To the Editor.—
Recently we followed up a patient who had transient hypoplastic anemia associated with metolazone.
Report of a Case.—
A 74-year-old woman had had mild hypertension for many years. In June 1977, 5 mg/day of metolazone was prescribed. There was resultant fair control of blood pressure. In August 1977, notable weakness developed. Moderate anemia was diagnosed, and the patient was given folic acid preparations in addition to other hematinies, including iron. Her condition worsened, and when referred to us in October, her hematocrit reading was 27.4%, with a reticulocyte count of 1.0%. The WBC, differential, and platelet counts were normal. Morphological examination of RBCs showed normochromia and normocytic pictures. Bone marrow aspiration showed hypoplastic marrow without suggestion of myeloproliferative disorders.Drug-induced marrow suppression was suspected, and metolazone therapy was stopped. The patient was given an anabolic agent (methandrostenolone) orally through mid-January 1978. Because of fluid retention, hypertension, and