Lecture 12 - Drug-Induced Heme Disorders

Question 1

How to determine if DI heme disorder?

Answer 1

Naranjo algorithm

Question 2

Clinical Diagnosis of Aplastic Anemia

Answer 2

2 of the 3…..

WBC < 3500
Platelet <55,000
Hemoglobin < 10

Severe if….
ANC < 500, platelet < 20,000, anemia w/ reticulocyte 1%

• Bone marrow biopsy for diagnosis*

Question 3

Drugs associated with aplastic Anemia

Answer 3

Carbamazepine
Methimazole
Phenytoin
sulfonamides

Question 4

Aplastic Anemia Treatment

Answer 4

Allogenic Hematopoietic cell transplant = best for younger, w/ HLA-match sibling

Immunosuppressive therapy….
ATG + cyclosporine (continue 12 month, then taper)

Question 5

Hemolytic Anemia Symptoms

Answer 5

Fatigue
pallor
malaise
SOB

Question 6

Drugs associated with hemolytic anemia

Answer 6

Oxidative: Dapsone, Nitrofurantoin

Immune-mediated: Phenobarbital, Phenytoin, Ribavirin

Question 7

How to treat oxidative Hemolytic Anemia

Answer 7

avoid drugs

Question 8

How to treat immune-mediated Hemolytic anemia

Answer 8

Glucocorticoids in severe cases

Rituximab haș been used before, uncommon

Question 9

Drugs associated with Megaloblastic anemia

Answer 9

Methotrexate
Phenobarbital = folic acid 1mg txm
Phenytoin = folic acid 1mg txm
Trimethoprim/Sulfamethoxazole = leucovorin QID txm

Question 10

Agranulocytosis symptoms

Answer 10

sore throat, fever,chills

can occur within days-weeks of exposure of drug
neutrophil rec takes 4-24 days

Question 11

NLMEB

Answer 11

Never.let.monekeys.eat.bananas

60/30/6/3/1

Question 12

ANC calc =

Answer 12

((%neutrophils + %bands) X WBC)) / 100

Question 13

Drugs associated with Agranulocytosis

Answer 13

B-lactam antibiotics
Clozapine
Methimazole
NSAIDs
Phenobarbital
Valproic Acid

Question 14

Thrombocytopenia platelet count?

Answer 14

< 100,000 or 50% reduction from baseline

Question 15

Drugs associated with Thrombocytopenia

Answer 15

Carbamazepine
Phenobarb
Phenytoin
Valproic Acid

NSAIDs
Antitubercular drugs
GPIIb/IIIa inhibitors
Heparin and LMWHs
Linezolid

Question 16

Type 1 vs Type 2 Heparin-Induced Thrombocytopenia

Answer 16

1 = mild, reversible, non-immune mediated…usually occurs within first 2 days

2 = less common, platelet count begins to decline 5-10 days after exposure

Question 17

4T score values

Answer 17

6-8 = High probability HIT > 80%
4-5 = intermediate
0-3 = Low HIT, < 5%

Question 18

HIT Treatment

Answer 18

1. stop all forms heparin
2. being alternative anticoagulants
3. hold warfarin until platelets recover
4. Look for DVTs
5. avoid prophylactic platelet transfusion