Mitomycin-C is a known nephrotoxin, and there is evidence that its mechanism for inducing TMA is a dose-dependent, direct toxic effect on endothelium. Small numbers of patients treated with radioimmunotherapy alone have shown a seemingly low risk for leukemia [ 93 ]. The time to reach steady state is often longer than 2 weeks. Megaloblastic anemias are characterized by the presence of a hypercellular bone marrow with large, abnormal hematopoetic progenitor cells megaloblasts.
The majority of patients recover without complications though severe bleeding may occasionally occur. Address reprint requests to Dr. Acetylation of cyclooxygenase 1 COX 1 leads to impaired synthesis of the important platelet agonist thromboxane.
Drug-induced sideroblastic anemia has been associated with isoniazid [ 18 ].
Drug-Induced Hematologic Syndromes
Ribavirin, used with peginterferon for treatment of hepatitis C, has been associated with anemia. Atropine Disopyramide Quinidine muscarinic agonist: Journal of Toxicology and Environmental Health. For some drugs, such as heparin, quinidine, and vancomyin, in vitro testing has been performed and mechanisms for cytopenias elucidated. They arise from excess platelet aggregation. Archived from the original on 7 October Drug-induced hematological disorders can span almost the entire spectrum of hematology, affecting red cells, white cells, platelets, and the coagulation system.
Ethotoin Fosphenytoin Mephenytoin Phenytoin ; Ureides: Treatment-related acute promyelocytic leukemia has also been described, most commonly in association with topo II inhibitors [ 87 ]. Drugs implicated include antibiotics, psychotropics, fludarabine, and interferon [ 67 ]. View at Google Scholar B. UW says it interferes with B12 metabolism.
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Reports have linked sulfonamides, ampicillin, chloramphenicol, tetracyclines, and cefoxitin to deficiency in vitamin -dependent clotting factors [ 71 ]. Patients treated with CMF may have reduced levels of the inhibitors proteins and [ 57 ]. Tentative evidence suggests that topical phenytoin is useful in wound healing in people with chronic skin wounds. It has been suggested that phenytoin causes a reduction in folic acid levels, predisposing patients to megaloblastic anemia.
Quinine may also induce TMA. Complex chromosomal abnormalities are typical, commonly with deletions of chromosome 5 and 7 and trisomy 8. Patients should be cautioned against concomitant use of antacids and phenytoin.
Aplastic Anemia Aplastic anemia AAcharacterized by pancytopenia with a hypocellular bone marrow, can be inherited or acquired.