Blood Dyscrasias Associated with Antituberculosis and/or Tranquilizing Chemotherapy A Long-Term Clinical Observation

¹ Chief, Pulmonary Disease Service

1. Between January 1, 1954 and December 31, 1961, 675 neuropsychiatric-tuberculous men were treated by antituberculosis and/or tranquilizing drugs. It has been observed that the spectrum of drug-associated blood dyscrasias ranged from a severe to a mild form. The working diagnostic methods used and significant clinical features which were associated with the type of blood-cell disorders and their management are described. The reported observations represent a clinical analysis with the assistance of a clinical laboratory.

2. Four patients, who developed the different type of blood-cell disorders, and the various clinical pictures are described in the report of cases. One hundred ten developed non-severe hematologic disorders on chemotherapy and most of them were closely observed until June 30, 1963. Follow-up observations showed that in 51, an occasional finding of mild leukocytosis or leukopenia may be considered normal variations of no particular clinical significance.

In 59 (8.8 per cent), strongly suggestive clinical evidence of the relationship between incriminated drugs and white blood-cell stimulation or depression has been determined. Of these patients, 23 also developed reversible anemia, hypochromic in type. In 24, findings in the differential smears showed that polymorphonuclears below 60 per cent and lymphocytes above 40 per cent preceded or were found with leukopenia, anemia and occasionally leukocytosis.

3. Certain clinically discernible etiopathogenic factors of importance in the development, diagnosis, treatment and prevention of drug-associated blood dyscrasia have been discussed. The drugs observed to be associated with leukopenia are listed.

4. It has been stressed that the etiology and pathophysiologic mechanism of a blood dyscrasia may be disclosed by in vitro serologic test. However, early recognition of drug-induced blood dyscrasia, without awaiting the results of the all-useful laboratory tests, is important for the outcome.

5. The results of observations seem to indicate that the extent and degree of drug-associated hematologic disorders and systemic symptoms can be minimized by an early detection of incipient blood-cell reaction and therapeutic consideration of etiopathogenic factors. The relatively rare severe reaction can be mitigated and a fatal outcome may be prevented. The incipient, moderate, and mild reactions are not uncommon and demand a close clinical supervision with frequent blood tests for an earlier recognition of a sudden worsening, to prevent the development of a severe reaction in hypersusceptible or sensitized individuals.