Management ofdrug‐inducedneutropenia, thrombocytopenia, and anaemia after solid organ transplantation: A comprehensive review

Abstract

What is known and objective Advances in the development of more effective immunosuppressive drugs have increased graft survival and drug induced adverse effects. Haematological complications including neutropenia, thrombocytopenia, and anaemia are common side effects that affect the grafts' and patients' outcomes. Several studies have stated the important role of various medications in haematological complications after transplantation. They have reported the incidence and different mechanisms of drug induced cytopenia, as well as an overview of possible treatment modalities. However, there is no comprehensive protocol for the management of these complications following transplantation. This narrative review was performed to develop a comprehensive practical approach for management of drug induced haematological complications following solid organ transplantation. Method PubMed, Embase, Cochrane library, Web of Science, and Google scholar databases were searched without time limitations until March, 2021. In addition, some valid drug information data bases (Uptodate and Micromedex) were searched for detailed information until October, 2021. Results and discussion Several immunosuppressive and antimicrobial medications may induce neutropenia, thrombocytopenia or anaemia following transplantation. Most of these agents cause dose‐related cytopenia, which resolves with dose reduction or drug withdrawal. However, any change in medications may result in negative consequences such as severe infections, bleeding, cardiovascular complications, acute allograft rejection, and graft or patient loss. Thus, cautious evaluation of the patient's condition and the pharmacological properties of the culprit medication are required. What is new and conclusion Three algorithms are presented to guide healthcare providers in the stepwise management of drug‐induced neutropenia, thrombocytopenia, and anaemia after solid organ transplantation.

Treatment Options for Anemia in Kidney Transplant Patients: A Review

“…Medication-induced anemia may be considered when other causative factors are apparently absent 12 ; an algorithm to manage drug-induced anemia in recipients of solid organ transplants has recently been suggested. 23 Immunosuppressive drugs (calcineurin inhibitors, mTOR inhibitors, anti-thymocyte globulin, and antimetabolites), antivirals (ganciclovir and valganciclovir), and antimicrobials (trimethoprim-sulfamethoxazole) can, directly or indirectly, suppress the bone marrow, causing anemia. 6 , 23 Several other drugs that may be used in KTRs can cause hemolytic or megaloblastic anemia.…”

“… 23 Immunosuppressive drugs (calcineurin inhibitors, mTOR inhibitors, anti-thymocyte globulin, and antimetabolites), antivirals (ganciclovir and valganciclovir), and antimicrobials (trimethoprim-sulfamethoxazole) can, directly or indirectly, suppress the bone marrow, causing anemia. 6 , 23 Several other drugs that may be used in KTRs can cause hemolytic or megaloblastic anemia. 24 Chronic use of proton-pump inhibitors may impair intestinal iron absorption resulting in iron-deficiency anemia.…”

What’s New: Updates on Cytomegalovirus in Solid Organ Transplantation

“…The cause of neutropenia in SOT recipients is multifactorial and includes immunosuppressive agents (eg, azathioprine, mycophenolate, antithymocyte globulin, and alemtuzumab), anti-CMV therapy (ie, ganciclovir and valganciclovir), antibiotics (eg, trimethoprim-sulfamethoxazole and beta-lactams), vitamin and nutritional deficiencies (eg, B12 and folic acid), and viral infections (eg, CMV, parvovirus B19, and human herpesvirus-6). 35 Calcineurin inhibitors have also been reported to cause neutropenia. 36 Neutropenia also exerts a detrimental effect on SOT patients.…”