Heme/Onc- Anemia (hemolytic)

Question 1

Drug-induced hemolytic anemia

Answer 1

Immune- mediated hemolysis that occurs within hours of drug administration.

Question 2

Mechanism of drug-induced immune-mediated hemolytic anemia

Answer 2

2 mechanisms:

1. Drug coats cell–> IgG bind–> splenic destruction (extravascular)
2. Drug trigger complexes–> compliment- mediated destruction (intravascular)

Question 3

Common triggers of drug-induced hemolytic anemia

Answer 3

NSAIDs
Penicillins
Cephalosporins

Question 4

Common triggers of G6PD hemolytic anemia

Answer 4

Oxidizing foods (fave beans)
Sulfa Drugs

Question 5

Ddx hemolytic anemia post medication. Drug induce immune vs G6PD

Answer 5

G6PD: 2-4 days. sulfa drugs not abx

Drug induced: Penicillins/ cephalosporins, Within hours

Question 6

S&S of drug-induced hemolytic anemia

Answer 6

Sudden onset
Tachycardia
Anemia  (fatigue, palor)
Jaundice
Elevated Bilirubin
Dark-colored urine 

Severe: Abdominal or back pain (erythrocytosis)

Question 7

Laboratory findings of drug induced immune hemolytic anemia

Answer 7

↑Bilirubin
↑Lactate Dehydrogenase
↑reticulocytes
↓Hemoglobin

Question 8

Diagnosis of drug included hemolytic anemia

Answer 8

Immune mediated hemolysis is made with direct anti globulin (Coombs) test.
Detects IgG or C3 on erythrocyte surface

Question 9

Management of drug induced hemolytic anemia

Answer 9

Removal of offending drug leads to resolution.

Blood transfusion or steroids in severe cases.

Question 10

Deficiency hereditary spherocytosis

Answer 10

RBC scaffolding proteins (eg electron, ankyrin)

Question 11

Hereditary spherocytosis triad

Answer 11

Hemolytic anemia
Jaundice
Splenomegaly

also: ↑ MCHC mean corpuscular hemoglobin concentration

Question 12

Management hereditary spherocytosis

Answer 12

Folate supplementation (hemolysis consumes folate)
Splenectomy (minimize hemolysis)
Cholecystectomy (acute cholecystitis from pigmented gall stones)

Question 13

Dactylitis

Answer 13

Earliest manifestation of vasoocclusion: symmetric swelling of hands and feet @ 6mo-4yr. Always evaluate for Sicklecell.

Question 14

S&S vaso-occlusive crisis sickle cell

Answer 14

Acute sever pain
Pain ≥ 1 site 
± low grade fever 
Erythema & warmth 
Trigger (dehydration)

Question 15

Vaso-occlusion imaging

Answer 15

soft tissue swelling

Recurrent episoded: mottled appearance of bone

Question 16

S&S osteomyelitis sickle cell

Answer 16

Acute or subacute pain
Focal (1 site)
Prolong fever
Erythema & warmth 
Positive blood culture

Question 17

S&S avascular necrosis sickle cell

Answer 17

Chronic worsening pain
NO fever
NO warmth/ erythema