Bleeding gums, haematuria or unexplained bruising are considered signs of a serious side effect of methotrexate.

• A. False
• B. True
• C. Not sure
• D. Not applicable

Answer: (B)

Bleeding gums, haematuria, and unexplained bruising arise from methotrexate–related toxicity affecting both the bone marrow and mucosal surfaces. MTX can suppress the bone marrow, leading to thrombocytopenia, which raises the risk of spontaneous and easy bleeding. It can also cause mucosal damage, such as mucositis, that can bleed and contribute to bruising. Because these signs signal significant toxicity, they necessitate prompt clinical assessment—checking the full blood count, renal and liver function, and reviewing the MTX dose and any interacting drugs. In practice, management involves stopping or delaying methotrexate and providing supportive care; in higher-risk or severe cases, folinic acid (leucovorin) rescue may be used to mitigate toxicity. So, this statement is true because these bleeding-related signs reflect serious adverse effects of methotrexate that require urgent evaluation and intervention.