<strong>Indian</strong> J. Pharm. Pract. 1(2), Jan-Mar, 200910. World Health Organisation. (WHO) 1997, the role <strong>of</strong> 15. Unwin N. Commentary: Non-communicablethe pharmacist in the health care system: Preparing disease and priorities for health policy in subthefuture pharmacist: Curricular development. Saharan Africa. Health Policy Plan. 2001; 4:351-Vancouver, Canada, 27-29 August 1997. 352.W H O / P H A R M / 9 7 / 5 9 9 . [ I n t e r n e t ] 16. Lee JK, Grace KA, Taylor AJ. Effect <strong>of</strong> a <strong>Pharmacy</strong>Available:http://www,whqlibdoc.who.int/hq/1997/ Care Program on Medication Adherence andWHO_PHAR M_97_599.pdf [Accesed 06/09/08]Persistence, Blood Pressure, and Low-Density11. Accreditation Council for <strong>Pharmacy</strong> Education.Lipoprotein Cholesterol. JAMA. 2006; 296: 2563-2006, Accreditation Standards and Guidelines for2571.the Pr<strong>of</strong>essional Program in <strong>Pharmacy</strong> Leading to 17. Downer SR, Meara JG, John G, Da Costa AC. Usethe Doctor <strong>of</strong> <strong>Pharmacy</strong> Degree. [internet] Available<strong>of</strong> SMS text messaging to improve outpatienthttp://www.acpeccredit.org/pdf/ACPE_Revised_attendance. Med J Aust. 2005; 183(7): 366-368.PharmD_Standards_Adopted_Jan152006.pdf 18. Biem HJ, Turnell RW, D'Arcy C. Computer[Accessed6/09/08]telephony: automated calls for medical care. Clin12. World Health Organisation. Regional Office forInvest Med . 2003 Oct; 26(5):259-68.Africa (WHO/AFRO) 2002, A special health19. Horne R, Weinman J. Patients' beliefs aboutpromotion project: The health promotions initiative.prescribed medicines and their role in adherence to[Internet]. Updated 24 October 2002.treatment in chronic illness. J Psychosom Res. 1999;[Internet]Available:http://afro.who.int/healthpromo47(6):555-567.tion/project.html [Accessed 06/09/08]13. World Health Organisation. (WHO) 2007, The20. Treweek S. Joining the mobile revolution. Scand J <strong>of</strong>Bangkok Charter for Health Promotion in the Pri Health Care. 2003 June; 21(2): 75-76.21. Many patients willing to pay for onlineGlobalized World. Health Promotion International.2006; 21:10-14.communication with their physician. [internet]14. Anderson C. Health promotion in community Available:http://www.harrisinteractive.com/news/apharmacy: the UK situation, Patient educ couns.2000; 39:285-291.llnewsbydate.asp?NewsID=446.[Last accessed06/09/08]80
<strong>Indian</strong> J. Pharm. Pract. 1(2), Jan-Mar, 2009<strong>APTI</strong><strong>ijopp</strong>L-ASPARAGINASE INDUCED CENTRAL VENOUS THROMBOSIS IN ACUTELYMPHOBLASTIC LEUKEMIA1 2 1 1 1Lavanya S , Vijayan K , Abhay Dharamsi , Rajasekaran A Vijayakumar A1,3 .1. Drug and Poison information Center, Department <strong>of</strong> <strong>Pharmacy</strong> <strong>Practice</strong>,KMCH College <strong>of</strong> <strong>Pharmacy</strong>,Kalapatti road, Kovai Estate, Coimbatore - 6410482. Consultant, Department <strong>of</strong> Neurology, Kovai Medical Center and Hospital, Coimbatore- 641014Address for Correspondence: vijayspharm@gmail.comBackgroundTo report a case <strong>of</strong> central venous thrombosis following treatment <strong>of</strong> acute lymphoblastic leukemia withL-asparaginase. A 13-year-old master presented with an acute lymphoblastic leukemia associated with threeepisodes <strong>of</strong> focal onset convulsions with secondary generalization, headache and altered sensorium. He was2 2initially treated with 5000 u/m <strong>of</strong> L-asparaginase followed by 10,000 u/m every third day for 4 weeks. After aweek’s course <strong>of</strong> L-Asparaginase, the patient experienced central venous thrombosis. MRI showed thrombosis <strong>of</strong>the sagittal, transverse and straight sinuses on the right side with partial recanalisation, suggesting a drug inducedneurotoxic reaction. According to the Naranjo probability scale, the central venous thrombosis was probablycaused by L-Asparaginase. L-Asparaginase-induced central venous thrombosis is rarely reported shortly afterbeginning L-asparaginase therapy in patientswith acute lymphoblastic leukemia. However, bleeding or thrombosisoccurring as a direct result <strong>of</strong> changes in coagulation factors has not been frequently reported. The purpose is toevaluate the current knowledge <strong>of</strong> central venous thrombosis in association with ALL in children. Health carepr<strong>of</strong>essionals should be aware <strong>of</strong> this potential adverse reaction and monitor the patients regularly duringL-asparaginase therapy.Key Words: L-asparaginase, Central Venous Thrombosis, Acute Lymphoblastic Leukemia.INTRODUCTIONCASE REPORTAcute lymphoblastic leukemia (ALL) is more frequent in A 13-year-old boy was presented to Kovai Medicalchildren than in adults; indeed, two thirds <strong>of</strong> all cases Center and Hospital, India in January 2005, with1occur at pediatric age . The risk <strong>of</strong> thrombosis is complaints <strong>of</strong> three episodes <strong>of</strong> focal onset convulsionsincreased in ALL patients, and its occurrence maywith secondary generalization. History revealed headcomplicate the treatment course with a negativeturning to left follow by generalized tonic-clonic2prognostic impact . L-asparaginase hydrolyses L-convulsions. Hemoglobin was 10.6 g/dl, leukocytes 1700asparagine which is a non essential aminoacid. L-cells/cumm, and the platelet count 1, 07,700 cells/cumm.asparaginase is used particularly in acute lymphoblasticThe differential count revealed 16% lymphocytes, 81%leukemia (ALL) and in other hematologicalmalignancies such as acute myeloblastic leukemianeutrophils, and 3% monocytes. The patient's bone(3,4)(AML) and lymphoma . Therapy has been associated marrow aspiration showed 90% blasts (L1 typewith various forms <strong>of</strong> toxicity, including according to French-American-British (FAB)hypersensitivity, coagulation abnormalities and classification) with Periodic acid Schiff reaction (PAS),(5,6)others . L-asparaginase shows this effect by decreasing sudan Black and myeloperoxidase stains negative. The(7,8)the synthesis <strong>of</strong> coagulation proteins . In literature, patient was on prednisolone, vincristine, daunorubicin, l-thrombosis is emphasized more than hemorrhagic asparaginase, methotrexate and cytosine. Computedcomplications due to L-asparaginase. This report Tomography (computerized type <strong>of</strong> x-ray that gives verydescribes a case who developed central venous detailed images <strong>of</strong> internal organs such as the brain) scanthrombosis confirmed by Magnetic Resonance Imaging<strong>of</strong> the brain was normal but during the next 48 hours, he(MRI) during L-asparaginase therapy.developed weakness <strong>of</strong> the left upper limb.The prothrombin time was 29 seconds, the partial<strong>Indian</strong> <strong>Journal</strong> <strong>of</strong> <strong>Pharmacy</strong> <strong>Practice</strong>Received on 12/01/2009 Modified on 11/02/2009thromboplastin time 48 seconds fibrinogen, protein C,Accepted on 24/02/2009 © <strong>APTI</strong> All rights reservedprotein S, antithrombin III levels were normal. Serum81
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