Hematopoietic growth factors: Nursing pharmacology

Hematopoietic agents are medications used to increase the production of different types of blood cells including white blood cells, red blood cells, and platelets. They are mainly used in disorders that decrease the levels of specific blood cells, but they are also used after treatments like chemotherapy, or radiation therapy, that suppresses the bone marrow.

Now, hematopoietic growth factors act like analogs or synthetic versions of the various physiological growth factors produced by the body. These include granulocyte colony-stimulating factor or G-CSF, granulocyte-macrophage colony-stimulating factor or GM-CSF, thrombopoietin agents, and erythropoietin stimulating agents or ESAs.

Let’s start with G-CSF analogs, which include filgrastim and pegfilgrastim. These medications can be administered intravenously and subcutaneously and work by increasing the production of neutrophils in the bone marrow. So they’re used to reduce the risk of infections on account of low neutrophil counts, which can be associated with leukemia, myelofibrosis, or severe, chronic neutropenia.

Another indication is for clients undergoing treatments that inhibit neutrophil production, like chemotherapy or radiation therapy for solid tumors or hematologic malignancies, as well as those receiving bone marrow transplantation. Finally, G-CSF analogs can be used in hematopoietic stem cell transplantation, where progenitor cells are mobilized from the bone marrow by G-CSF, and then collected from the peripheral blood.

The most commonly reported side effects of G-CSF analogs are nausea and bone pain, resulting from the high production of new neutrophils in the bone marrow. Other side effects include fever, fatigue, skin rashes, coughing, dyspnea or chest pain. Less commonly, alopecia or hypertension can also occur, as well as diarrhea or severe hypersensitivity reactions. Very rarely, G-CSF analogs might cause the spleen to become enlarged and rupture. In clients with sickle cell disease, sickle cell crises have also been reported.