Discrasias sanguíneas e medicamentos: uma revisão de literatura

Abstract

It is a study based on scientific publications with the objective of conducting a survey about the main drug groups implicated in reactions of hematological nature. For such, were considered publications from 2000 to 2017 conducted in several countries around the world such as United States of America (USA), United Kingdom, Germany, Netherlands, Spain and some countries from Scandinavia, consisting in a sample of 30 scientific publications, 1 being a thesis from Brazil. The analyses of those shows that, among the main drug-induced hematological disorders, there are agranulocytosis, thrombocytopenia, megaloblastic, hemolytic and aplastic anemias. Concerning the main drug groups implicated in those adverse reactions there are the antineoplastics, due to their intrinsic antiproliferative pharmacological properties, the psychotropics antiseizures and antipsychotics, some antibiotics, the thioamide antithyroid drugs and the nonsteroidal anti-inflammatory drugs (NSAIDs) as a whole. Upon relating the drug groups to the blood disorders, it shows that the antineoplastics, mainly the alkylating agents ant the antimetabolites, are megaloblastic and aplastic anemia inducers once they interfere in the nucleic acids metabolism; the psychotropics are related to agranulocytosis (clozapine and carbamazepine with an incidence of 0,18% and 0,14% respectively), thrombocytopenia and aplastic anemia (antiseizures with OR 9,5 [IC 95%, 3,0-39,7]). The antibiotics may cause agranulocytosis (cephalosporins showing RR 13,8 [IC 95%, 3,6-52,6], sulfonamides with RR 7,6 [IC 95%, 2,0-29,2] and penicilliums with RR 3,1 [IC 95%, 1,4-7,0])), thrombocytopenia (38 cases in 1 million users of cotrimoxazole), hemolytic anemia (cefotetan with 47 cases and 5 fatalities from 1971 to 2008 and ceftriaxone with 29 cases and 10 fatalities) and cases of aplastic anemia (chloramphenicol with 2 to 3 cases in 1 million users); the thioamide antithyroid drugs are agranulocytosis (OR 52,75 [IC 95%, 5,82-478,03]) and aplastic anemia (34 cases until the year of 2008) inducers, and the NSAIDs are related to agranulocytosis (1 to 9 cases in 1 million in Europe and 2 to 15 cases in USA) and thrombocytopenia (10 cases in 1 million). As a conclusion, this study demonstrated that hematological adverse reactions are idiosyncraticnatured due to the great genetic variability existing in humans and that, even though there are difficulties because of the lack of homogeneity regarding those reactions, it is imperative an effective surveillance of those drugs as well as a diligent clinical management in order to minimize the damages upon the committed users’ health.