Presentation
On cessation of HU the DM-LE clears avoiding unnecessary immunosuppression and demonstrating the importance of consideration of medication aetiology in DM presentations. We present a case report and review of the literature. [ncbi.nlm.nih.gov]
Presenters are required to disclose only those relationships that are relevant to their specific presentation. [hopkinsmedicine.org]
An 18-year-old woman with sickle cell anemia presents with recurrent painful crises, and treatment with hydroxyurea is recommended. Hydroxyurea causes a shift toward the production of red cells containing fetal hemoglobin. [dx.doi.org]
Entire Body System
- Gangrene
The affected tissues become red, hot and swollen resembling cellulitis and the area rapidly becomes gangrenous. Patients are acutely ill with sepsis and progress rapidly to multi-organ failure. [omicsonline.org]
Defined Nausea Vomiting Constipation Diarrhea Mucositis Acute pulmonary reactions (rare) Genetic mutation (long-term use) Myelosuppression Secondary leukemia (long-term use) Elevated BUN, Cr Hyperuricemia Renal failure Rash Hyperpigmentation Skin ulcer Gangrenous [reference.medscape.com]
Be sure to notify your healthcare provider of any rash or ulcers that develop, as this can be a serious reaction that can lead to gangrene. [oncolink.org]
Respiratoric
- Cough
Tell your doctor about the allergy and what signs you had, like rash; hives ; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs. [drugs.com]
Side effects needing medical attention after stopping this medication Black, tarry stools; blood in urine; cough or hoarseness; fever or chills; lower back or side pain; painful or difficult urination; pinhead-sized red spots on skin; unusual bleeding [lls.org]
Tell the doctor about the allergy and what signs your child had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs. [mskcc.org]
I was having thoughts of my hair falling out, horrible GI symptoms, nausea, vomiting, dehydration, exhaustion, more anemia, constipation, diarrhea, skin turning pale, insomnia, cough, soreness, fever, chills, back pain, black tarry stools, bleeding, confusions [sicklecellwarriors.com]
Gastrointestinal
- Nausea
Patients being initiated on HU should be advised that rarely, fevers, chills, nausea, and elevations in liver function tests may occur. [ncbi.nlm.nih.gov]
[…] reactions (5.7%) Anemia (4.2%) Skin reactions (3.7%) Parvovirus B19 infections (3.7%) Other skin and subcutaneous tissue disorders (3.2%) Other nervous system disorders (2.7%) Respiratory thoracic and mediastinal disorders (2.7%) Constipation (2.5%) Nausea [reference.medscape.com]
Hydroxyurea causes little nausea. But if you should experience nausea, take anti-nausea medications as prescribed by your doctor, and eat small frequent meals. Sucking on lozenges and chewing gum may also help. Avoid sun exposure. [chemocare.com]
- Vomiting
Other nervous system disorders (2.7%) Respiratory thoracic and mediastinal disorders (2.7%) Constipation (2.5%) Nausea (2.5%) Other metabolic and nutrition disorders (2%) Weight gain (2%) Renal and urinary disorders (2%) Frequency Not Defined Nausea Vomiting [reference.medscape.com]
Eight days after initiation of HU he experienced anorexia, nausea, vomiting, fever, fatigue, dizziness, and shaking chills. Discontinuation of the HU resulted in resolution of his symptoms within 2 days, and HU was re-started. [ncbi.nlm.nih.gov]
[…] reactions, and instruct him to immediately report postdose vomiting, and unusual bruising or bleeding. • Advise patient to avoid exposure to people with infections and to report signs of infection immediately. [glowm.com]
I eventually ended up taking it for 6 months a year later, to no avail and really bad nausea/vomiting. [sicklecellwarriors.com]
Skin
- Hyperpigmentation
Hydroxyurea is a cytostatic agent used to treat myeloproliferative disorders and long-term treatment is associated with mucocutaneous adverse events and nail hyperpigmentation. [ncbi.nlm.nih.gov]
The palmar hyperpigmentation, which has previously been reported with hydroxyurea use, further solidifies the diagnosis. [mdedge.com]
[…] disorders (2%) Frequency Not Defined Nausea Vomiting Constipation Diarrhea Mucositis Acute pulmonary reactions (rare) Genetic mutation (long-term use) Myelosuppression Secondary leukemia (long-term use) Elevated BUN, Cr Hyperuricemia Renal failure Rash Hyperpigmentation [reference.medscape.com]
- Eruptions
The patient presented withhyperpigmentation, ichthyosis, plantar keratoderma, dermatomyositis-like eruptions, two squamous cell carcinomas, and actinic keratoses. [ncbi.nlm.nih.gov]
We report a patient in whom chronic HU therapy resulted in a dermatomyositis-like eruption. [jamanetwork.com]
- Dry Skin
Skin: Dermatological changes may be seen with prolonged use. These include Skin Pigmentation and rash: Hyperpigmentation, erythema of the face and hands, diffuse maculopapular rash and dry skin. Severe reactions may resemble lichen planus. [allaboutblood.com]
skin brushes, I kept coming back to this one because something about the way it's shaped made me feel it would work the best.hydrea 500mg 360 pills $546.35LOWEST PRICES ONLINE - ORDER NOW! [bebacasadaermelinda.it]
• Nausea and vomiting • Diarrhea • Constipation • Mouth sores • Loss of appetite • Abnormalities in nails • Darkening of skin at the site of previous radiation therapy • Rash, dry skin, itching What are the possible late side effects of treatment with [news.cancerconnect.com]
Rash Some patients may develop a rash or very dry skin. Be sure to notify your healthcare provider of any rash or ulcers that develop, as this can be a serious reaction that can lead to gangrene. [oncolink.org]
- Papule
Intensive xerosis (ichthyosis-like) and violaceous papules on the dorsal hand surfaces were observed. There was also reddish purple periorbital erythema resembling "heliotrope erythema". [ncbi.nlm.nih.gov]
- Erythema
There was also reddish purple periorbital erythema resembling "heliotrope erythema". Such a disease pattern has been described as "hydroxyurea-induced dermatomyositis-like eruption" - a drug-adverse reaction associated with hydroxyurea therapy. [ncbi.nlm.nih.gov]
Avoid exposure to excessive heat. • Monitor CBC at least weekly throughout therapy. • Monitor intake and output levels; patient must remain hydrated. • Drug may exacerbate postirradiation erythema. [glowm.com]
Alopecia: Alopecia may occasionally be seen with the use of hydroxyurea Radiation Recall: Erythema or pigmentation of previously radiated skin may be seen in some patients. [allaboutblood.com]
Neurologic
- Dizziness
Eight days after initiation of HU he experienced anorexia, nausea, vomiting, fever, fatigue, dizziness, and shaking chills. Discontinuation of the HU resulted in resolution of his symptoms within 2 days, and HU was re-started. [ncbi.nlm.nih.gov]
Side effects needing medical attention Fever; chills; sore throat; sores in mouth and on lips; unusual bleeding or bruising; convulsions; unusual tiredness or fatigue; dizziness; side or stomach pain; hallucinations (seeing, hearing or feeling things [lls.org]
Adverse reactions CNS: drowsiness, malaise, confusion, dizziness, headache GI: nausea, vomiting, diarrhea, constipation, stomatitis, anorexia GU: dysuria, hyperuricemia, infertility, renal tubular dysfunction Hematologic: anemia, megaloblastosis, leukopenia [medical-dictionary.thefreedictionary.com]
When to Call the Doctor Call your doctor or nurse if you have any of these symptoms and/or any new or unusual symptoms: Fever of 100.5 F (38 C) or higher Chills Fatigue that interferes with your daily activities Feeling dizzy or lightheaded Easy bleeding [upmc.com]
If you experience drowsiness, dizziness, hypotension or a headache as side-effects when using Hydroxycarbamid Sandoz Capsule medicine then it may not be safe to drive a vehicle or operate heavy machinery. [tabletwise.com]
Workup
Serum
- Macrocytosis
The exact mechanism of action of HU is not known although the induction of Hb F synthesis and macrocytosis seem to be apparent possible mechanisms [ 7 - 10 ]. [omicsonline.org]
[…] patients develop some toxicity, which may occur at any time during a course of treatment: Leucopaenia (reduced white cell count) Anaemia (reduced red cell count) Thrombocytopenia (reduced platelet count) Pancytopaenia (reduction in all blood cell types) Macrocytosis [dermnetnz.org]
[…] effect with Siklos (seen in more than one patient in 10) is bone marrow suppression, causing neutropenia (low levels of neutrophils, a type of white blood cell), reticulocytopenia (low levels of reticulocytes, a type of immature red blood cell) and macrocytosis [emea.europa.eu]
Treatment
Complete remission was observed after 6 to 10 weeks of imiquimod 5% (10 mg/cm of skin cancer) treatment. [ncbi.nlm.nih.gov]
Prognosis
We know that patients who have intolerance to hydroxyurea, due to hematologic toxicity, are patients defined in a couple of studies as having a worse prognosis. [targetedonc.com]
Technique Follow-Up Studies Humans Hydroxyurea/pharmacology* Leukemia, Myeloid, Acute/drug therapy* Leukemia, Myeloid, Acute/genetics Leukemia, Myeloid, Acute/pathology Male Mice Mice, Inbred NOD Mice, SCID Middle Aged Mutation/genetics Neoplasm Staging Prognosis [ncbi.nlm.nih.gov]
Awareness of the possibility of necrotizing fasciitis following hip replacements is warranted in patients with MPNs on hydroxyurea as the prognosis is poor without early aggressive treatment with antibiotics and surgical debridement. [omicsonline.org]
Introduction Recent progress in the therapy of sickle cell disease, particularly the use of hydroxyurea, has considerably improved the prognosis of patients with this disease. 1, 2 Their mean life expectancy is currently about 50 years, 3 their quality [haematologica.org]
Survival and prognosis among 1545 patients with contemporary polycythemia vera: an international study. Leukemia. 2013;27:1874–81. View Article PubMed Central PubMed Google Scholar Bjorkholm M, Hultcrantz M, Derolf AR. [ehoonline.biomedcentral.com]
Etiology
In males, copegus bijsluiter 40mg the etiology is more often related to alcohol; in females, it is more often related to biliary tract disease. [thebandhustle.co.uk]
The etiologies of DM-LE, HU-NMSC, and HUSD are not fully elucidated; however, they appear to share similar mechanisms involving direct effects of both HU and UVR. [jamanetwork.com]
Development of new painful oral ulcers, histo-pathologic findings of which were not unlike those in the colon led us to suspect that etiology of ulcers at these various sites was the same. [bmcgastroenterol.biomedcentral.com]
The underlying etiology is thought to be an infarctive event secondary to large-vessel stenosis or occlusion ( 4 ). [ajnr.org]
Epidemiology
Bronx, NY, United States. 3 Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, United States. 4 Children's Hospital at Montefiore, Department of Pediatrics, Division of Hematology/Oncology, Bronx, NY, United States. 5 Dept. of Epidemiology [ncbi.nlm.nih.gov]
Carrying out the Public Health Research Epidemiology and Surveillance for Hemoglobinopathies (PHRESH) project in California, Georgia and Mississippi, which will strengthen and improve upon the information gathering strategies developed in RuSH to help [cdc.gov]
Felix AA, Souza HM, Ribeiro SB (2010) Epidemiologic and social aspects of sickle cell disease (in Portuguese). Rev Bras Hematol Hemoter 32: 203-208. [omicsonline.org]
Epidemiology of psoriasis. In: Sharma VK, editor. Practical guidelines for the management of psoriasis. 1st ed. New Delhi: Department of Dermatology and Venereology, AIIMS, New Delhi; 2002. p. 1-3. 2. Kumar B, Saraswat A, Kaur I. [web.archive.org]
Pathophysiology
However, elucidation of the multiple pathophysiologic mechanisms leading to vaso-occlusion and tissue injury in SCD has now resulted in a burgeoning effort to identify new treatment modalities to prevent or ameliorate the consequences of the disease. [ncbi.nlm.nih.gov]
Inati A, Koussa S, Taher A, Perrine S (2008) Sickle cell disease: new insights into pathophysiology and treatment. Pediatr Ann 37: 311-321. [omicsonline.org]
Marvelle Brown, Sickle Cell Disease and Thalassaemia: Pathophysiology, Care And Management, Haematology Nursing, (117-149), (2013) ., Spezielle Arzneimitteltherapie in der Schwangerschaft, Arzneimittel in Schwangerschaft und Stillzeit, 10.1016/B978-3- [doi.org]
OBJECTIVES After participating in this activity, the participant will demonstrate the ability to: - Describe the basic pathophysiology of a vaso-occlusive crisis. - Describe the role of hemoglobin F in sickle cell disease. - Outline the evidence of hydroxyurea [hopkinsmedicine.org]
Prevention
[…] potentially lead to the formation of a malignant tumour, but DNA damage does not lead inevitably to the creation of cancerous cells. antimetabolite A substance which is structurally similar to a metabolite but which competes with it or replaces it, and so prevents [ebi.ac.uk]
HU initiation for disease severity prevention decreases the prevalence of abnormal TCDi velocities. © 2016 Wiley Periodicals, Inc. [ncbi.nlm.nih.gov]