Cytotoxic disease

Cytostatic disease - a kind of polysyndromic disease that arises in connection with the impact on the body of cytostatic factors and is caused by the death of mainly dividing cells, primarily the bone marrow, the epithelium of the digestive tract, the skin; A common manifestation of cytostatic disease is liver damage.

Etiology: the use of cytostatics used in the treatment of tumors or as immunosuppressants, the effects of ionizing radiation (in this case they speak of radiation sickness).

Pathogenesis: the death of large numbers of dividing cells with the destruction of the bone marrow, a violation of the integrity of the epithelium of the digestive tract, hair loss, as well as the defeat of varying degrees of all organs and systems. Developing in patients agranulocytosis, thrombocytopenia, ulcerative-necrotic changes in the gastrointestinal tract can be complicated by secondary processes: angina, sepsis, hemorrhages, perforation of the intestine, etc. The most important role in the pathological process is played by the dose of the cytostatic and the "power" of the effect, i.e. The amount of the drug taken per unit of time (the higher the single dose of the cytostatic, the heavier the lesion). The widespread use of cytostatics leads to accidental poisoning of children, use with a suicidal goal, and use in hysteria.

The clinical picture consists of a number of consecutive developing syndromes. In the beginning, there is swelling of the oral mucosa, which later can be replaced by hyperkeratosis (whitish hard-to-remove overlaps, mainly on the gums), followed by oral lesions, sometimes almost simultaneously with it, the number of leukocytes, platelets, reticulocytes decreases. Unlike immune agranulocytosis, granulocytes, decreasing in number, do not disappear at all. At the height of granulocytopenia, infection develops (sore throats, pneumonia, abscesses at injection sites, etc.); Deep thrombocytopenia is accompanied by bleeding from the nose, gastrointestinal tract, cutaneous hemorrhages. In the absence of blood loss at the height of agranulocytosis, severe anemia does not occur, it appears later. In the bone marrow - devastation of the cellular composition. The defeat of the gastrointestinal tract is manifested by necrotic enteropathy (see Acute Radiation Disease).

Individual systems of the body are affected by different cytostatics unequally. Cyclophosphamide causes pronounced immunosuppression, rapidly developing afanulocytosis (short), general shallow thrombocytopenia, intestinal lesion. Myelosan, on the contrary, almost does not cause immunosuppression, almost does not affect the intestine; Afanulocytosis and thrombocytopenia appear late (2 weeks after poisoning), but are very deep and last for several weeks. Rubomycin and adriablastin in case of an overdose can cause severe myocarditis. Vincristine almost does not affect the phanulocyte and platelet sprouts, but causes immunosuppression, often polyneuritis. Hepatotropic effects are mainly cyclophosphamide, 6-mercaptopurine.

One of the frequent manifestations of cytostatic disease is septicemia: high fever, sometimes chills, bacteremia (pathogenic microflora) in the absence of a foci of infection. Pneumonia is characterized by a low degree of clinical signs: there may be a dry cough, radiographic data are scarce, there is little wheezing, they are moist fine-bubbly, sometimes creping.

Treatment is similar to that in acute radiation sickness. Prednisolone in cytotoxic disease is not indicated. Isolation of patients and observance of conditions of asepsis are obligatory. The decisive role is played by antibacterial therapy, transfusion of platelets in thrombocytopenic hemorrhagic syndrome. In the absence of severe anemia, blood transfusion is not indicated. Injection drugs are administered only intravenously.

The prognosis is determined by the severity of the lesion. It was established that without recurrence of cytotoxic drugs, the disease does not recur.