Which toxicities are commonly associated with L‑asparaginase and warrant monitoring?

• A. Pancreatitis, hypersensitivity reactions, coagulation abnormalities
• B. Nephrotoxicity and hypertension
• C. Hyperthyroidism and hypoglycemia
• D. Pulmonary fibrosis and edema

Answer: (A)

L-asparaginase can cause effects that involve the pancreas, the immune system, and the liver’s production of clotting factors, so those are the toxicities you monitor closely. Pancreatitis is a known risk with this drug, so watching for abdominal pain and testing pancreatic enzymes helps catch it early and guide management. Hypersensitivity reactions are common because the enzyme is a foreign protein to the body; signs range from mild allergic symptoms to anaphylaxis, so vigilance for allergy signs is essential and may require stopping or switching therapy. Coagulation abnormalities occur because asparaginase can impair the liver’s synthesis of clotting factors and inhibitors like fibrinogen, leading to prolonged PT/aPTT and bleeding or thrombotic risk; regular coagulation tests and fibrinogen levels are important to detect and address these issues promptly.

Other potential toxicities listed, such as nephrotoxicity and hypertension, hyperthyroidism and hypoglycemia, or pulmonary fibrosis and edema, are not typical or characteristic of L-asparaginase and do not usually drive routine monitoring in the same way.