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KEY CONCEPTS

KEY CONCEPTS

  • imageThe most common drug-induced hematologic disorders are aplastic anemia, agranulocytosis, megaloblastic anemia, hemolytic anemia, and thrombocytopenia.

  • imageDrug-induced hematologic disorders are rare adverse drug reactions (ADRs) associated with drug therapy.

  • imageThe incidence of rare ADRs is usually established by postmarketing surveillance and reporting.

  • imageRechallenging a patient with an agent suspected of inducing a blood disorder is not generally recommended.

  • imageDrug-induced hematologic disorders can occur by two mechanisms: direct drug or metabolite toxicity or an immune reaction.

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

BEYOND THE BOOK

BEYOND THE BOOK

Watch the video entitled “Part 1: Anemia: Pathophysiology and Diagnostic Approach” (https://accessmedicine.mhmedical.com/MultimediaPlayer.aspx?MultimediaID=16442308) in AccessMedicine by Scott Stern, MD. This can be found by clicking on Multimedia, Lectures, Diagnostic Reasoning, then Part 1: Anemia (https://accessmedicine.mhmedical.com/MultimediaPlayer.aspx?MultimediaID=16442308). This 21-minute video provides an overview of the foundational knowledge of anemia, the approach to evaluate a patient with anemia, common causes of anemias, and differential diagnosis for different types of anemias. This video increases student understanding regarding the COLLECT and ASSESS steps in the patient care process.

PATIENT CARE PROCESS

Patient Care Process for Drug-Induced Hematologic Disorders

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Collect

  • Medication history

  • ADR probability scale data

  • Laboratory data (eg, CBC, antibody tests)

  • Medication history (eg, has the patient taken heparin? What is the timing?)

Assess

  • Determine probable cause and severity of illness based on information above (eg, how likely is heparin-induced thrombocytopenia based on the Naranjo Algorithm? Have bleeding or thrombotic complications arisen?)

Plan*

  • Determine alternate and additional therapy if indicated (eg, which alternative anticoagulant should be chosen? Is there a preference for IV, SQ, or PO therapy? Is there a contraindication to argatroban? If severe bleeding is present, should corticosteroids, IVIG, or blood transfusions be considered?

Implement

  • Remove suspected causative agent and replace as needed (eg, stop heparin, start argatroban)

Follow-up: Monitor and Evaluate

  • Reassess clinical and laboratory data (eg, CBC to ensure that platelet counts recover appropriately)

  • Consider appropriateness of transition to SQ or PO anticoagulation

  • Continue to follow pertinent parameters to ensure resolution (eg, daily CBCs while patient is hospitalized with goal of platelet recovery within 1 week)

  • Continue anticoagulation at least 2 to 3 weeks to minimize ongoing risk of thrombosis.

  • Evaluate over time (eg, has the situation been resolved satisfactorily? Is additional therapy or action needed? In the future, what could be changed to provide better care in similar situations)

See Introduction and Drug-Induced Thrombocytopenia (Clinical Presentation and Management of Toxicity) sections for more information related to the patient care process.

*Collaborate with patient, caregivers, and other healthcare professionals.

INTRODUCTION

image Hematologic disorders have long been a potential risk of modern pharmacotherapy. Granulocytopenia (agranulocytosis) was reported in association with one of medicine’s early therapeutic agents, sulfanilamide, in 1938.1...

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