HAEMOTOXIC EFFECTS OF DRUGS AND CHEMICALS

Appendix B HAEMOTOXIC EFFECTS OF DRUGS AND CHEMICALS Drugs and chemicals which have been reported in the medical literature to have caused: (1) megaloblastic anaemia, (2) haemolyic anaemia, (3) methaemoglobinaemia, (4) sideroblastic anaemia, (5) aplastic anaemia, (6) neutropenia or agranulocytosis, (7) leukaemia, (8) thrombocytopenia, and (9) thrombopathy are listed alphabetically by their 'approved' names. The asterisk signifies an antimitotic and cytotoxic drug; HB, Heinz body type haemolytic anaemia; IM, immunological type haemolytic anaemia or thrombocytopenia; and M, microangiopathic type haemolytic anaemia. MEGALOBLASTIC ANAEMIA Isoniazid Alcohol 6-Mercaptopurine * Aminopterin* Methotrexate* Barbiturates Para-aminosalicylic acid Colchicine Phenylbutazone Contraceptives (oral) Phenytoin Cycloserine Pyrazinamide Cytosine arabinoside* Pyrimidone Diamidine compounds Pyrimethamine Diopterin* Teropterin* Diphenylhydantoin 6-Thioguanine* Epanutin Ethotoin HAEMOLYTIC ANAEMIA Acetanilide (HB) Acetylsalicylic acid (HB, Im) Acetazolamide Aminopyrine (Im) Amphetamine Acetomenaphthonum Aniline (HB) Acetophenetidine (HB) Antazoline Acetylphenylhydrazine (HB) 275

THE PERIPHERAL BLOOD FILM Haemolytic anaemia (cont.) Antimony compounds Antistine (Im) Arsenic and compounds Benzene Bromates Carbon disulphide Chloramphenicol Chlorates Chlorobenzene Chloroquine (HB, Im) Chlorpromazine (Im) Chlorpropamide (M) Dapsone (HB) Dexamphetamine Dichlorobenzene Dichlorohydrine Dimercaprol Dinitrobenzene Diphenylsemicarbazide Diphenylsulphone (HB) Dipyrone Ethopropazine Fava beans (HB) Fuadin (Im) Furaltadone Furazolidine (HB) Gold salts (M) Insecticides (Im) Isoniazid (Im) Mepacrine (HB) Mephenesin Methoin Methylamphetamine Methyldopa (Im) Naphthalene and derivatives (HB)

Neoarsphenamine (HB, Im) Nitrobenzene Nitrofurantoin (HB) Nitrofurazone (HB) Pamaquin (HB) Para-aminosalicylic acid (Im) Paramethadone Paraphenylenediamine Penicillin (Im, M) Pentaquin (HB) Phenacetin (Im) Phenazone Phenylbutazone (M) Phenylhydrazine (HB) Phenylsemicarbazones Phosphorus Plasmaquin (HB) Primaquin (HB) Primizole Probenecid Promin Pyramidon (Im) Pyrimethamine Quinidine (Im, M) Quinine (HB, Im) Solapsone Stibophen (Im) Sulphonamides (HB, Im) Thiacetazone Thiouracil Thiourea Trinitrotoluene Tripelennamine Vitamin K (HB) Vaccines

METHAEMOG METHAEMOGLOBINAEMIA Acetanilide Acetophenetidine Aminobenzene Aniline and derivatives In marking ink In shoe dyes In blanket dyes In wax crayons and chalk 276

Benzocaine Bismuth subnitrate Chlorates Nitrates I« meat In well water Nitrites Nitrobenzenes

APPENDIX B Methaemoglobinaemia (cont.) Nitroglycerine Nitrotoluenes Nitrous gases Arc welders Phenacetin Phenylhydrazine Plasmoquin

Pyrogallol Quinones Resorcinol Sulfonal Sulphonamides Trional

SIDEROBLASTIC ANAEMIA Alcohol Azathioprine* Chloramphenicol Cycloserine Isoniazid

Lead Para-aminosalicylic acid Paracetamol Phenacetin Pyrazinamide

APLASTIC ANAEMIA - PANCYTOPENIA Acetarsol Acetazolamide Acetophenetidine Acetylsalicylic acid Actinomycin D and C* Aloxidone Aminopterin* Aminopyrine Aminouracil* Amphotericin B Apronal Arsenic compounds Asparaginase* Azaserine* 6-Azauracil Benzene Bismuth and compounds Busulphan (Myleran)* Carbimazole Carbon tetrachloride Carbutamide Chlorambucil* Chloramphenicol Chlorates Chlordane 6-Chloro purine Chlorothiazide Chlorpheniramine

Chlorpromazine Chlorpropamide Chlort et r a cy cline Cy clophosphamide * Cytosine arabinoside* Demecolcin Dinitrophenol Diopterin* Diphenylhydantoin Ethosuximide 5-Fluorouracil Gamma benzene hexachloride Gold salts Hydrallazine Isoniazid Mepacrine Mephalan* Meprobamate 6-Mercaptopurine * Mercurial salts Methimazole Methoin Methotrexate* Methsuximide Methyldopa Methylthiouracil Methylphenylhydantoin Naphthyl chlorethylamine 277

THE PERIPHERAL BLOOD FILM Aplastic anaemia-pancytopenia (cont.) Quinidine Neomycin Salicylamide Nitrogen mustard* Streptomycin Paramethadione Paraphenylenediamine Sulphonamides Pecazine Teropterin* Phenacemide Thioridazine Phenothiazines Thiosemicarbazones Phensuximide Thio-tepa Phenylacetylurea Tolbutamide Phenylbutazone Triethylenemelamine Phosphor amides * Trimethadione Phosphorus Trinitrotoluene Primidone Tripelennamine Prochlorperazine Troxidone Propylthiouracil Urethane* Pyrimethamine Vinca alkaloids* Quinacrine NEUTROPENIA - AGRANULOCYTOSIS Acetanilide Cyclophosphamide* Acetarsol Dapsone Acetazolamide Demecolcine* Amidopyrine Desipramine Aminopterin* Dicoumarol Aminouracil* Diethazine Amodiquine Dihydrallazine Antazoline Dihyprylone Antimony and compounds Dinitrophenol Arsenic and compounds Ethotoin Gold salts Barbiturates Hydrallazine Benzene Hydroxyphenylbutazone Biallylamicol Imipramine Bismuth and compounds Isoniazid Busulphan (Myleran)* Mephenesin Carbimazole Mepyramine Carbutamide Mercaptomerin Chlorambucil* 6-Mercap t opurine * Cinchophen Mercurial salts Chlorophenothane Chloroquin Mersalyl Chlorothiazide Metapheniline Chlorpheniramine Methicillin Chlorpromazine Methimazole Chlorpropamide Methoin Colchicine Methylthiouracil 278

APPENDIX B

Neutropenia-agranulocytosis (cont.) Naphthylchlorethylamine * Nitrogen mustards* Novobiocin Paracetamol Para-aminosalicylic acid Paramethadione Pecazine Perphenazine Phenacetin Phenazone Phenindione Phenothiazine Phensuximide Phenylbutazone Phenytoin Phosphorus Plasmaquin Primaquin Procaineamide Prochlorperazine Promazine Promethazine

Propylthiouracil Pyrimethamine Pyrithyldione Quinine Ristocetin Streptomycin Sulphasalazine Sulphonamides Tetracyclines Thiacetazone Thiantoin Thiocyanates Thioglycollate Thioridazine Thiosemicarbazones Thiourea Thiouracils Tolbutamide Triethylenemelamine * Trifluoperazine Urethane*

LEUKAEMIA Phenylbutazone Sulphonamides

Aminopyrine Chloramphenicol Ionizing radiation

THROMBOCYTOPENIA Acetarsol Acetazolamide (Im) Acetylcarbromal Acetylsalicylic acid (Im) Amidopyrine Aminouracil* Antazoline (Im) Antipyrine (Im) Apronal Arsenicals, organic (Im) Barbiturates (Im) Benzene Bismuth and compounds (Im) Bromvaletone Busulphan (Myleran)*

Carbimazole Carbromal Carbutamide Cephalothin (Im) Chlorambucil* Chloramphenicol Chlorophenothane Chloroquine (Im) Chlorothiazide (Im) Chlorpromazine Chlorpropamide (Im) Colchicine Demecolcin* Desipramine (Im) Digitoxin (Im) 279

THE PERIPHERAL BLOOD FILM Thrombocytopenia (cont.) Dihydrallazine Dilantin (Im) Dinitrophenol Ergot and preparations Glyceryl trinitrate Gold salts (Im) Insulin (Im) Iodides Isoniazid Mephenesin Meprobamate (Im) 6-Mercaptopurine * Mercurial salts Mersalyl (Im) Methoin Methyldopa (Im) Naphthylchlorethyiamine * Nitrogen mustards* Novobiocin (Im) Oestrogens Para-aminosalicylic acid (Im) Paracetamol (Im) Penicillin (Im) Phenindione Phenylbutazone Phenytoin

Piperazine Prochlorperazine (Im) Propylthiouracil Quinidine (Im) Quinine (Im) Reserpine Ristocetin Salicylates Sedormid (Im) Stibophen (Im) Streptomycin (Im) Sulphonamides (Im) Tetanus Toxoid (Im) Tetracyclines Thallium Thiocyanates Thiouracils (Im) Thiourea Tolbutamide (Im) Triethylenemelamine * Triflupromazine Trimeprazine Trimethadione Tripelennamine Troxidone Vaccines

THROMBOPATHY Acetylsalicylic acid Amitryptyline Chloroquin Citrate Cocaine Colchicine Dextran Dihydroergotamine Dipyridamole Furosemide Heparin Imipramine Indomethacin

280

Isoprenaline Methylxanthines Nitrofurantoin Papaverine Penicillin (high doses) Phentolamine Phenylbutazone Procaine Sequestrene Sulfinpyrazone Theophylline Vinca alkaloids*

Plate 1. Red cells and polymorphonuclear neutrophil (PMN) leucocyte ( x 1,200)

Plate 2. Monocyte ( x 1,200)

(a) Plate 3 (a). Small lymphocyte (x 1,200)

(h) (b) Large lymphocyte ( x 1,200)

Plate 4. Platelets ( x 1,200)

Plate 5. Target cells ( x 1,200)

Plate 6. Stomatocytes ( x 1,200)

Plate 7. Spherocytes (x 1,200)

(a) Plate 8 (a). Round macrocyte (x 1,200)

(b) (b) Oval macrocyte ( x 1,200)

Plate 9. EUiptocytes ( x 1,200)

Plate 11. Crenated cells ( x 1,200)

(a)

Plate 10. Sickle cells ( x 1,200)

Plate 12. Acanthocytes ( x 1,200)

(b) Plate 13 (a), (b) and (c). Burr cells ( x 1,200)

(c)

Plate 14. Tear drop cells ( x 1,200)

Plate 15. Howell - Jolly bodies ( x 1,200)

Plate 16. Pappenheimer bodies ( x 1,200)

(a) Plate 17 (a). Malarial parasite — ring trophozoite ( x 1,200)

(b) (b) Malarial parasite — amoebo idal trophozoite ( x 1,200)

Plate 18. Pelgeroid anomaly ( x 1,200)

Plate 19. Hypersegmented PMN — macropolycyte (x 1,200)

Plate 20. L.E. cell ( x 1,200)

(a) (b) Plate 21 (a) and (b). Malignant monocytes ( x 1,200)

(a) Plate 22 (a). Lymphocytoid mononucleosis cell.

(b) (b). Monoblastoid mononucleosis cell ( x 1,200)

Plate 23. Thesaurocyte (x 1,200)

(a) Plate 24 (a).

(b) (c) Plate 24 (a), (b) and (c). Phagocytîc plasma cells ( x 1,200)

Plate 25. Intermediate normoblast (x 1,200)

Plate 26. Late normoblast (x 1,200)

Plate 27. Trefoil nucleus ery thro blast (x 1,200)

Plate 28. Vacuolated late erythroblast (x 1,200)

Plate 30. Myelocyte ( x 1,200)

Plate 33. Malignant monoblast ( x 1,200)

Plate 29. Intermediate megaloblast ( x 1,200)

Plate 31. Stab cell ( x 1,200)

Plate 32. Malignant myeloblast ( x 1,200)

Plate 34. Megakaryoblast ( x 1,200)

Plate 35. Megakaryocyte ( x 1,200)

Plate 36. Malignant lymphoblasts ( x 1,200)

Plate 37. Malignant plasma blasts ( x 1,200)

Plate 38. Megakaryocytoid plasmablast ( x 1,200)

Plate 39. Polycythaemîa ( x 700)

Plate 40. Megaloblastic anaemia ( x 700)

Plate 41. Acquired stomatocytosis ( x 700)

Plate 42. Nutritional anaemia ( x 700)

Plate 43. Hereditary elliptocytosis ( x 700)

Plate 44. Hereditary spherocytosis ( x 700)

Plate 45.

Acquired

Plate 46.

spherocytosis

Sicklaemia

( x 700)

( x 700)

Plate 47. Rouleaux of red cells ( x 700)

Plate 48. Agglutination of red cells ( x 700)

Plate 49.

Plate 50.

Myelocytic

Lymphocytic

leukaemia

leukaemia

( x 700)

( x 700)

Plate 51. Infectious mononucleosis ( x 700)