test is negative.
Why it matters
This case underscores the potential haematologic toxicity of phenobarbital, which is not commonly associated with such adverse effects in the context of alcohol withdrawal management.