Doctors often encounter patients with leukopenia in the clinic, and their first reaction is to ask if there is something wrong with the hematopoietic system.
We all know that many hematologic disorders like aplastic anemia and leukemia can cause leukopenia. Mild reductions in leukocytes can occur without any signs, but patients with severe reductions in leukocytes are prone to infections, weakness, dizziness, and other common ones.
However, some leukopenia is caused by the drug itself and is often not due to a hematologic disorder.
Anti-tumor chemotherapy drugs: Anti-tumor chemotherapy drugs can kill leukocytes non-specifically, and leukopenia is a common toxic reaction to the use of the drugs. In addition to killing leukocytes, they can also inhibit red blood cells and platelets in the blood.
Alkylating agents and antimetabolites are mainly included: 1. Nitrogen mustard, ethylenimine, nitrosoureas and hydrazines (procarbazine), which are widely used clinically, including nitrogen mustard and cyclophosphamide.
2.Anti-metabolic drugs. The main ones are: methotrexate, pemetrexed, fluorouracil, capecitabine, tigeo, mercaptopurine, cytarabine, gemcitabine, etc.
Antipyretic and anti-inflammatory drugs: Antipyretic and anti-inflammatory drugs, commonly used in clinical practice are: acetaminophen, aspirin, ibuprofen, diclofenac and indomethacin.
Antibacterial drugs: In recent years, the application of systemic administration of chloramphenicol has generally decreased at home and abroad due to the increase of resistance of common pathogenic bacteria to chloramphenicol and its serious adverse effects such as bone marrow suppression. It is important to note that aplastic anemia also occurs after topical administration of chloramphenicol. In addition, penicillins, streptomycins, polymyxins, sulfonamides, and tetracyclines can also cause leukopenia.
Anti-tuberculosis drugs: isoniazid, ethambutol, para-aminosalicylic acid, rifampin, etc. All of these drugs may cause leukopenia. After the drugs enter the body, antibodies are produced in the body, and when the drugs are used again, a large number of granulocytes are destroyed by agglutination, causing a decrease in leukocytes, with a more pronounced decrease in granulocytes.
Anti-thyroid drugs: propylthiouracil and methimazole. Possible mechanisms include 1, drug toxicity, drug inhibition of bone marrow cell deoxyribonucleic acid synthesis, resulting in reduced mitosis of granulocytes, resulting in a decrease in granulocytes and lack of; 2, immune response to excessive destruction of granulocytes, anti-thyroid drugs into the body, resulting in the body to produce antibodies, when the drug is used again, a large number of granulocytes are agglutinated and destroyed, resulting in a decline in white blood cells.
Antimalarial drugs: Chloroquine, primaquine, and ethidium, etc. In addition to treating malaria, these drugs may also suppress bone marrow and cause leukopenia.
Anticonvulsant/epileptic drugs Clinically used drugs in this category include phenytoin sodium, carbamazepine, and phenobarbital, all of which may cause leukopenia. Therefore, regular monitoring of blood count is performed during treatment.
Blood pressure lowering drugs: 1. Captopril, an angiotensin-converting enzyme inhibitor (ACEI), clinically doctors pay more attention to the cough caused by captopril, the chance of leukopenia caused by captopril is relatively low, the main mechanism of causing leukopenia may be related to the myelosuppressive effect of the drug itself and the metabolic reaction induced by the drug; 2. Methyldopa, there occurs mild granulocytopenia, thrombocytopenia and hemoglobin reduction with or without a positive Coombs test. Positive complement binding tests for platelet and leukocyte antibodies, positive Coombs’ test, and positive antinuclear antibodies have also been reported. All of these changes are often reversible after discontinuation of the drug.
Immunosuppressive drugs: Mortylmacrolate interferes with the synthesis of guanine nucleotides so that they cannot form DNA and inhibits the activation and proliferation of lymphocytes to achieve immunosuppressive effects, and is an anti-rejection drug after organ transplant. However, it also impairs the growth of other normal cells in the body and can lead to bone marrow suppression.
The incidence of myelosuppression due to mortification is 7%-35%, including anemia, leukopenia and thrombocytopenia, with anemia and leukopenia being the most common.
Treatment of psychiatric disorders: including antipsychotics chlorpromazine, tricyclic antidepressants, etc. Leukopenia caused by chlorpromazine usually occurs in the first few weeks of drug use. This adverse reaction is more common with chlorpromazine than with other more potent antipsychotics (e.g., endeprazine, trifluoperazine). Chlorpromazine can also cause neutropenia to deficiency.