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Clinical - Drug induced blood disorders
Blood
disorders can result from side-effects of medicines. There are a
few drugs which are particularly important to recognise a serious
side-effect which may occur in the future.
Aminosalicylates (Sulfasalazine)
Patients receiving aminosalicylates should report any unexplained
bleeding, bruising, purpura, sore throat, fever or malaise
that occurs during treatment. A blood count should be performed and
the drug stopped immediately if there is suspicion of a blood dyscrasia.
Carbimazole
Doctors are reminded of the importance of recognising bone
marrow suppression induced by carbimazole and the need to stop
treatment promptly.
- Patient
should be asked to report symptoms and signs suggestive of
infection, especially sore throat.
- A white
blood cell count should be performed if there is any clinical
evidence of infection
- carbimazole
should be stopped promptly if there is clinical or laboratory
evidence of neutropenia
Methotrexate
In view of reports of dycrasias (including fatalities) and liver
cirrhosis with low-dose methotrexate, the CSM has advised:
 | Full blood
count and renal and liver function tests before starting
treatment and repeated weekly until theraphy stabilised,
thereafter patients should be monitored every 2-3 months |
| That
patients should be advised to report all symptoms and signs
suggestive of infection, especially sore throat. |
Treatment with folinic acid(calcium
folinate) may be required in acute toxicity.
The patient must be warned to report
immediately the onset of any feature of blood disorders (e.g sore
throat, bruising, and mouth ulcers), liver toxicity (e.g nausea,
vomiting, abdominal discomfort, and dark urine), and respiratory
effects (e.g shortness of breath)
Warfarin
Poeple taking warfaring must report any unexplained bleeding and
bruising. This is due to a high INR value, meaning the anticoagulant
effect of warfarin is causing the blood to be "too thin", and
platelets and clotting factors can't act effectively enough to stop
bleeding or haemorrage. There is a similar effect with aspirin, and
note should especially be made with the interaction between warfarin
and low dose aspirin, which may cause an increased risk of bruising
and bleeding.
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