Tacrolimus-induced bone marrow suppression

Association of long‐term tacrolimus (FK506) therapy with abnormal megakaryocytosis, bone marrow fibrosis, and dyserythropoiesis

“…Tacrolimus can bind to FKBP in T lymphocytes and the final outcome is inhibition of the gene transcription for IL‐2 and other transcription factors essential to early T cell activation . Hematopoietic abnormalities associated with tacrolimus are rare with reversible pure red cell aplasia the most common . The mechanism by which tacrolimus causes bone marrow hypoplasia is unclear.…”

“…The hematopoietic abnormalities associated with tacrolimus are relatively rare. There are very few case reports of reversible pure red cell aplasia (PRCA) and generalized bone marrow suppression in transplantation recipients following the use of tacrolimus. The bone marrow suppression associated with tacrolimus appears to be reversible as all the patients in the case reports recovered after tacrolimus was discontinued.…”

Hematologic abnormalities in children and young adults receiving tacrolimus‐based immunosuppression following cardiothoracic transplantation

“…Tacrolimus is a highly effective immunosuppressant, with a broad spectrum of side‐effects, including possible sensitization of the red blood cell membrane leading to hemolysis (5). Anemia has been described in adults undergoing treatment with tacrolimus (4–6). Early in our experience, we noted the common occurence of anemia and neutropenia in our pediatric patients receiving tacrolimus after cardiothoracic organ Tx (2).…”

“…We have observed anemia and neutropenia in our pediatric cardiothoracic transplant population receiving tacrolimus‐based immunosuppression (2). The etiology of these findings is unclear, although tacrolimus has been linked to red cell aplasia after renal and liver Tx (3, 4), to hemolytic anemia after liver and bone marrow Tx (5), and to generalized bone marrow suppression after liver Tx (6). To clarify the role of tacrolimus in the development of anemia, neutropenia, and thrombocytopenia, we reviewed hemograms and related data on all children who had undergone cardiothoracic Tx at the Children's Hospital of Pittsburgh from 1989 to 1997.…”