77Letter to the Editor
The association between calcium dobesilate and
pancytopenia in type 2 diabetes: A case report
Tip 2 diyabet hastasında kalsiyum dobesilat ile pansitopeni ilişkisi:
Bir olgu sunumu
Aylin Cesur1, Meltem Aylı2, Mustafa Cesur3, Sibel Ertek4
1Department of Biochemistry, Medical Faculty, Gazi University, Ankara, Turkey
2Department of Hematology, Medical Faculty, Ufuk University, Ankara, Turkey
3Department of Endocrinology and Metabolic Diseases, Guven Hospital, Ankara, Turkey
4Department of Endocrinology and Metabolic Diseases, Medical Faculty, Ufuk University, Ankara, Turkey
Address for Correspondence: M.D. Sibel Ertek, Department of Endocrinology and Metabolic Diseases, Medical Faculty, Ufuk University, Ankara, Turkey
Phone: +90 312 204 42 30 E-mail: email@example.com
To the Editor,
Diabetic patients with polypharmacy are prone
to unexpected drug side effects. Chronic venous
insufficiency (CVI) is frequent in the type 2 diabetic
population due to advanced age and obesity, and is
associated with increased podiatric risk [1,2].
Calcium dobesilate (CaD) is a widely prescribed
veno-tonic drug for CVI, diabetic retinopathy, and
the symptoms of hemorrhoid attacks . To date,
all published cases of CaD-induced agranulocytosis
are >60 years of age [4,5-10]. Ibanez et al. recently
reported that CaD was strongly associated with the
risk of agranulocytosis . Herein we present a
case of CaD-induced pancytopenia in an 80-year-
old male diabetic patient. We had written informed
consent from the patient.
The patient presented to our hospital with a fever
of 39°C. He had been type 2 diabetic for 25 years and
was treated with repaglinide 2mg b.i.d. and insulin
glargine 20U o.p.d. He was also hypertensive and
dyslipidemic, and was using atenolol 50 mg/day,
lisinopril 20 mg/day, amlodipine 10 mg/day,
hydrochlorothiazide 50 mg/day, atorvastatin 10 mg/
day, and acetylsalicylic acid 100 mg/day for last 8
years. Six weeks before he presented to hospital he
was diagnosed with CVI and CaD 500 mg b.i.d. was
started following a cardiovascular surgery
After 6 weeks of the treatment leukopenia,
thrombocytopenia, and anemia were observed. His
hematoxylin-eosin-stained blood smear confirmed
markedly decreased platelet and leucocyte counts,
accompanied by normochromic normocytic red
cells (Table). CaD treatment was withdrawn
because of the potential side effects. On physical
examination the patient did not have organomegaly
or palpable lymph nodes. His iron, ferritin, vitamin
B12, and folate levels, and reticulocyte count were
within normal limits, and ANA (anti nuclear
antibody) and anti-double stranded DNA test results
were negative. The patient was hospitalized and
was prescribed intravenous ceftriaxone 2 g/day and
clarithromycin 400 mg/day, following the diagnosis
of pneumonia. The patient was discharged after 1
week of hospitalization with improved hemogram
results (Table 1).
Three months after discharge he was again
admitted to our hospital with a fever of 38.6°C. It
was learned that he again had started taking CaD.
Pancytopenia was diagnosed, CaD was withdrawn,
and the same intravenous antibiotic therapy was
started again. Bone marrow biopsy and aspiration
were performed from the iliac crest. Wright staining
of the bone marrow aspiration smear microscopically
showed normal erythroid and myeloid cell lines.
The patient was discharged with a normal blood
count after 1 week.
In conclusion, we want to emphasize the
potential for serious side effects that affect the
immune system in polypharmacy diabetic patients,
such as granulocytopenia, and the importance of
pharmacovigilance in patients with chronic diseases
and the risk of comorbidity.
Conflict of interest statement
None of the authors of this paper has a conflict of
interest, including specific financial interests,
relationships, and/or affiliations relevant to the
subject matter or materials included.
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Cesur et al.
Pancytopenia with calcium dobesilate
Turk J Hematol 2011; 28: 77-8
Table 1. The patient’s complete blood count during the follow-up peri-
od, with and without medication
Before 6 Weeks After 1 Week After 3 months later,
WBC (×109 L-1) 6.2 2.4 5.93 4.0
Neutrophils (%) 67 34 70 74
Lymphocytes (%) 20 48 21 16
Basophiles (%) 9 16 7 6
Eosinophils (%) 1 1 1 2
3 1 1 2
Hb (g dL-1) 13.1 10.3 11.4 10.8
Platelet (×109 L-1) 219 122 235 101
Platelet (×109 L-1) 219 122 235 101
CaD: Calcium dobesilate; WBC: white blood cells; Hb: hemoglobin