Management of Haematological ADR

MANAGEMENT OF HAEMATOLOGICAL ADR

Once a haematological ADR is suspected, the two principal components of appropriate management are firstly the identification and withdrawal of any potentially implicated agent and secondly the provision of necessary expert supportive care of the patient pending recovery.

IDENTIFICATION AND WITHDRAWAL OF CAUSATIVE AGENT

This may be readily apparent in the case of cyto-toxic chemotherapy. Idiosyncratic reactions may be suspected by exposure to a drug having an established association with myelosuppression. Newly licensed preparations in the drug history of patients presenting with otherwise unexplained marrow failure should be regarded with suspicion.

It is critically important that all potentially impli-cated drugs are discontinued at the first sign of idio-pathic myelosuppression. Unlike with some allergic reactions, cross-reactivity between different drugs of the same class for these reactions is not problematical. It is safer to stop or switch all potentially implicated medication if there is any doubt that it may be involved.

SUPPORTIVE CARE

Haematological cytopenias (especially neutropenia) are potentially life threatening, and it is critically important that patients are referred to specialists with appropriate expertise and facilities for manage-ment (Carey, 2003). Strategies for the logical empir-ical antimicrobial treatment of presumed infection in febrile neutropenic patients are well developed. Red cell and platelet transfusion support may be appropri-ate for anaemia and thrombocytopenia, respectively. Recombinant growth factors such as granulocyte CSF (G-CSF) and erythropoietin can help to reduce the severity and duration of neutropenia and anaemia, respectively.

Specific therapy for prolonged drug-induced marrow failure that does not improve after causative drug withdrawal involves the consideration of immunosuppressive therapy or allogeneic stem cell transplantation, as for idiopathic AA (Bacigalupo et al., 2000).