• 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 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 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