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PR3154 > IC7 - Anemia and Drug-induced hematologic disorder > Flashcards

IC7 - Anemia and Drug-induced hematologic disorder Flashcards

1
Q

How are anemia classified?

A
  1. Hypo-proliferative
  2. Maturation disorder
  3. Hemorrhage/ hemolysis
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2
Q

What are the four common causes of anemia?

A
  1. Iron-deficiency
  2. Vitamin B12 or folic deficiency
  3. Anemia of inflammation
  4. Drug-induced
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3
Q

What are the two physical examinations that may suggest anemia?

A

Pallor
Jaundice

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4
Q

What are the laboratory evaluation that can be done for anemia?

A
  1. Full blood count
  2. Reticulocyte count
  3. Peripheral Smear
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5
Q

How is iron deficiency anemia diagnosed?

A
  1. Low MCV > Low serum ferritin
  2. Normal MCV > High reticulocyte count
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6
Q

What are the causes for iron-deficiency anemia?

A
  1. Decreased iron absorption
  2. Blood/ iron loss
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7
Q

How can iron-deficiency anemia be treated?

A
  1. 1000 to 1500 mg of elemental iron for complete supplementation
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8
Q

What is the duration of treatment for iron-induced anemia?

A

3 to 6 months

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9
Q

How is anemia of chronic disease diagnosed?

A
  1. Low MCV > Normal or high Serum ferritin > Low TIBC
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10
Q

What causes anemia of inflammation?

A

Co-morbidities (IBD, Rheumatologic disorders, Renal insufficiency etc)

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11
Q

What type of class of anemia does iron-deficiency anemia and anemia of inflammation belong to?

A

Microcytic

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12
Q

Megaloblastic anemia are related to ______ and _____ disorders.

A

vitamin B12
folic acid

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13
Q

MCV of megaloblastic anemias have _____ MCV.

A

high

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14
Q

What are the three possible paths for megaloblastic anemia?

A
  1. Decreased B12, normal folate
  2. Normal B12, decreased folate
  3. Normal B12 and folate
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15
Q

How to treat pernicious anemia?

A

Parental (IM or SQ) 1000ug OD 1 week > 1000ug weekly 4 weeks > 1000 ug monthly for life

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16
Q

How can cobalamin deficiency due to other causes be treated?

A

IV or oral B12 (1000ug or 2000ug daily)

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17
Q

What is the common cause of folate deficieny?

A

Nutritional deficiency

18
Q

How can folate deficiency be treated?

A

1mg/d of folate (1 to 4 months or till hematologic recovery)

19
Q

Drug-induced haematologic disorders are due to _________ issues.

A

haematopoiesis

20
Q

How is aplastic anemia diagnosed?

A

Any of the following 2:
1. WBC ≤ 3500 cells/mm3
2. Platelet count ≤ 55000 cells/mm3
3. Haemoglobin value ≤ 10g/dL and reticulocyte count ≤ 30000 cells/mm3

21
Q

What can be done to treat aplastic anemia?

A
  1. Remove offending drug
  2. Start prophylactic antimicrobial if neutrophil less than 500 cells/mm3 OR broad spectrum if febrile neutropenia
  3. Transfusion support with RBCs and platelets
22
Q

Over transfusion in aplastic anemia can be given _____ or ______.

A

deferxamine, deferasirox

23
Q

What is drug-induced neutropenia or agranulocytosis?

A

Absolute neutrophil count < 1500/ul

24
Q

What is the prototype drug for aplastic anemia?

A

Chloramphenicol

25
Q

What are the drugs that are associated with aplastic anemia?

A

Drugs causing bone marrow failure involved in processes such as radiation therapy or cytotoxic chemotherapy

26
Q

What are the three prototype drugs associated with agranulocytosis?

A

Anti-thyroid (i.e. propylthiouracil)
Clozapine and other phenothiazines
Penicillin

27
Q

How can agranulocytosis be managed?

A
  1. Hold off offending drug
  2. Start GSF (filgrastim) SQ if neutrophil nadir < 100 cells/mm3
28
Q

Penicillin can be restarted at ____ doses once neutropenia has been resolved without any recurrence of drug-induced agranulocytosis.

A

low

29
Q

How is hemolytic anemia diagnosed?

A

Direct and indirect Coombs’ test

30
Q

What is one cause of hemolytic anemia?

A

G6PD (Metabolic)

31
Q

What are some medications unsafe for people with G6PD deficiency and are associated with anemia?

A

Fluoroquinolones, primaquine, tafenoquine, sulfonylureas

32
Q

What are some chemical exposures and foods associated with hemolytic anemia and should be avoided in G6PD?

A

Fava beans, henna compounds, naphthalene

33
Q

Name a drug that is safe to be used in G6PD deficient patient and not associated with hemolytic anemia.

A

Chloroquine and hydroxychloroquine

34
Q

What are the medications associated with megaloblastic anemia?

A

Antimetabolite
Co-trimoxazole (esp when folate or B12 deficient)
Phenytoin and phenobarbital (inhibit folate absorption or catalyze folate catabolism)

35
Q

What is thrombocytopenia?

A

Platelet count ≤ 100000 cells/mm3 or greater than 50% reduction from baseline values

36
Q

Heparin induced thrombocytopenia is paradoxically associated with _____.

A

thrombosis

37
Q

What can be used in management of heparin induced thrombocytopenia?

A

DOACs

38
Q

What is the management for thrombocytopenia?

A

Hold off offending drug and KIV corticosteroids if severe

39
Q

How do one monitor for Heparin induced thrombocytopenia following major surgery?

A

4T score
Score of 4: intermediate
Score of 6: high

40
Q

What are the 4T in the 4T score?

A

Thrombocytopenia
Timing of platelet count fall
Thrombosis or other sequelae
Other causes for thrombocytopenia

41
Q

What should one do when 4T score is intermediate or high?

A
  1. Stop heparin and start non-heparin
  2. Conduct PF4/ heparin immunoassay
42
Q

What causes pernicious anemia?

A
  1. Decrease absorption due to lack of intrinsic factor or gastric disruption
  2. Nutritional
  3. Other causes: PPI, H2RA, H.pyloric

PR3154 (16 decks)

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