Leukopenia

Aromatic Hydrocarbons. These are the most toxic of the hydrocarbons and inhalation of the vapor can cause acute intoxication. Benzene is particularly toxic and long-term exposure can cause anemia and leukopenia, even with concentrations too low for detection by odor or simple instmments. The currendy acceptable average vapor concentration for benzene is no more than 1 ppm. PolycycHc aromatics are not sufftcientiy volatile to present a threat by inhalation (except from pyrolysis of tobacco), but it is known that certain industrial products, such as coal tar, are rich in polycycHc aromatics and continued exposure of human skin to these products results in cancer. 

Penicillamine (29) can be effective in patients with refractory RA and may delay progression of erosions, but adverse effects limit its useflilness. The most common adverse side effects for penicillamine are similar to those of parenteral gold therapy, ie, pmritic rash, protein uria, leukopenia, and thrombocytopenia. Decreased or altered taste sensation is a relatively common adverse effect for penicillamine. A monthly blood count, platelet count, and urinalysis are recommended, and also hepatic and renal function should be periodically monitored. Penicillamine is teratogenic and should not be used during pregnancy. 

There appear also to be toxic effects. In animals, nitrous oxide has been shown to inactivate methionine synthetase which prevents the conversion of deoxyuridine to thymidine and thus has the potential for inducing megaloblastic anemia, leukopenia, and teratogenicity (44—46). A variety of epidemiologic surveys suggest positive correlations between exposure to nitrous oxide and spontaneous abortion in dental assistants (47). 

Thorotrast (colloidal Th02) was once used as a radiopaque agent in medicine (see Radiopaques). Its injection in a dose of 2.0—15.0 g caused rises in body temperature, nausea, and injury to tissues at the injection site, followed by anemia, leukopenia, and impairment of the reticuloendothehal system. After intravenous adrninistration, thorotrast particles are taken up by reticuloendothehal cells of the fiver and spleen. Thorotrast is virtually not eliminated from the body (91). Between 1947 and 1961, 33 cases of cancer of the fiver, larynx, and bronchi and sarcoma of the kidneys, developing from 6 to 24 years after thorotrast administering, have been described in the literature (92). 

The dosage of flucytosine is 150—200 mg/kg orally in four portions every six hours. A 1% flucytosine solution has been developed for intravenous adrninistration. In some countries, a 10% ointment is also available. In patients with normal renal function, flucytosine is seldom toxic, but occasionally severe toxicity may be observed (leukopenia and thrombocytopenia). Plasma levels should be determined and the dose in patients with impaired renal function should be checked. Liver function tests (transaininases and alkaline phosphatase) should be performed regularly. In some patients with high flucytosine plasma levels, hepatic disorders have been observed (24). 

Dacarbazine is the most active compound used for treating metastatic melanoma. It is also combined with anthracyclines and other cytostatics in the treatment of different sarcomas and Hodgkin s disease. Dacarbazine may cause severe nausea and vomiting. Myelosuppres-sion results in leukopenia and thrombocytopenia. Alopecia and transient abnormalities in renal and hepatic function also occur. 

The daily dose of allopurinol is 300-600 mg. In combination with benzbromarone, the daily allopurinol dose is reduced to 100 mg. In general, allopurinol is well tolerated. The incidence of side effects is 2-3%. Exanthems, pruritus, gastrointestinal problems, and dty mouth have been observed. In rare cases, hair loss, fever, leukopenia, toxic epidermolysis (Lyell syndrome), and hqDatic dysfunction have been reported. Allopurinol inhibits the metabolic inactivation of the cytostatic dtugs azathioprine and 6-mercaptopurine. Accordingly, the administered doses of azathioprine and 6-mercaptopurine must be reduced if allopurinol is given simultaneously. 

The most common adverse effects are myelosuppression, with leukopenia and thrombocytopenia appearing 7-10 days after treatment, as well as mild nausea. Liver toxicity with jaundice has been reported in rare cases. 

Leukopenia—decrease in the number of white blood cells... 

Other adverse reactions associated with penicillin are hematopoietic changes such as anemia, thrombocytopenia (low platelet count), leukopenia (low white blood cell count), and bone marrow depression. When penicillin is given orally, glossitis (inflammation of the tongue), stomatitis (inflammation of die mouth), dry mouth, gastritis, nausea, vomiting, and abdominal pain occur. When penicillin is given intramuscularly (IM), there may be pain at die injection site Irritation of the vein and phlebitis (inflammation of a vein) may occur witii intravenous (IV) administration. 

More than half of the patients receiving this drug by the parenteral route experience some adverse reaction. Severe and sometimes life-threatening reactions include leukopenia (low white blood cell count), hypoglycemia (low blood sugar), thrombocytopenia (low platelet count), and hypotension (low blood pressure). Moderate or less severe reactions include changes in some laboratory tests, such as the serum creatinine and liver function tests. Other adverse reactions include anxiety, headache, hypotension, chills, nausea, and anorexia Aerosol administration may result in fatigue a metallic taste in the mouth, shortness of breath, and anorexia... 

Administration may result in nausea, vomiting, diarrhea, rash, anemia, leukopenia, and thrombocytopenia Signs of renal impairment include elevated blood urea nitrogen (BUN) and serum creatinine levels. Periodic renal function tests are usually performed during therapy. 

Mebendazole—The patient may chew, swallow whole, or mix the tablets with food. The patient should take these drugs with foods high in fat to increase absorption. The nurse should make sure a complete blood count is obtained before therapy and periodically during therapy because mebendazole can cause leukopenia or thrombocytopenia. 

Hematologic—neutropenia, eosinophilia, leukopenia, pancytopenia, thrombocytopenia, agranulocytosis, and aplastic anemia... 

Hydroxychloroquine administration may result in irritability, nervousness, anorexia, nausea, vomiting, and diarrhea This drug also may have adverse effects on the eye, including blurred vision, comeal edema, halos around lights, and retinal damage. Hematologic effects, such as aplastic anemia and leukopenia, may also be seen. 

MTX is a potentially toxic dmg that is also used in the treatment of malignancies and psoriasis. Nausea, vomiting, a decreased platelet count, leukopenia (decreased white blood cell count), stomatitis (inflammation of the oral cavity), rash, pruritus, dermatitis, diarrhea, alopecia (loss of hair), and diarrhea may be seen with the administration of this dmg. 

MTX is potentially toxic. Therefore, the nurse observes closely for development of adverse reactions, such as thrombocytopenia (see Nursing Alert in Gold Compounds section) and leukopenia (see discussion of adverse reactions associated with hydroxychloroquine). Hematology, liver, and renal function studies are monitored every 1 to 3 months with MTX therapy. The primary care provider is notified of abnormal hematology, liver function, or kidney function finding. The nurse immediately brings all adverse reactions or suspected adverse reactions to the attention of the primary health care provider. 

Administration of trimethadione (Tridione) may result in hematologic changes, such as pancytopenia (decrease in all the cellular components of the blood), leukopenia, aplastic anemia, and thrombocytopenia Also reported are various types of skin rashes, diplopia (double vision), vomiting, changes in blood pressure, CNS depression, photosensitivity, and fatal nephrosis. Because these dm have been associated with serious adverse reactions and fetal malformations, they should be used only when other less toxic dm are not effective in controlling seizures. The oxazolidinediones may precipitate a tonic-clonic seizure... 

The most common serious adverse reactions to amantadine are orthostatic hypotension, depression, congestive heart failure, psychosis, urinary retention, convulsions, leukopenia, and neutropenia Less serious reactions include hallucinations, confusion, anxiety, anorexia, nausea, and constipation. Adverse reactions with selegiline include nausea, hallucinations, confusion, depression, loss of balance, and dizziness. 

Reactions after administration of 131I include sore diroat, swelling in the neck, nausea, vomiting, cough, and pain on swallowing. Otiier reactions include bone marrow depression, anemia, leukopenia, thrombocytopenia, and tachycardia... 

Anemia, proteinuria, nausea, vomiting, fever, rash, leukopenia, neutropenia, thrombocytopenia, diarrhea, constipation, alopecia Bone marrow depression, hyperuricemia, hepatotoxicity, skin rash... 

Nausea, skin rash, pruritus, stomatitis, vomiting, anemia, leukopenia, neutropenia, arthralgia, alopeda, asthenia, fever, infections Diarrhea, nausea, vomiting, flushing, myalgia, arthralgia, fever, peripheral neuropathy, opportunistic infections Leukopenia, nausea, vomiting, paresthesias, malaise, weakness, mental depression, headache, hypertension, alopecia, diarrhea, constipation... 

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