683

liver, and central lung, kidney, and 1

nervous

system,

as

in the

previous report.

Misericordia General

Hospital, Winnipeg, Manitoba, Canada

W. B. FINLAYSON

G. JOHNSON

THROMBOCYTOPENIA DUE TO SLOW-RELEASE OXPRENOLOL

SIR,-We have seen a’case of thrombocytopenia induced by slow-release oxprenolol. We know of no other published case, but four patients with thrombocytopenia detected while they were taking oxprenolol have been reported to the Committee on Safety of Medicines (personal communication). A 57-year-old man was admitted to hospital in May, 1978. A rash had developed 2 days previously, and on the morning of admission he passed a melaena stool and later had two epistaxes. The only other symptom was tiredness. An extensive petechial rash was noted over the limbs, face, and inside the

Blood-pressure was 160/112 mm Hg and there was grade-ii hypertensive retinopathy. The remainder of the physi-

mouth.

cal examination was normal. Hypertension had been found in November, 1975, the blood-pressure being stabilised on a combination of hydralla-

maturation and granulation were normal but platelet budding and shedding were virtually absent with the peripheral cytoplasm showing degranulation and dissolution. Erythropoiesis and granulopoiesis were normal and no abnormal infiltrate was detected. Within 7 days of withdrawal of slow-release oxprenolol the platelet-count was normal and repeat bone-marrow examination showed the megakaryocytes to be numerically and morphologically normal. Culture and serological studies revealed no evidence of infection. Chest X-ray and urine analysis were normal. Antinuclear factor and L.E. cells were not detected and D.N.A. antibodies were normal. When the patient was re-challenged with a single dose of 320 mg slow-release oxprenolol the platelet-count fell to 30 x 109/1 within 15 h, but the petechial rash did not recur and Hess’s test was negative. When the platelet-count had again returned to normal the patient was given 80 mg of propranolol three times daily with adequate blood-pressure control and no untoward symptom or adverse blood changes. We thank Dr M. MacLeod for

permission

Departments of Medicine and Hæmatology, Aberdeen Royal Infirmary, Aberdeen AB9 2ZB

to

report this

case.

W. N. DODDS R. J. L. DAVIDSON

PREVENTION OF ALCOHOLIC LIVER DISEASE

SIR,-Dr Howorth (Sept. 2, p. 529) suggested that it is safe to ingest 50-70 g of ethanol a day without undue risk of liver disease, and referred to the possibility that 50 g a day might confer some protection from ischaemic heart-disease.’2 colleagues with a personal interest have asked me to

probably

MAXIMUM NUMBER OF

"BRITISH

CONSUMER

UNITS"

ALCOHOLIC BEVERAGES WHICH TOTAL NOT MORE THAN

OF

50 g

ETHANOL

Platelet-counts

in

patient re-challenged

with

slow-release

oxprenolol. Arrow shows time of re-challenge.

zine, oxprenolol, and cyclopenthiazide with potassium chloride. Cyclopenthiazide and hydrallazine were later withdrawn and at the end of 1976, 640 mg slow-release oxprenolol was introduced to replace 640 mg of standard oxprenolol taken in four divided daily doses. This dose was continued until admission. The patient was taking no other drug; naproxen had been prescribed in August, 1977, for osteoarthrosis of the knee but had not been taken for 8 months. There was no history of alcoholic overindulgence and liver-function tests were normal. After admission the only drug initially administered was 11 mg diazepam daily. Platelet-count on admission was 11 x 109/1 and those recorded after withdrawal of slow-release oxprenolol are shown in the figure. Apart from the thrombocytopenia, the peripheral blood indices and morphology on admission were normal. Bone-marrow aspiration on the day after admission revealed that megakaryocytes were numerically normal but many showed excessive nuclear lobulation. Early cytoplasmic 1.

Brockner, J., Boisen, E. Lancer, 1978, i, 831.

*Or 5 small cans (275 ml). t107 ml (7 glasses from a 750 ml bottle) t70 ml (10 glasses from a 700 ml bottle)

50 g of ethanol to units intelligible to the average conThe table is based on data given in the 1978 edition of "McCance and Widdowson". I have estimated unit volumes of wines which might be dispensed by a reasonably generous host. Volumes are rounded down to the nearest whole "British consumer unit."

convert sumer.

Department of Chemical Pathology, St James’s University Hospital, Leeds LS9 7TF

R. B. PAYNE

1. Klatsky, A. L., and others. Ann. intern. Med 1974, 81, 294. 2. Stason, W. B., and others. Am. J. Epidemiol. 1976, 104, 603. 3. Paul, A. A., Southgate, D. A. T. McCance and Widdowson’s the tion of Foods. H.M. Stationery Office, 1978.

Composi-