200 Section - Drug-induced thrombocytopenia in the inpatient rehabilitation unit, a case series.

First case: 95-year-old male TBI patient who suffered a right subdural hematoma due to ground-level fall (GLF) and used Levetiracetam for seizure prophylaxis. Admission platelets (PLTs) were 86,000 (4/26/25), and on 4/28/25, PLTs were 46,000. On 4/28/25, Levetiracetam was weaned off, and Enoxaparin was discontinued. PLTs increased from 37,000 (5/2/25) to 51,000 (5/6/25).

Second case: 62-year-old female with multiple medical conditions, including interstitial lung disease. Prior to stay, patient was started on Acetazolamide for pulmonary hypertension treatment. Admission PLTs were 89,000 (5/10/25). Follow-up PLTs 54,000 (5/14/2025), and Acetazolamide was discontinued on 5/14/25. PLTs increased from 57,000 (5/16/25) to 92,000 (5/20/25).

Third case: 71-year-old male patient with traumatic spinal cord injury due to GLF who received pain management with Ultracet at previous hospital. Admission PLTs were 72,000 (8/1/2025). Follow-up PLTs decreased from 75,000 (8/4/2025) to 47,000 (8/9/25). Ultracet was discontinued on 8/9/25. Follow-up PLTs increased from 80,000 (8/11/25) to 137,000 (8/15/25).

Discussions:
Each case was able to safely participate in rehabilitation using guidelines for recommended exercises and corresponding cutoff platelet count values (Morishita et al., 2020). No major bleeding occurred. All cases met rehabilitation goals and were discharged home. 

Conclusions: Drug-induced thrombocytopenia can occur during an inpatient rehabilitation stay. Commonly prescribed medications can be the culprit. Despite literature being scarce, physiatrists should be aware of this condition to diagnose and manage it, while providing safe participation in an intense rehabilitation program following thrombocytopenia guidelines.