Which anticancer agent class commonly causes myelosuppression and a nursing implication?

• A. Antimetabolites; CBC weekly
• B. Hormonal agents; CBC monthly
• C. Plant alkaloids; CBC daily
• D. Alkylating agents; CBC frequently

Answer: (D)

Alkylating agents commonly cause myelosuppression because they damage DNA by forming cross-links, which disrupts replication in rapidly dividing cells, especially bone marrow progenitors. This makes bone marrow suppression a frequent, dose-limiting toxicity for this class, leading to reduced white blood cells, red blood cells, and platelets.

Nursing implications center on close, frequent monitoring of the complete blood count to catch the nadir early and respond appropriately. Regular CBCs help determine when counts are too low to continue treatment safely, guiding dose adjustments or hold periods. Because patients become susceptible to infection with neutropenia, bleeding with thrombocytopenia, and fatigue from anemia, nurses emphasize infection prevention, monitor for signs of bleeding or fatigue, and coordinate with the care team on supportive measures such as growth factor support or transfusions as needed. The nadir often occurs about 7–14 days after therapy, so scheduling CBCs around that window is particularly important.