A 52-year-old patient with renal impairment was prescribed allopurinol 300mg for gout. In the 6th week, the patient developed severe aplastic anemia and died. The aplastic anemia was likely associated with allopurinol, which can cause it as a rare side effect. The dose was not appropriate for the patient's renal function. The adverse event could have been avoided by prescribing a lower starting dose of allopurinol and monitoring the patient more closely given their risk factors, including renal impairment.

1. Pharmacy Practice – Theory
PT718
Name of the Teacher : Debjit Sur
Assignment Number : 1 Date : 01/09/2020
Student Name : Washif Islam Roll No : 18601917017
Case Presentation I
A 52-year-old patient commenced on allopurinol 300 mgfor the prevention of another acute
attack of gout that recently occurred. The patient is known to have moderate to severe renal
impairment, but no liver impairment present. Other concomitant medicines:
• iron sorbitol
• insulin (short and long acting)
• calcium carbonate
In the 6th week after starting the medicine, the patient developed severe aplastic anemia and
died.
1. The aplastic anemia and subsequent death are adverse events but are they an ADR?
(Yes/No)
 Answer : Yes , As because its due to suspected drug Allopurinol causes Aplastic
anemia also bone marrow showed extremely decreased cellularity (< 20%), Cuases
death of the patient.
2. What is the likelihood that the aplastic anemia is associatedwith allopurinol?
Answer :a. Probable b. Possible c. Unlikely
3. Did the patient have any risk factors for prescribing the allopurinol?
 Answer : Allopurinol can lower blood cells that help your body fight infections. This
can make it easier for you to bleed from an injury or get sick from being around others
who are ill.
 It also causes risk if the patient have such renal or hepatic impairment.
4. Was the dose prescribedby the doctor appropriate for the patients' renal function?

2. Answer :The dose is not appropriate for the patients prescribed by the doctor because
the patient have renal impairment and in most patients it should be start with at 100
mg/day (50 mg/day in patients with renal insufficiency).
5. Is aplastic anemia a possible knownside-effectwith allopurinol?
 Answer : No , it is unlike side effect with allopurinol as because it is generally rare
cases with allopurinol, but cases find of those patients having the risk factors of
allopurinol.
6. Which of the following factors possibly contributed to the harm in this patient?
 Answer :
 Elderly Patient
b. low therapeutic Index
 c. lack of knowledge of possible side effect of drug d. genetic
factor
 e. hepatic and renal impairment
f. compliance problem
g. poorknowledge of prescriber on the dosing in renal impairment
7. Do you think that this adverse event possibly due to allopurinol could have been
avoided in the patient?
Answer : Yes , it should be de-challenged cause in case studies it is found that
Allopurinol was discontinued immediately and treatment with blood transfusions and
prednisolone was begun. After 6 months, the bone marrow cellularity improved to
approximately 70%.