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cytopenia ( 3 ) , meclofenamate was restarted at 100 mg 3 times daily on day 3. The patient was discharged to a nursing home and clonidine and meclofenamate were prescribed.

On day 8 the patient complained of fatigue, malaise, and nausea. There was no evidence of new bleeding. Laboratory studies at that time revealed a platelet count of 5,000. The patient was readmitted, and the meclofenamate was promptly discontinued. On day 9 the patient received 6 units of platelets. From day 8 to day 13 the platelet count increased steadily from 5,000/mm3 to 198,000/mm3. When she was dis- charged on day 13, she was receiving clonidine and was subsequently restarted on aspirin. Five weeks after her discharge from the hospital, her followup platelet count was 210,000/mm~.

We believe that this is the first report of throm- bocytopenia associated with the use of meclofena- mate. However, there are at least 5 reports of throm- bocytopenia associated with the use of flufenamic acid-related compounds (3). Coombs positive hemo- lytic anemia and marrow suppression with hypoplasia have also been reported (4). Meclofenamate has only recently been made available for widespread use in rheumatic conditions and has not previously been associated with blood dyscrasias.

The mechanism of thrombocytopenia in our patient is unclear. It seems unlikely that marrow suppression would explain the rapid onset of thrombo- cytopenia with the second administration and rapid recoveries after discontinuation. Since Coombs posi- tivity with hemolysis (4) occurs with related com- pounds, an immunologically mediated peripheral con- sumption with decreased platelet survival time may be a more likely explanation.

GREGORY F. SCHIMIZZI, MD PHILLIP M. GRAEHL, MD JOSEPH P. MICHALSKI, MD Veterans Administration Medical Center Long Beach, C A University of California Irvine, CA

Morris EL, Hochberg MC, Dorsch CA: Agranulocytosis and sulindac. Arthritis Rheum 24:752-753, 1981 Rosenbaum JT, O’Connor M: Thrombocytopenia associ- ated with sulindac. Arthritis Rheum 24:753-754, 1981 Swanson M, Cool R: Drugs, Chemicals and Blood Dys- crasias. Hamilton, IL, Drug Intelligence, Inc., 1977, p 601 Mills JA: Nonsteroidal anti-inflammatory drugs (Part 11). N Engl J Med 290:1002-1004, 1974

BOOK REVIEW

Progress in Clinical Immunology. Volume 4 . Edited by Robert S . Schwartz, MD, New York, Grune and Stratton, Inc., 1980. 179 pages. Illustrated. $23.50.

The fourth volume of this series contains articles on “Drug-Induced Systemic Lupus Erythematosus” by Arthur Weinstein; “Immune Responses of Human Lymphocytes In Vitro” by Barton F. Haynes, Paul Katz, and Anthony S. Fauci; “Evaluation and Clinical Significance of Circulating Immune Complexes” by A. N . Theofilopoulos; “Autoantibodies to the Insulin Receptor: Clinical Significance and Experimental Applications” by Len C . Harrison and C. Ronald Kahn; “Prospects for the Clinical Control of IgE Synthesis” by David H. Katz; and “Lymphocytotoxic Antibodies” by Raphael J. DeHoratius.

Each review summarizes in moderate detail the most recent results in the respective areas. Particular emphasis is placed on the potential clinical applica- tions of the experimental data. The references are complete through 1979. However, rapid change in clinical immunology will probably render many of these reviews obsolete within a few years. Thus, although the volume is well worth reading for rheuma- tologists with a particular interest in the subject mat- ter, it is not a good investment for a personal library. Moreover, a few of the articles are duplicated in other immunology review series.

DENNIS CARSON, MD Scripps Clinic and Research Foundation La Jolla, CA 92037