Digitoxin intoxication with severe thrombocytopenia: reversal by digoxin‐specific antibodies

Abstract

As a result of overdosage, a 77-yr-old patient with heart disease developed digitoxin intoxication, associated with arrhythmias, extracardiac symptoms of intoxication of severe thrombocytopenia. Treatment with digoxin-specific antibody fragments relieved the signs and symptoms of intoxication within a few hours. The rise in platelet count from the pretreatment value of 26,000/mm3 to 47,000 within 12 h and to over 60,000/mm3 within 16 h of starting the antibody infusion may also be attributed to the treatment with antibodies. Such a rapid recovery from digitoxin-induced thrombocytopenia has not previously been described. Digoxin-specific antibodies, obtained by immunization of sheep with a digoxin-albumin conjugate, were used to treat intoxication with digitoxin, since cross-reaction had been demonstrated in vitro and in animal experiments. The mode of action and the general problems relating to the antibody therapy of digitalis poisoning are discussed.