Oral contraceptives: A cause of hyperbilirubinemia in stem cell transplantpatients

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 hig h-dose estrogen-progesterone combination to treat breakthrough menstrual bl eeding during transplant are reported. Conjugated hyperbilirubinemia develo ped in both patients within days of beginning therapy and resolved after th e ethinyl estradiol and norgestrel (Ovral; Pharmacia and Upjohn, Kalamazoo, MI, U.S.A.) was discontinued. In one of the patients, this occurred on thr ee separate occasions during the course of transplantation. Recognizing the cholestatic effect of estrogens during transplantation may prevent unneces sary alterations in therapy beyond the simple discontinuation of these medi cations.