Lubran M M
Harbor-UCLA Medical Center, Department of Pathology, Torrance 90509.
Ann Clin Lab Sci. 1989 Mar-Apr;19(2):114-21.
Bone marrow and peripheral blood cells may be adversely affected by drugs. Although the risk from most drugs is very small, many cases are reported because of the millions of doses of drugs taken each year by the population. Neutropenia, thrombocytopenia, hemolytic anemia, aplastic anemia, and macrocytic anemia are the commonest effects, in that order. Aplastic anemia is rare, but very serious when it does occur. Adverse effects may be produced by a direct toxic action of the drug or its metabolites on the bone marrow or, less often, on circulating cells. Antineoplastic drugs and chloramphenicol are examples. Most drugs produce their adverse effects through an immunological mechanism. The drug may act as a hapten or may affect the immune system leading to the production of antidrug antibodies and sometimes autoantibodies. Hemolytic anemia may result. Penicillins may behave in this manner. Some drugs act on erythrocytes with enzyme defects, e.g. glucose-6-phosphate dehydrogenase (G-6-PD) abnormalities, to produce hemolysis. In many cases, the mechanism underlying the adverse effect is unknown. The paper lists the drugs reported to have caused some hematological adverse effect and describes the mechanisms in those cases where they are known.
骨髓和外周血细胞可能会受到药物的不良影响。尽管大多数药物的风险非常小，但由于每年人群服用数以百万计剂量的药物，仍有许多病例被报道。中性粒细胞减少、血小板减少、溶血性贫血、再生障碍性贫血和巨幼细胞贫血是最常见的影响，依次排列。再生障碍性贫血很少见，但一旦发生则非常严重。药物或其代谢产物对骨髓或较少情况下对循环细胞的直接毒性作用可能会产生不良反应。抗肿瘤药物和氯霉素就是例子。大多数药物通过免疫机制产生不良反应。药物可能作为半抗原起作用，或可能影响免疫系统导致产生抗药物抗体，有时还会产生自身抗体。可能会导致溶血性贫血。青霉素可能就是以这种方式起作用。一些药物作用于有酶缺陷的红细胞，例如葡萄糖-6-磷酸脱氢酶（G-6-PD）异常，从而产生溶血。在许多情况下，不良反应的潜在机制尚不清楚。本文列出了据报道会引起某些血液学不良反应的药物，并描述了已知情况下的机制。
