Upon completion of the chapter, the student will be able to:
- 1. Discuss the most commonly encountered drug-induced hematologic disorders.
- 2. Explain the process of adverse event causality evaluations for drug-induced hematologic disorders.
- 3. Describe the limitations of applying the most commonly used adverse event assessment tool to severe hematologic adverse events.
- 4. Critique the current adverse event reporting system used in the United States.
- 5. Discern precursor cells in their normal differentiation from stem cells to plasma cells.
- 6. Identify the point in maturation at which cells are damaged for a specific drug-induced hematologic adverse event.
- 7. Compare the mechanisms by which medications cause hematologic adverse events.
- 8. Determine the frequency at which specific drug-induced hematologic disorders have been observed to occur.
- 9. Prepare a discussion of drug-induced hemolytic anemia for a patient and provide a list of nonprescription medications to avoid.
- 10. Review the medication regimen of a patient experiencing a hematologic adverse event and identify the medication(s) that have been associated with the disorder.
- 11. Evaluate the current management options for treating specific drug-induced hematologic disorders.
- 12. Discuss the challenges to patient care presented by heparin-induced thrombocytopenia thrombosis.
- 13. Develop a monitoring plan for a patient receiving a medication associated with a severe hematologic adverse event.
- 14. Formulate appropriate counseling information to be provided a patient receiving a medication implicated in causing a severe hematologic adverse event.
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 Some agents cause predictable hematologic disease (e.g., antineoplastics), but others induce idiosyncratic reactions not directly related to the drugs' pharmacology. The most common drug-induced hematologic disorders include aplastic anemia, agranulocytosis, megaloblastic anemia, hemolytic anemia, and thrombocytopenia.
The incidence of idiosyncratic drug-induced hematologic disorders varies depending on the condition and the associated drug. Few epidemiologic studies have evaluated the actual incidence of these adverse reactions, but these reactions appear to be rare. A multinational study in Latin American countries estimated the incidence of agranulocytosis was 0.38 cases per 1 million inhabitant-years and reported a rate of 1.6 cases of aplastic anemia per million ...