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• Acute renal failure manifest as brisk urine output with
rapidly rising creatinine
• Skin rash (especially at sites of prior trauma/radiation)
Platinumcontaining
(carboplatin,
cisplatin)

• Salt wasting
• Hypomagnesemia
• Chronic renal insufficiency (especially at high doses)
• Delayed nausea and vomiting (2–5 days after treatment)

Tacrolimus
Tretinoin

• Hypomagnesemia and seizures
• Increased intracranial pressure

Vinca alkaloids
(vincristine and
vinblastine)

• SIADH
• Reversible motor, sensory, and autonomic neuropathy
• Cranial nerve neuropathy (ptosis, vocal cord paralysis)

Most chemotherapy causes immunosuppression that affects WBC function,
independent of WBC count. The immunosuppression persists throughout treatment
and for 6 to 12 months after completion of chemotherapy, but varies by
chemotherapy regimen. The impact of immunosuppression may be more profound
in the patient younger than 1 year because of the immaturity of the immune system.

Stem cell transplant recipients have very severe immunosuppression (see
“Complications of Hematopoietic Stem Cell Transplantation” section).
Thrombocytopenia is defined as a platelet count of less than 150,000/μL, but the
risk of bleeding at a given platelet count may vary ( Table 98.7 ). Anemia is very
common in oncology patients and tends to be a chronic problem due to
underproduction.
Bleeding complications are common in oncology patients. In addition to
thrombocytopenia, bleeding may occur because of coagulopathy resulting from a
number of different factors. Leukemia itself may cause coagulopathy. Many patients
are also on anticoagulation therapy for previous clotting problems. Any bleeding
risk from the anticoagulation may be exacerbated by intercurrent thrombocytopenia.
Bleeding in and around solid tumors tends to be more common at diagnosis and with
relapse. Bleeding can also occur after biopsy or tumor resection. Mucosal injury
from treatment can contribute to bleeding throughout the GI tract.
Cancer patients have an increased risk of clotting due to a number of factors such
as compression of vessels by tumor, disturbance of flow from central lines,
asparaginase-induced deficiency of endogenous anticoagulants, decreased physical
activity, and immobilization due to surgery. Thrombotic complications may include
pulmonary emboli (PE), deep venous thromboses (DVT), or central venous sinus
thrombosis, a rare complication in patients on asparaginase chemotherapy.