Fludarabine is a purine nucleoside analogue, which inhibits DNA synthesis by inhibiting DNA polymerase and ribonucleoside reductase.1 It affects both dividing and non- dividing cells.2 Fludarabine possesses proven efficacy in the treatment of a variety of indolent B cell lymphoproliferative disorders including chronic lymphocytic leukemia3, low-grade non-Hodgkin\u27s lymphoma4 and Waldenstrom macroglobulinemia.5 It is also a part of conditioning regimes in non-myeloablative bone marrow transplantation.6 The common side effects include myelosuppression, immunosuppression, and neurologic toxicity.7 The rare side effects are immune mediated hemolytic anemia8 and thrombocytopenia.9 Here we describe a case of a middle-aged lady who was diagnosed as B cell chronic lymphocytic leukemia and developed immune mediated thrombocytopenia following oral Fludarabine
