Aplastic anemia, drug-induced treatment

It has been postulated that early treatment with very high doses of intravenous A-acetylcysteine and the use of immunomodulatory drugs, such as antithymocyte globulin and ciclosporin, can improve the recovery of hematological parameters, even in the case of pancytopenia (37). One case of gold-induced aplastic anemia, unresponsive to various treatments, recovered after therapy with antithymocyte globulin (SED-12, 522). 

Felbamate. Felbamate is an adjuvant anticonvulsant, containing the warning that its use is associated with a marked increase in the incidence of aplastic anemia and that patients being started on the drug should have liver function tests performed before therapy is initiated. Animal studies have revealed a statistically significant increase in hepatic cell adenomas in high dose studies (18). It is postulated that this cancer was induced by toxic by-products urethane and methyl carbamate. Felbamate is not recommended as first-line therapy and is indicated for those patients who respond inadequately to alternative treatments and whose epilepsy is so severe that a substantial risk of aplastic anemia or liver failure is deemed acceptable in light of the benefits provided by its use. 

All medications suspected to be possible triggers for the disease should be discontinued. Supportive measures, especially blood transfusions, are often necessary for treatment of anemia and bleeding complications. Drug-induced aplastic anemia is treated like the idiosyncratic form of the disease, and responds to therapy at about the same rate. Overall, immtmosuppressive therapy produces significant improvement in more than half of all patients younger individuals have a considerably better prognosis than those who are older than 45 years (Young et al. 2008). 

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