Drug-Induced Hematological Disorders

Question 1

HAT

Answer 1

Platelet sequestration

Resolves on its own

Question 2

HIT

Answer 2

IgG
Platelet activation –> clot cascade
Decrease platelet count

Question 3

HIT Patho

Test Question

Answer 3

Activated platelets secrete Factor 4
Heparin binds Factor 4 and induces an immunogenic response that causes antibody formation
The antibodys then bind further activating it and causes aggregation and clot
This also marks them for destruction

Question 4

4 T Score

Answer 4

Thrombocytopenia
Timing (5-10 days)
Thrombosis
oTher

Question 5

Diagnosis Via

Answer 5

HIT panel

Serotonin release assay

Question 6

HIT RF

Answer 6

Any heparin exposure
Longer duration of therapy
Previous use ( LMWH
Females > Males
Post-surgical > medical patients

Question 7

True HIT

Answer 7

D/c heparin

Initiate alternative anticoagulant

Question 8

Argatroban

Answer 8

Direct thrombin inhibitor
Continuous IV
2 mcg/kg/min
Dose adjust in hepatic insuff!!!

Question 9

Argatroban Monitor

Answer 9

INTERFERES WITH PT/INR!!

aPPT 2 hours after initiation

Question 10

Lepirudin (Refludan)

Bivalirudin (angiomax)

Answer 10

RENAL INSUFF

Question 11

Warfarin

Test question

Answer 11

Long-term anticoagulation if their platelet recovers >150,000
Want their INR at 2 until its 4
Stop the argatroban and measure INR 4 hours later
If it is not between 2-3, restart argatroban and up the warfarin dose!

Question 12

Drugs that can cause low platelets

Test Question

Answer 12

Quinine
Quinidine
Vancomycin
Zosyn

Question 13

Management of Thrombocytopenia

Answer 13

Remove the cause
Supportive Care
Platelet transfusion (<20,000)

Question 14

Drug-Induced Aplastic Anemia

Answer 14

Congenital or acquired

Pancytopenia (deficiency in WBC, RBC and platelets)

Question 15

Drug-Induced Aplastic Anemia Mechanisms

Answer 15

Direct dose-dependent

Immune-mediated

Question 16

Drug-Induced Aplastic Anemia Diagnosis

Answer 16

2 of the following:

- WBC <30,000

Question 17

Drug-Induced Aplastic Anemia Severe Diagnosis

Answer 17

2 of the following
- ANC <20,000
Anemia

Question 18

Drug-Induced Aplastic Anemia Drug causes

Answer 18

Chloramphenicol
Felbamate
Antineoplastic agents

Question 19

Drug-Induced Aplastic Anemia Goal

Answer 19

Improve blood count

Minimize risk of opportunistic infections

Question 20

Drug-Induced Aplastic Anemia Treatment

Answer 20

Immunosuppressive therapy -steroids, cyclosporine, antithymocyte globulin or last line stem cell transplant

Question 21

Drug-induced Agranulocytosis

Answer 21

Reduction in granulocytes and immature granulocyte <500

Question 22

Drug-induced Agranulocytosis Drugs

Answer 22

Chemotherapy
BL antibiotics
Valproic acid
Clozapine

Question 23

Drug-induced Agranulocytosis Management

Answer 23

Remove the cause
GF in chemotherapy
- Filgramstim, Neupogen (GCSF)
- Sargramostim, Leukine (GMCSF)
Monitor ANC twice weekly and discontinue when ANC >1500 X 3d

Question 24

Drug-induced Hemolytic Anemia

Answer 24

Immune related or metabolic

Question 25

Drug-induced Hemolytic Anemia Diagnosis

Answer 25

Coombs test

Question 26

Drug-induced Hemolytic Anemia Drugs

Answer 26

BL

Methyldopa

Question 27

Drug-Induced Oxidative Hemolytic Anemia

Answer 27

G6PD deficiency (RBC susceptible to stress)

Question 28

Drug-Induced Oxidative Hemolytic Anemia Drugs

Answer 28

Dapsone

Sulfamethoxazole

Question 29

Drug-Induced Hemolytic Anemia Management

Answer 29

Remove offending agent

Supportive

Question 30

Drug-Induced Megaloblastic Anemia

Answer 30

Metformin (B12 lack)
Methotrexate (inhibits DHFR)
Phenytoin and Phenobarbital (inhibit folate ab)

Question 31

Drug-Induced Megaloblastic Anemia Treatment

Answer 31

Stop offending agent

Supplement folate and vitamin 12