aspirin, diltiazem, isosorbide, noririptyline. theophylline, and beclomethasone, ipratropium. and metaprotered inhalers. The platelet count was 214,OOO/p.l, prothrombin time activated (ma) I1.9/11. and the partial thrornboplastin time ( a P m 34/32. He was treated with digoxin.semide. captopril, verapamil. metoprolol. and pmainamide. After a difficult hospital course, he was discharged on digoxin. fwosanide, i m h i d e , potassium, aspirin, capopril, procainamide. ranitidine. temazepam, SSKI, and his inhalers. His platelet Count Was 1 7 9 9~/~l .Three weeks later, he was readmitted with digoxin toxicity. His platelet Count was 8,ow/pI, but there was MI evidence of bleeding. The PTa was 12.9. and the a m ~3 2 . he peripheral smear showed reduced numbers of large platelets. The bone marrow aspirate revealed increased megakaryocytes. A repeat a m was 42/32, with a I: I mix of 36/32 and a 2-hr incubation at W C o f 38/32 (Table I). The phospholipid antibody and platelet neutralization procedure we= positive for a LA. The antinuclear antibody (ANA) was < I:20. All medim cations were discontinued but were later rcinstitured. with the exception of the procainamide. He was started on steroids. Nine days later, his platelet count was 93,000/~.1, and the a m 36/32. The steroids were tapered. and 2 wceks later, the platelet count was 231 .oao/p.l. After 2 months. the a m was 30/32. 2. Mcirner DJ. Carlwn RJ. Gottlich AJ: Thmmhrytopenia following sustained-3. Williams PE: Lupus anticoagulant. J Ark Mcd Scr X6:4VMY7. 1990. 4. Avehuch M. Koifman B. Lcvo Y: Lupus anlicougulunt. thnnnhmis and thrombocytopenis in systemic lupus erythcmutosus. Am J Mcd Sci 2932-5. 19117. 5. lwahara Y, Niiya K. Yamuto K. Miyohhi I: Thromhtrytopenic purpun in a p t i c n l with lupus anticoagulant: Rcquircnlcnt of hoth inimunosupprenbive and untithrombotic therapies. Am J llcmutol 33:75-77. IVCK). 6. Kozlowski CL. Johnuin MI, Gorst DW. Willcy R F Lung cancer. immune Ihrombcrytopcnia and the lupus inhihitor. Postgrud Mcd J 633793-795, 1987. anticoagulant. Stwth Mcd J 81:934936. 19XX. rclcasc prcrainamidc. Arch Intern Mud 145:70&702. 1985.
