Induced Hematologic Disorders

TABLE A3-1 1 Drugs Associated with Aplastic Anemias  

Observational study evidence Case report evidence probable or deSnite causality rating)  

Observational Study Evidence Case Report Evidence probable or deSnlte causality rating)  

Prednisone Propranolol Spironolactone Sulfonamides Desipramine Pyrimethamine 

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See Chapter 107, Drug-Induced Hematologic Disorders, authored by Dale H. Whitby and Thomas E. Johns, for a more detailed discussion of this topic... 

Some drugs and ingested toxins such as nitrofurantoin, cancer chemotherapy agents, phenazopyridine, sulfones, amyl nitrate, mothballs, paraquat, and hydrogen peroxide can cause direct oxidative damage to erythrocytes (see Chap. 102 on drug-induced hematologic disorders). 

Drug-induced hematologic disorders are, in general, rare adverse effects associated with drug therapy. 

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

The mechanisms of drug-induced hematologic disorders are thought to be the result of direct toxicity or an immune reaction. 

The primary treatment of drug-induced hematologic disorders is removal of the drug in question and symptomatic support of the patient. 

By most reports, idiosyncratic drug-induced hematologic disorders are rare. Relatively few epidemiologic studies have addressed the actual incidence of these adverse reactions. A report from The Netherlands estimated the incidence of drug-associated agranulocytosis as 1.6 to 2.5 cases per million inhabitants per year. Similar results were found in epidemiologic studies conducted in Thailand and BraziU Older data from a study conducted in Europe and Israel estimated the incidences of aplastic anemia and agranulocytosis to be 0.5 and 3.1 cases per million per year, respectively. ... 

Drug-induced hematologic disorders can affect any ceU line, including white blood cells (WBCs), red blood cells (RBCs), and platelets. When a drug causes decreases in all three cell fines accompanied by a hypoplastic bone marrow, the result is drug-induced... 

FIGURE 102-1. Differentiation of the stem cell into committed cell lines, illustrating the origins of various drug-induced hematologic disorders. 

The evaluation of anti-BPO antibodies of the IgG class, by a similar procedure to the one used in the RAST assay, has proved of interest in the evaluation of penicillin-induced hematological disorders, such as hemolytic anemia or leukopenia (Neftel et al. 1981), although anti-BPO IgG antibodies are also encountered in asymptomatic individuals treated with high doses of penicillins. Previously described methods, such as hemagglutination or bacteriophage inhibition, are cumbersome, less reproducible, and may be considered as obsolete. 

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