Drug Induced Blood Disorders Flashcards
Aplastic anemia mechanisms
- direct dose dependent toxicity
- idiosyncratic
- immune mediated
What is the most common type of aplastic anemia?
Immune mediated (overproduction of cytokines)
What drugs can cause aplastic anemia?
Carbamazepine
Phenytoin
What are examples of direct dose dependent toxicity aplastic anemai?
Chemotherapy/radiation
Pgp
Symptoms of neutropenia
Infection
Fever
Symptoms of thrombocytopenia
Bruising
Bleeding
Main three symptoms of aplastic anemia
- anemia
- neutropenia
- thrombocytopenia
Aplastic anemia affect what type of cells?
Pluripotent stem cells (RBC, WBC, platelets)
Who is at risk for aplastic anemia?
Young
Old
What is the mortality rate of aplastic anemia?
50%
T/F the higher the dose, the worse aplastic anemia is
True
How do you diagnose aplastic anemia?
Bone marrow biopsy
Aplastic anemia treatment
- remove drug
- supportive care (antibiotic/antifungal)
- bone marrow transplant
- immunosuppressive therapy
What is the treatment of choice for 20 years and younger for aplastic anemia?
Bone marrow transplant
Possibly 45 and younger
What are the immunosuppresive therapy that can be done in aplastic anemia?
- antithymocyte globulin
- cyclosporine
- corticosteroids
- G-CSF
Carbamazepine causes what blood induced disorder?
Aplastic anemia
Phenytoin causes what blood induced disorder?
Aplastic anemia
Agranulocytosis affects what cells?
WBC
Granulocytes (eosinophils, NTs, basophils)
When do you see drug induced agranulocytosis?
1-2 weeks after exposure
Risk factors of agranulocytosis
Female
Increasing age
Mechanisms of agranulocytosis
Direct toxic effect
Immune mediated
Symptoms of agranulocytosis
Fever, infection, chills
Drugs that can cause agranulocytosis
- methimazole
- clozapine
Methimazole can cause what drug induced disorder?
Agranulocytosis
Clozapine can cause what drug induced disorder?
Agranulocytosis
T/f clozapine is dose dependent
False!
Independent
When are you more likely to see clozapine induced agranulocytosis?
First 3 months
Hemolytic anemia affect what cells?
RBCs
Mechanisms of hemolytic anemia
- immune mediated
- metabolic (G6PD deficiency)
How do you diagnose hemolytic anemia?
Coombs test or DAT (direct antiglobulin test)
What drugs can cause hemolytic anemia?
- penicillin
- cephalosporin
- rifampin
- methyldopa
Penicillin can cause what drug induced blood disorder?
Hemolytic anemia
Cephalosporin can cause what drug induced blood disorder?
Hemolytic anemia
Rifampin can cause what drug induced blood disorder?
Hemolytic anemia
Methyldopa can cause what drug induced blood disorder?
Hemolytic anemia (autoantibodies)
T/F Hispanics are more likely to have G6PD
false!
African americans
Treatment of hemolytic anemia
Remove drug
Supportive care
Severe: GC
What cells are affected in thrombocytopenia?
Platelets
Platelet count for thromobocytopenia
<100,000 or >50% reduction
Non drug causes of thrombocytopenia
Alcoholism
Post viral infection
Lupus
Symptoms of thrombocytopenia
Bruising
Bleeding
Thrombosis (HIT)
Drugs that can cause throbomocytopenia
- heparin
- glycoprotein IIb/IIIa inhibitors
Heparin can cause what drug induced blood disorder?
Thrombocytopenia
Glycoprotein IIb/IIIa inhibitors can cause what drug induced blood disorder?
Thrombocytopenia
HIT
Heparin induced throbmocytopenia
Which type of HIT would you see in the first few days?
Type I
Which type of HIT is reversible?
Type I
Which HIT has higher platelet count?
Type I
Which HIT typically has no clinical consequence?
Type I
Which HIT has a direct effect on platelet activation?
Type I
Which HIT would you see 5-10 days after?
Type II
Which HIT is a white clot syndrome?
Type II
Which HIT has a lower platelet count?
Type II
Which HIT is at risk in unfractionated heparin, surgical patients and females?
Type II
Which type of HIT can cause thrombosis?
Type II
Thrombosis
Release of procoagulants and endothelial cell activation
What is the clinical diagnosis for type II HIT?
Thrombosis
Treatment of type II HIT
- Stop all forms of heparin
- need another anticoagulant
- NO WARFARIN
- NOT PLATELETS
T/f you can give someone with type II HIT warfarin
False!
Needs to be stably anticoagulated and platelet count >150,000
T/f do not give someone with type II HIT platelets
True
Prevention of HIT
Shortest course of heparin
Low MW heparin
Early warfarin initiation
Treatment of thrombocytopenia
Removal of drug
What are 2 direct thrombin inhibitors you can use in type II HIT?
Bivalrudin
Agatroban
T/f epifibatide and tirofiban drug induced thrombocytopenia is immediate
True
T/f abciximab induced thrombocytopenia is immediate reaction
Immediate AND delayed
T/f all 3 types of glycoprotein inhibitors are typically given with heparin
True!
