Leucopenia e trombocitopenia induzidas por etanercepte: relato de dois casos e revisão da literatura

Azevedo, Valderílio Feijó; Silva, Marilia Barreto Gameiro; Marinello, Débora Karine; Santos, Felipe Dunin dos; Silva, Guilherme Barreto Gameiro

doi:10.1590/s0482-50042012000100011

Cited by 24 publications

(17 citation statements)

References 11 publications

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“…O fator de necrose tumoral TNF-alfa é sentetizado principalmente pelos macrófagos, porém, outras células imunológicas como linfócitos T, monócitos e células Natural Killer (NK) também podem sintetizar a substância após estímulo antigênico externo (21) . É um importante fator na estimulação da cicatrização de feridas, bem como na resposta imune, no entanto, quando em altas concentrações podem desencadear diversas complicações (25) .…”

Section: Tnf-alfaunclassified

Uma Abordagem Sobre a Inter-Relação De Citocinas Na Artrite Reumatóide.

Campos¹,

Pontes²,

Torres³

et al. 2016

Rev Cient Fac Educ e Meio Ambient

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O sistema imunológico é importante mecanismo de defesa e proteção do corpo contra as ações de agentes internos e externos, contudo, tal sistema pode atuar contra substâncias, células, órgão ou tecidos do próprio organismo, processo este denominado auto-imunidade, importante na regulação homeostática, que quando se desenvolve de forma patológica é capaz de gerar danos irreparáveis ao organismo, ocasionando as doenças auto-imunes. A artrite reumatóide é uma doença auto-imune, de etiologia exata ainda desconhecida, caracterizada pela ação inflamatória e degenerativa dos ossos e cartilagens das articulações, onde durante o desenvolvimento do processo inflamatório ocorre à síntese em grande escala de mediadores químicos denominados citocinas, principalmente as interleucinas IL-1, IL-6 e fator de necrose tumoral TNF-alfa. O objetivo deste trabalho foi descrever através de pesquisa sobre forma de revisão de literatura a relação entre artrite reumatóide e a ação das citocinas. A artrite reumatóide é uma doença que apresenta alta taxa de morbidade e é fator de risco para diversas doenças. A ação inflamatória da artrite reumatóide envolve uma série de processos, dentre os quais as ações de mediadores químicos como as citocinas desempenham papel fundamental durante o quadro inflamatório, consequentemente contribuindo para o quadro evolutivo crônico da doença.

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Section: Tnf-alfaunclassified

Uma Abordagem Sobre a Inter-Relação De Citocinas Na Artrite Reumatóide.

Campos¹,

Pontes²,

Torres³

et al. 2016

Rev Cient Fac Educ e Meio Ambient

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“…Two cases of rheumatoid arthritis patients who developed leukopenia and thrombocytopenia induced by an anti-tumor necrosis factor-α (TNF-α) drug were reported; a case showed an improved thrombocytopenia after withdrawal of infliximab; in another case, there was a recovery of leukopenia and a persistence of thrombocytopenia for 2 months [1]. A study of 130 patients having rheumatoid arthritis on anti-TNF-α therapy showed a cytopenia rate of 12 %, mainly leukopenia, and these cases did not require bone-marrow examination [2].…”

Section: Dear Editormentioning

confidence: 99%

Infliximab-induced thrombocytopenia in a patient with ulcerative colitis

Matsumoto

Mashima

2015

Int J Colorectal Dis

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Dear Editor:We report here a case of drug-induced thrombocytopenia associated to infliximab in a patient with ulcerative colitis (UC). A 30-year-old male was first diagnosed with ulcerative colitis of pancolitis type in 2007. He had been treated with 5-aminosalicylate and azathioprine. Two months prior to hospitalization, he had abdominal pain, diarrhea, and bloody stool, and got worse. He was subsequently started with oral prednisone 0.5 mg/kg daily and cytapheresis. However, the symptoms did not improve, and the sigmoidoscopy study revealed loss of a vascular pattern, erosions, and ulcerations in the rectum and sigmoid colon. Then, he was admitted to our hospital.A blood test on admission revealed a white blood cell (WBC) count of 15,390/μL (Neut; 90.5 %), hemoglobin 12.6 mg/dL, platelet count of 223×10 9 /L, and serum CRP of 1.02 mg/dL. The disease activity index showed a Lichtiger's clinical activity index of 12 points, indicating high activity of UC. After confirming the absence of tuberculosis and hepatitis B virus infection by serological test and computer tomography, infliximab was administered at a dose of 5 mg/kg. Five days after administration of infliximab treatment, diarrhea and bloody stool disappeared, and his general condition was much improved. However, the routine blood test at the tenth day after infliximab infusion showed a platelet count of 23×10 9 / L, WBC count of 6,260/μL, and hemoglobin count of 8.5 mg/ dL. His fibrinogen, fibrin, fibrin-degradation products, PT, and aPTT were all within normal limits. We suspected infliximab-induced thrombocytopenia. We stopped infliximab treatment and transfused ten units of blood platelet to him. Despite the discontinuation of the infliximab treatment, thrombocyte counts remained low (20-60 × 10 9 /L) for 7 weeks. Prednisone was tapered in 5 mg per week. We evaluated the serum infliximab concentration, speculating that residual infliximab may be the cause of thrombocytopenia. The serum infliximab concentration at 6 weeks after infusion was 0.68 μg/mL. The patient was discharged 2 months later, and he recovered from thrombocytopenia (122×10 9 /L) at the 12th week after infliximab infusion.We present a case of a patient who developed thrombocytopenia due to the first administration of infliximab. Thrombocytopenia lasted for 7 weeks after infliximab infusion. The concentration of infliximab at 6 weeks after administration of infliximab fell below the effective blood concentration (above 1 μg/mL) but kept a little lower level (0.68 μg/mL). Therefore, we strongly suspect that the cause of continuous thrombocytopenia was residual infliximab.Two cases of rheumatoid arthritis patients who developed leukopenia and thrombocytopenia induced by an anti-tumor necrosis factor-α (TNF-α) drug were reported; a case showed an improved thrombocytopenia after withdrawal of infliximab; in another case, there was a recovery of leukopenia and a persistence of thrombocytopenia for 2 months [1]. A study of 130 patients having rheumatoid arthritis on anti-TNF-α therapy showed a...

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“…Severe leukopenia (leukocyte count <2000/mm 3 ) and thrombocytopenia (platelet count <100,000/ mm 3 ) are adequate indicators to discontinue therapy in patients whose hematopoietic system were normal at the beginning of therapy. 5,8 The grade of toxicity has also become one of the criteria to take into account before conducting chemotherapy. Chemotherapy can only be prescribed when the toxicity does not exceed grade three based on the WHO toxicity grading scale.…”

Section: Introductionmentioning

confidence: 99%

Hematologic Toxicities of Chemotherapy in Lung Cancer Patients: A Retrospective Study in Dr. M. Djamil Hospital Padang, Indonesia

Yuliandra

Nasif

Ermayanti

et al. 2019

ijcp

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The use of chemotherapeutic agents in the management of cancer is often followed by a range of toxicities to various organ systems. A retrospective study on the hematologic toxicities of chemotherapy in lung cancer patients has been carried out. The study was conducted by a cross-sectional method from medical records of four-year data in 2010–2014 at Dr. M. Djamil Hospital Padang, West Sumatra, Indonesia. Data from medical records of patients diagnosed with lung cancer and underwent chemotherapy, not suffering from primary hematologic diseases, and with normal kidney and liver function prior to chemotherapy were studied. A number of 22 medical records of lung cancer patients which met the criteria with a total of 40 chemotherapy cycles were observed. The study revealed that a combination of carboplatin-paclitaxel was the most common chemotherapy used for the patients (72.7%). The hematologic toxicities comprised anemia, leukopenia, and thrombocytopenia with the severity ranging from grade 1–3. Carboplatin-paclitaxel was the only combination that caused these three toxicities, and the only combination to cause thrombocytopenia as well. Anemia was the major hematologic toxicity experienced by more than half of the patients. The study concludes that there is a reasonably high incidence of hematologic toxicities from chemotherapy among lung cancer patients.Keywords: Anemia, chemotherapy, hematologic toxicity, leukopenia, lung cancer, thrombocytopenia Toksisitas Hematologis Akibat Kemoterapi pada Pasien Kanker Paru: Studi Retrospektif di RSUP Dr. M. Djamil PadangAbstrak Penggunaan obat kemoterapi dalam pengobatan kanker sering disertai dengan toksisitas pada beberapa sistem organ. Kajian retrospektif terhadap toksisitas hematologis akibat kemoterapi pada pasien kanker paru sudah dilaksanakan. Studi ini dilaksanakan dengan metode cross-sectional dari data rekam tahun 2010–2014 di RSUP Dr. M. Djamil Padang, Sumatera Barat. Data pasien yang didiagnosis menderita kanker paru yang menjalani kemoterapi, tidak menderita penyakit hematologis dan gangguan hematopoiesis, serta memiliki fungsi ginjal dan hati yang normal dimasukkan ke dalam kajian. Sejumlah 22 pasien memenuhi kriteria dengan jumlah siklus kemoterapi sebanyak 40. Hasil kajian ini mengungkap bahwa kombinasi karboplatin-paklitaksel merupakan kemoterapi yang paling banyak digunakan (72,2%). Toksisitas hematologis yang terjadi meliputi anemia, leukopenia, dan trombositopenia dengan tingkat keparahan 1–3. Karboplatin-paklitaksel merupakan satu-satunya kombinasi kemoterapi yang menyebabkan ketiga toksisitas hematologis tersebut, sekaligus juga merupakan satu-satunya kombinasi yang menimbulkan trombositopenia. Anemia merupakan toksisitas hematologis yang paling banyak terjadi meliputi lebih dari separuh pasien. Penelitian ini menyimpulkan bahwa terdapat toksisitas hematologis yang cukup tinggi akibat kemoterapi pada pasien kanker paru.Kata kunci: Anemia, kanker paru, kemoterapi, leukopenia, toksisitas hematologis, trombositopenia

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Leucopenia e trombocitopenia induzidas por etanercepte: relato de dois casos e revisão da literatura

Cited by 24 publications

References 11 publications

Uma Abordagem Sobre a Inter-Relação De Citocinas Na Artrite Reumatóide.

Uma Abordagem Sobre a Inter-Relação De Citocinas Na Artrite Reumatóide.

Infliximab-induced thrombocytopenia in a patient with ulcerative colitis

Hematologic Toxicities of Chemotherapy in Lung Cancer Patients: A Retrospective Study in Dr. M. Djamil Hospital Padang, Indonesia

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