Hematological disorders thrombocytopenia

Hematologic disorders Immunosuppression Autoimmune hemolytic anemia, congenital hypoplastic anemia, erythroblastopenia, thrombocytopenia... 

Adverse Effects. The most serious problems associated with ganciclovir include anemia, granulocytopenia, thrombocytopenia, and related hematologic disorders. Ganciclovir may also cause gastrointestinal disturbances (nausea, loss of appetite) and CNS disturbances (mood changes, nervousness, tremor). 

Adverse Effects. Cyclophosphamide is used very cautiously as an immunosuppressant because of the possibility of severe side effects, including carcinogenic effects during long-term use. Other side effects include hematologic disorders (leukopenia, thrombocytopenia), cardiotoxicity, nephrotoxicity, and pulmonary toxicity. 

In addition to the risk of bleeding, which will be detailed in the different studies, thienopyridines are able to cause skin disorders (rashes or prurit) and gastrointestinal disorders (diarrhea). In the CLASSICS study, these side effects were observed in 8.2% of patients treated with ticlopidine and in 3.5% of those taking clopidogrel treatment. The most serious problem was related to hematologic disorders neutropenia or thrombocytopenia. These disorders are much less frequent with clopidogrel than with ticlopidine 0.04% of neutropenia in the CAPRIE study and 0.05% in the CURE trial, Thrombotic thrombocytopenic purpura are exceptional one for 200,000 patients. 

Interferon alfa has direct myelosuppressive effects and can also cause hematological disorders by immune blood cell destruction, as suggested by reports of immune-mediated thrombocytopenia, immune hemolytic anemia (205,206), or a positive direct Coombs test, with or without hemolysis (207-209). 

NSAIDs have been reported to cause potentially severe hematological disorders thrombocjdopenia, agranulocytosis, aplastic anemia, and hemolytic anemia (50). Thrombocytopenia is generally mild and reversible and has a low case-fatahty rate, but deaths from bleeding have been reported, particularly with indometacin, oxjrphen-butazone, and phenylbutazone (50). 

The most common drug-induced hematologic disorders in- elude aplastic anemia, agranulocytosis, megaloblastic anemia, thrombocytopenia, and hemolytic anemia. 

Hematological disorders induced by the cephalosporins have been reported but the incidence of hemolytic anemia in no way parallels the occurrence of positive Coombs tests. Hemolytic anemia has been reported after cephalotin (Molthan 1969 Gralnick et al. 1972), cephalexin (Ford 1967 Forbes et al. 1972), and ce-phaloridine (Kaplan and Weinstein 1967) therapy. Thrombocytopenia (Sheiman et al. 1968 Gralnick et al. 1972) and granulocytopenia (Davis et al. 1964 Levin et al. 1971 Silber and Dioknoa 1973 Dicato and Ellmann 1975) have also been reported. 

Acute exacerbation of autoimmune thrombocytopenia (30) or hemolytic anemia has been linked to macrophage activation (31), and it has been suggested that patients with previous autoimmune blood disorders are at increased risk of hematological toxicity from GM-CSF. 

The hematological effects of tumor necrosis factor alfa mostly consist of dose-related thrombocytopenia and granulocytopenia, and decreased monocyte or lymphocyte counts (SED-13, 1111) (11,12). Septic episodes are sometimes associated with leukopenia. Coagulopathy with laboratory evidence of disseminated intravascular coagulopathy was found in 30% of patients and was sometimes associated with thromboembolic events (13). Other coagulation disorders include transient alterations in prothrombin time, and a rise in the plasma concentrations of von Willebrand factor was found in healthy volunteers (14). 

Understanding of the role of platelets, platelet activation and consumption in diseases characterized by thromboembolic phenomena or thrombocytopenia (Baldini and Myers 1980 Letter et al. 1986 International Committee for Standardization in Hematology 1988 Vallabhajosula et al. 1986) as well as in vascular disorders or endothelial (surface) abnormalities (Baldini and Myers 1980 Vallabhajosula et al. 1986 Harker et al. 1977)... 

---