title: Oral contraceptives: a cause of hyperbilirubinemia in stem cell transplant patients.
abstract: Conjugated hyperbilirubinemia in the clinical setting of hematopoietic stem cell transplantation can have multiple etiologies that may prompt various therapeutic interventions. Two patients who received short courses of a high-dose estrogen-progesterone combination to treat breakthrough menstrual bleeding during transplant are reported. Conjugated hyperbilirubinemia developed in both patients within days of beginning therapy and resolved after the ethinyl estradiol and norgestrel (Ovral; Pharmacia and Upjohn, Kalamazoo, MI, U.S.A.) was discontinued. In one of the patients, this occurred on three separate occasions during the course of transplantation. Recognizing the cholestatic effect of estrogens during transplantation may prevent unnecessary alterations in therapy beyond the simple discontinuation of these medications.
authors.affiliation: Department of Pediatrics, University of Louisville, Kentucky, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Kline
authors.forename: L
authors.initials: L
authors.lastname: Fennewald
authors.forename: M
authors.initials: M
authors.lastname: Vore
authors.forename: S J
authors.initials: SJ
authors.lastname: Bertolone
authors.forename: M L
authors.initials: ML
authors.lastname: Hente
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001663:Bilirubin / Q000097:blood; D016190:Carboplatin / Q000008:administration & dosage; D003277:Contraceptives, Oral, Combined / Q000009:adverse effects / Q000627:therapeutic use*; D019304:Ethinyl Estradiol-Norgestrel Combination / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D006932:Hyperbilirubinemia / Q000139:chemically induced*; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000628:therapy*; D018242:Neuroectodermal Tumors, Primitive / Q000628:therapy*; D010289:Parenteral Nutrition, Total; D012074:Remission Induction; D015173:Supratentorial Neoplasms / Q000628:therapy*; D013852:Thiotepa / Q000008:administration & dosage; D014182:Transplantation, Autologous; D014592:Uterine Hemorrhage / Q000209:etiology / Q000517:prevention & control*
chemical_list: D003277:Contraceptives, Oral, Combined; D019304:Ethinyl Estradiol-Norgestrel Combination; D013852:Thiotepa; D016190:Carboplatin; D001663:Bilirubin