Blood Dyscrasias Associated with the Use of Antipsychotics, Dipyrone, Heparin, and TNF Inhibitors: A Narrative Review

Abstract

Introduction: Adverse drug reactions (ADRs) represent a major public health problem and can cause blood dyscrasias—hematological alterations such as leukocytosis, neutropenia, agranulocytosis, and thrombocytopenia—that compromise vital body functions.
Objective: To analyze the main blood dyscrasias associated with the use of antipsychotics, dipyrone, heparin, and tumor necrosis factor (TNF) inhibitors, by understanding the mechanisms involved, raising awareness among healthcare professionals about early diagnosis, and assessing therapeutic management and clinical outcomes. Methodology: A narrative review was conducted with searches performed in the PubMed/Medline and LILACS databases, including observational studies in humans published in Portuguese, English, or Spanish. Methodological quality was assessed based on the STROBE Statement. Results: Of the 214 studies initially identified, 19 were included. Antipsychotics, particularly clozapine, were associated with neutropenia and agranulocytosis. Dipyrone was most frequently related to severe agranulocytosis. Heparin was linked to heparin-induced thrombocytopenia (HIT) and hemorrhagic events. TNF inhibitors, in turn, were associated with neutropenia and hematological disorders such as leukopenia and thrombocytopenia. Conclusion: Despite advances in understanding drug-induced blood dyscrasias, there is a lack of studies evaluating the individual risk of specific drugs. Continuous clinical monitoring remains essential to prevent, detect, and manage these ADRs, ensuring greater safety for patients under treatment.