IC3b (blood disorders)

Question 1

what are the drugs that cause aplastic anaemia (two types)

Answer 1

dose dependent: cancer chemo, chloramphenicol

idosyncratic: carbamazepine, phenytoin

Question 2

what is used in management of aplastic anemia

Answer 2

withdraw

immunosuppresants: GC, ciclosporin, cyclophosphamide, azathriopine, antithymocyte immunoglobulin (MAIN)

transfusion of erythrocytes and platelets

GM-CSF : sargramostim, G-CSF : filgrastim (MAIN)

HSCT transplantation

Question 3

what are the drugs causing immune thrombocytopenia

Answer 3

heparin,
sulphonamides, carbamazepine, phenytoin, gp2b3a inhibitors (abciximab, eptifibatide, tirofiban)

Question 4

what is used for management of immune thrombocytopenia

Answer 4

withdraw

immunosuppressants

platelet transfusion if clincially significant

Question 5

what are the drugs causing agranulocytosis/neutropenia?

Answer 5

direct drug toxicity: thiamazole, chlorpromazine, ticlopidine, busulfan, zidovudine

toxic metabolite: clozapine, carbimazole (metabolite is thiamazole)

immune (hapten or complement): beta lactam abx, propylthiouracil

Question 6

what is the maanagement of agranulocytosis, neutorpenia

Answer 6

withdraw

prophylatic admin of GCSF or GMCSF

routine weekly monitoring of WBC

Question 7

what are the drugs used for hemolytic anemia? two types

Answer 7

immune hemolytic anemia:
(i) true: methlydopa
(ii) innocent bystander immune complex: qunine, quinidine
(iii) hapten induced: penicillin, cephalosporin, streptomycin

non immune:
protein adsoprtion: cisplatin, oxaliplatin, beta-lactamase inhibitors

Question 8

what is the maanagement of hemolytic anemia

Answer 8

withdraw

rbc transfusion if low hb
hemodialysis for those with acute renal

steroids and immunoglobulins (MAIN)
for autoimmune. use rituximab

Question 9

drugs used for management of anemia

Answer 9

iron: ferrous sulphate (oral) , iron sucrose (parenteral)

vitb12: hydroxycobalamin

folic acid

erythropoiesis stimulating agents: darbepoetin alfa, epoetin alfa

Question 10

drugs used for management of neutropenia

Answer 10

myeloid growth factors:

GCSF
recombinant human: filgrastim. pegfilgrastim (conjugated with PEG)

GMCSF
sargramostim

Question 11

drugs used for management of thrombocytopenia

Answer 11

megakaryocyte growth factor/platelet stimulating agents

recombinant IL11 = oprelvekin

fc fusion protein thrombopoietin receptor agonist = romiplostim

oral nonpeptide thrombopoietin receptor agonist = eltrombopag

Question 12

what are the etiologies of diff anemia (in terms of nutrient deficits)

Answer 12

inhibition of hemoglobin synthesis = iron deficiency = few small hemoglobin poor RBC

inhibition of DNA synthesis = vitb12 def OR. folate def = very few large hemoglobin rich erythrocyte