There may be other changes in blood counts, requiring careful control, including anemia and transient increase in the number of myeloid progenitor cells.
The development of acute leukemia or masteron steroids
should be implemented timely diagnosis and differentiate this diagnosis from other violations of the hematopoietic system, such as aplastic anemia, and myeloid leukemia. Before initiation of therapy should be an overall analysis of blood with determination of leukocyte and platelet counts, as well as to determine the morphology of bone marrow and karyotype.
During clinical studies on a small number (approximately 3%) patients with receiving filgrastim observed and leukemia. These results were obtained only when monitoring patients with congenital neutropenia (Kostmana syndrome). Leukemia – the most frequent complications ; and their relationship to filgrastim treatment is not defined. Approximately 12% of patients with normal cytogenetics when re-examination detected abnormalities, including monosomy 7. If a patient with manifest cytogenetic disorders should be carefully weigh the expected benefits and possible risks of continued therapy. The drug should be discontinued in case of MDS or leukemia. Currently, it is unclear whether long-term use provokes drug development Tevagrastim cytogenetic disorders, or leukemia in patients . It is recommended at regular intervals (about 12 months) to conduct morphological and cytogenetic studies of bone marrow.
With long-term (over 5 years), the use of filgrastim were found cytogenetic disorders, leukemia and osteoporosis in 9.1% of patients with TXH. Communication with filgrastim has not been established.
necessary to eliminate the causes of transient neutropenia, such as viral infections.
Enlargement of the spleen is the likely effect related to filgrastim therapy. In clinical studies 31% of patients at palpation detected splenomegaly. When masteron steroids radiography enlarged spleen sizes detected shortly after the beginning of treatment and filgrastim tends to stabilize. It was noted that the dose reduction slows or stops the increase in spleen size; 3% of patients may need to splenectomy. It is necessary to regularly monitor the size of the spleen in a clinical examination.
A small number of patients had haematuria / proteinuria. To eliminate these manifestations should regularly check the general analysis of urine.
The safety and efficacy of the drug in neonates and patients with autoimmune neutropenia have not been established.
Precautions for patients with infection
The number of blood cells must be strictly controlled, especially during the first weeks of therapy with Tevagrastim. Some patients may experience a very rapid and a significant increase of at an initial dose of Tevagrastim drug. During the first 2-3 days of the drug it is recommended to measure daily . Subsequently, the masteron steroidsmust be checked at least two times a week for the first two weeks and then every week or every other week over the course of maintenance therapy. When a break in the use of the drug at a dose of Tevagrastim 30 million. IU / day (300 mg / day) in a patient significant fluctuations may occur during treatment. In order to determine the minimum (nadir) recommended to control blood count before each administration of the drug Tevagrastim.
The risk caused by the use of high doses of myelosuppressive medications
monotherapy Tevagrastim does not apply to prevent the development of thrombocytopenia and anemia during treatment . In the case of higher doses or multiple simultaneously in combination with drug therapy Tevagrastim risk of thrombocytopenia and anemia increases. Recommended regular monitoring of full blood count.
Development myelosuppression due to infection or a tumor
Neutropenia may be due to bone marrow lesions of opportunistic infections, which are caused by pathogens such as Mycobacterium avium complex, or malignancies. such as lymphoma. In identifying infiltrative lesions of bone marrow inflammatory lesion or malignancy, along with the use of the drug for the treatment of neutropenia Tevagrastim you must use the appropriate treatment of diagnosed diseases. The effectiveness of the drug in the treatment of neutropenia Tevagrastim due to bone marrow lesions of infectious origin or a tumor, has not been established.
Precautions for patients with sickle cell anemia
in patients with sickle cell anemia were cases of hemolytic crisis (increase in the number of abnormal cells), sometimes with fatal consequences. Patients masteron steroids with sickle cell disease should use the drug Tevagrastim only if the expected benefits outweigh the potential risks when using Tevagrastim drug.