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Medication Causes of Macrocytic Anemia

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1. Medication Causes of Macrocytic Anemia

Medication Causes of Macrocytic Anemia Medication Causes of Macrocytic Anemia Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 (...) Medication Causes of Macrocytic Anemia Medication Causes of Macrocytic Anemia Aka: Medication Causes of Macrocytic Anemia , Medications Affecting Folate Metabolism , Medications Affecting Cobalamin , Medication Causes of Marrow Toxicity , Drug-Induced Macrocytic Anemia From Related Chapters II. Causes: Megaloblastic Macrocytic Anemia Related Changes Use Pyrimethamine ( ) s (Questran) Anticonvulsants ( ) ( ) Phenobarbital ( ) Antibiotics ( ) Sulfamethoxazole Trimethoprim (e.g. or ) Reverse transcriptase

2018 FP Notebook

2. Macrocytic Anemia

to ( s are slightly larger than mature s) Increased RBC production in response to , or other red cell loss IV. Causes: Megaloblastic Macrocytic Anemia See ( ) (often related) Atrophic Gastrointestinal malabsorption Primary disorders V. Causes: Non-megaloblastic Macrocytic Anemia See Accelerated (High ) Post-hemorrhagic Increased RBC membrane surface area Hepatic disease Post-splenectomy disorders Myelophthisic ( ) Acquired VI. Causes: Spurious Macrocytosis (False positive) Cold agglutinins Causes s (...) ) VIII. Evaluation: Step 1 - Peripheral Blood Smear Megaloblastic Anemia Go to step 2 Non-megaloblastic Macrocytic Anemia Consider non-megaloblastic causes listed above Consider or ( increased) Consider Check liver function panel (LFT) Check (TSH) IX. Evaluation: Step 2 - Reticulocyte Count less than 2% Go to step 3 greater than 2% Evaluate for X. Evaluation: Step 3 - Serum Vitamin B12 >400 pg/ml Go to Step 5 100-400 pg/ml Go to Step 4 <100 pg/ml Treat with Replacement XI. Evaluation: Step 4

2018 FP Notebook

3. Medication Causes of Macrocytic Anemia

Medication Causes of Macrocytic Anemia Medication Causes of Macrocytic Anemia Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 (...) Medication Causes of Macrocytic Anemia Medication Causes of Macrocytic Anemia Aka: Medication Causes of Macrocytic Anemia , Medications Affecting Folate Metabolism , Medications Affecting Cobalamin , Medication Causes of Marrow Toxicity , Drug-Induced Macrocytic Anemia From Related Chapters II. Causes: Megaloblastic Macrocytic Anemia Related Changes Use Pyrimethamine ( ) s (Questran) Anticonvulsants ( ) ( ) Phenobarbital ( ) Antibiotics ( ) Sulfamethoxazole Trimethoprim (e.g. or ) Reverse transcriptase

2015 FP Notebook

4. CRACKCAST E121 – Anemia, Polycythemia, and White Blood Cell Disorders

to underlying disease: hypothyroid, hypoadrenal, hypopituitary, uremia, chronic inflammation, liver disease Macrocytic (high MCV) Vit B12 deficiency / Folate deficiency Liver disease Hypothyroidism [5] What is the differential diagnosis of normocytic anemia? See above [6] What are the 3 different types of thalassemia? Homozygous beta-chain thalassemia (Thalassemia major) Mediterranean, severe anemia, most common single gene disoder Heterozygous beta-chain thalassemia (Thalassemia minor) Mild anemia, mostly (...) asymptomatic Alpha-thalassemia Wide spectrum of manifestation, viable forms in Asian/Afro-Americans [7] What is the underlying pathophysiology of sideroblastic anemia? List causes of sideroblastic anemia Pathophysiology: Defect in porphyrin synthesis causes impaired Hb production leading to excess iron deposited in mitochondria of RBC precursors → poor erythropoiesis (anemia) Causes of Sideroblastic Anemia: Primary: Rare sex-linked form and idiopathic in elderly with refractory anemia Secondary: Toxins

2017 CandiEM

5. CLINICAL STUDIES OF THE BLOOD VOLUME. VIII. MACROCYTIC AND HYPOCHROMIC ANEMIAS DUE TO CHRONIC BLOOD LOSS, HEMOLYSIS AND MISCELLANEOUS CAUSES, AND POLYCYTHEMIA VERA (PubMed)

CLINICAL STUDIES OF THE BLOOD VOLUME. VIII. MACROCYTIC AND HYPOCHROMIC ANEMIAS DUE TO CHRONIC BLOOD LOSS, HEMOLYSIS AND MISCELLANEOUS CAUSES, AND POLYCYTHEMIA VERA 16694695 2006 05 31 2018 11 13 0021-9738 18 6 1939 Nov The Journal of clinical investigation J. Clin. Invest. CLINICAL STUDIES OF THE BLOOD VOLUME. VIII. MACROCYTIC AND HYPOCHROMIC ANEMIAS DUE TO CHRONIC BLOOD LOSS, HEMOLYSIS AND MISCELLANEOUS CAUSES, AND POLYCYTHEMIA VERA. 621-32 Gibson J G JG Medical Clinic of the Peter Bent

Full Text available with Trip Pro

1939 Journal of Clinical Investigation

6. Macrocytic Anemia

to ( s are slightly larger than mature s) Increased RBC production in response to , or other red cell loss IV. Causes: Megaloblastic Macrocytic Anemia See ( ) (often related) Atrophic Gastrointestinal malabsorption Primary disorders V. Causes: Non-megaloblastic Macrocytic Anemia See Accelerated (High ) Post-hemorrhagic Increased RBC membrane surface area Hepatic disease Post-splenectomy disorders Myelophthisic ( ) Acquired VI. Causes: Spurious Macrocytosis (False positive) Cold agglutinins Causes s (...) ) VIII. Evaluation: Step 1 - Peripheral Blood Smear Megaloblastic Anemia Go to step 2 Non-megaloblastic Macrocytic Anemia Consider non-megaloblastic causes listed above Consider or ( increased) Consider Check liver function panel (LFT) Check (TSH) IX. Evaluation: Step 2 - Reticulocyte Count less than 2% Go to step 3 greater than 2% Evaluate for X. Evaluation: Step 3 - Serum Vitamin B12 >400 pg/ml Go to Step 5 100-400 pg/ml Go to Step 4 <100 pg/ml Treat with Replacement XI. Evaluation: Step 4

2015 FP Notebook

7. Classification of Anemias

, ?or normal transferrin, normal- ? ferritin; Tx disease, ?transfusion,?Epo & not iron if ? or normal ferritin. Aplastic anemia, Mixed deficiency anemia, Endocrine hypothyroidism , Hemoglobinopathy MCV >100 fL Macrocytic anemia Consider loss of blood, Reticulocyte count, Vitamin B12 & folate level, Blood film, TSH, LFTs Blood loss ? No Blood loss ? Treat cause GI or menstrual bleed (Use of ASA/NSAIDs, warfarin etc.), high reticulocyte Liver dx normal RDW , Myelodysplasia high RDW , Folate or Vit B12 (...) -normal TIBC & transferrin saturation, only ~25% microcytic , Hemoglobinopathy, Lead Overload , Thalassemia normal TIBC, normal to ? serum iron & transferrin saturation major high RDW & minor normal RDW ; Sideroblastic anemia ? RDW MCV 80-100 fL Normocytic anemia Consider loss of blood, Reticulocyte count Blood loss, Hemolysis ? No blood loss ? Treat cause GI or menstrual bleed (Use of ASA/NSAIDs, warfarin etc.), high reticulocyte Anemia of chronic dx normal- ? RDW, low serum iron, low-normal TIBC

2014 RxFiles

8. Hemoglobin Optimization to Prevent Transfusion and Adverse Events in Perioperative Patients With Iron Restricted Anemia

or knee arthroplasty surgery (primary) Hemoglobin concentration of less than 120g/L; but greater than 60g/L Exclusion Criteria: Anemia attributed to something other than iron deficiency anemo/ACI: Any other diagnosed or suspected cause of anemia (e.g. macrocytic anemia , lead toxicity, myelodysplastic syndrome) Suspected of having acute blood loss due to any diagnosed condition (e.g. malignancy or gastric ulcer) Mean Cell Volume (MCV) > 97fL Known deficiency of vitamin B12 and/or folate A known (...) Hemoglobin Optimization to Prevent Transfusion and Adverse Events in Perioperative Patients With Iron Restricted Anemia Hemoglobin Optimization to Prevent Transfusion and Adverse Events in Perioperative Patients With Iron Restricted Anemia - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum

2018 Clinical Trials

9. KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease

, 288–291; doi:10.1038/kisup.2012.33 TESTING FOR ANEMIA BACKGROUND In any individual, anemia may be the initial laboratory sign of an underlying medical problem. Consequently, a complete blood count, including the hemoglobin (Hb) concentration, is routinely part of global health assessment in most adults, whether or not they have chronic kidney disease (CKD). In patients with CKD but stable kidney function, the appear- ance or progression of anemia may herald a new problem that is causing blood loss (...) of, or in addition to, TSATand ferritin levels if available. Measurement of hepcidin levels has not been shown to be clinically useful or superior to more standard iron status tests in patients with CKD. 22,23 Vitamin B 12 and folate Folate and vitamin B 12 de?ciency are uncommon but important causes of treatable anemia, typically associated with macrocytic red blood cell (RBC) indices. Limited data indicate a prevalence of vitamin B 12 and folate de?ciency in r10% of HD patients; the prevalence in CKD patients

2012 National Kidney Foundation

10. Anemia in Older Adults

(as an acute phase reactant) Consider workup as below IX. Evaluation: Macrocytic Anemia Abnormal Consider or other malignancy Consider hematology and Normal >2% (normal) Increased LDH or or decreased <25 mg/dl or positive Normal LDH, , , Recent blood loss Hypersplenism <=2% (low) Level <100 pg/ml or <5 ng/ml OR Serum Level or borderline low Methylmalonic Acid level low level high Level or borderline normal Medication causes of increased MCV Disease X. Complications Even mild ( 11 mg/dl) is associated (...) See See See VIII. Evaluation: Microcytic or Normocytic Anemia Low (<46 ng/ml or <103 pmol/L) Treat as Evaluate for causes including gastrointestinal (e.g. endoscopy) Intermediate (46 to 100 ng/ml or 103 to 225 pmol/L) Serum receptor (sTfR) to index <1.5 (GFR) <60 (GFR) >60 Consider other causes of , Serum receptor (sTfR) to index >1.5 Treat as Evaluate for causes including gastrointestinal (e.g. endoscopy) High (>100 ng/ml or >225 pmol/L) Consider congenital Consider other causes of elevation

2018 FP Notebook

11. Megaloblastic Macrocytic Anemias

Megaloblastic Macrocytic Anemias Megaloblastic Macrocytic Anemias - Hematology and Oncology - MSD Manual Professional Edition Brought to you by The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases / / / / IN THIS TOPIC OTHER TOPICS IN THIS CHAPTER Test your (...) ) can also cause macrocytosis. Nonmegaloblastic macrocytosis is suspected in patients with macrocytic anemias when testing excludes vitamin B 12 deficiency, folate deficiency, and reticulocytosis. The macro-ovalocytes on peripheral smear and the increased RBC distribution width that are typical of classic megaloblastic anemia may be absent. If nonmegaloblastic macrocytosis is unexplained clinically (eg, by the presence of , chronic liver disease, or alcohol use) or if is suspected, bone marrow

2013 Merck Manual (19th Edition)

12. Anemia (Follow-up)

& Management Updated: Oct 08, 2018 Author: Joseph E Maakaron, MD; Chief Editor: Emmanuel C Besa, MD Share Email Print Feedback Close Sections Sections Anemia Treatment Approach Considerations The purpose of establishing the etiology of an anemia is to permit selection of a specific and effective therapy. For example, corticosteroids are useful in the treatment of autoimmune hemolytic anemia. Therapy and medical care vary considerably in the group of hereditary disorders. Splenectomy has been advantageous (...) . Surgery is useful to control bleeding in patients who are anemic. Most commonly, bleeding is from the GI tract, uterus, or bladder. Patients should be hemodynamically stable before and during surgery. A blood transfusion may be needed. Management of beta-thalassemia major and major hemoglobinopathies Patients with beta-thalassemia major and the major hemoglobinopathies associated with sickle hemoglobin (Hb) usually require medical attention at frequent intervals for the treatment of anemia, infection

2014 eMedicine.com

13. Anemia (Overview)

present as a severe or may be asymptomatic with compensated hemolysis. Similarly, glucose-6-phosphate dehydrogenase (G-6-PD) deficiency may manifest as chronic hemolytic anemia or exist without anemia until the patient receives an oxidant medication. Immunologic etiologies for anemia may include antibody-mediated abnormalities. In the emergency department (ED), acute hemorrhage is by far the most common etiology for anemia. Drugs or chemicals commonly cause the aplastic and hypoplastic group (...) deficiency. Women have a markedly lower incidence of X-linked anemias, such as G-6-PD deficiency and sex-linked sideroblastic anemias, than men do. In addition, in the younger age groups, males have a higher incidence of from traumatic causes. Age-related demographics Previously, severe, genetically acquired anemias (eg, sickle cell disease, thalassemia, Fanconi syndrome) were more commonly found in children because they did not survive to adulthood. However, with improvement in medical care

2014 eMedicine.com

14. Aplastic Anemia (Overview)

-Blackfan anemia (DBA) is characterized by a normochromic macrocytic anemia that can be isolated, or it can be associated with growth retardation or congenital malformation in the upper limbs, heart, and genitourinary systems. In a small minority of patients, DBA can progress to aplastic anemia. Nine genes have been found to be causative for DBA, and they are inherited in an autosomal dominant manner. [ ] Approximately 50% of cases are inherited from a parent, and about 50% result from de novo mutations (...) mycobacterial and viral infections; however, the yield is generally low. See for more detail. Management Severe or very severe aplastic anemia is a hematologic emergency, and care should be instituted promptly. Clinicians must stress the need for patient compliance with therapy. The specific medications administered depend on the choice of therapy and whether it is supportive care only, immunosuppressive therapy, or hematopoietic cell transplantation. [ ] Pharmacotherapy The following medications are used

2014 eMedicine.com

15. Megaloblastic Anemia (Diagnosis)

and pancytopenia, gastrointestinal dysfunction and glossitis, personality changes, psychosis, and neurological disorders. [ ] Megaloblastic changes can occur in HIV infections and myelodysplastic disorders as a result of interference of DNA synthesis. [ , , ] Vitamin B-12 and folic acid deficiencies and certain medications are the most common causes of megaloblastic anemia, a macrocytic anemia. Vitamin B-12 differs from other water-soluble vitamins in that it is stored in the liver. In addition, vitamin B-12 (...) Physiological folate absorption and transport is receptor mediated. There is no equivalent of IF to stabilize and transport ingested folate. Uptake occurs in the jejunum and throughout the small intestine. Previous Next: Etiology Major causes for cobalamin deficiency The daily requirement cobalamin is about 5-7 µg/. Dietary cobalamin deficiency rarely causes megaloblastic anemia, except in strict vegetarians who avoid meat, eggs, and dairy products. Atrophic gastritis and achlorhydria commonly occur

2014 eMedicine.com

16. Anemia (Diagnosis)

present as a severe or may be asymptomatic with compensated hemolysis. Similarly, glucose-6-phosphate dehydrogenase (G-6-PD) deficiency may manifest as chronic hemolytic anemia or exist without anemia until the patient receives an oxidant medication. Immunologic etiologies for anemia may include antibody-mediated abnormalities. In the emergency department (ED), acute hemorrhage is by far the most common etiology for anemia. Drugs or chemicals commonly cause the aplastic and hypoplastic group (...) deficiency. Women have a markedly lower incidence of X-linked anemias, such as G-6-PD deficiency and sex-linked sideroblastic anemias, than men do. In addition, in the younger age groups, males have a higher incidence of from traumatic causes. Age-related demographics Previously, severe, genetically acquired anemias (eg, sickle cell disease, thalassemia, Fanconi syndrome) were more commonly found in children because they did not survive to adulthood. However, with improvement in medical care

2014 eMedicine.com

17. Aplastic Anemia (Diagnosis)

-Blackfan anemia (DBA) is characterized by a normochromic macrocytic anemia that can be isolated, or it can be associated with growth retardation or congenital malformation in the upper limbs, heart, and genitourinary systems. In a small minority of patients, DBA can progress to aplastic anemia. Nine genes have been found to be causative for DBA, and they are inherited in an autosomal dominant manner. [ ] Approximately 50% of cases are inherited from a parent, and about 50% result from de novo mutations (...) mycobacterial and viral infections; however, the yield is generally low. See for more detail. Management Severe or very severe aplastic anemia is a hematologic emergency, and care should be instituted promptly. Clinicians must stress the need for patient compliance with therapy. The specific medications administered depend on the choice of therapy and whether it is supportive care only, immunosuppressive therapy, or hematopoietic cell transplantation. [ ] Pharmacotherapy The following medications are used

2014 eMedicine.com

18. Anemia (Treatment)

& Management Updated: Oct 08, 2018 Author: Joseph E Maakaron, MD; Chief Editor: Emmanuel C Besa, MD Share Email Print Feedback Close Sections Sections Anemia Treatment Approach Considerations The purpose of establishing the etiology of an anemia is to permit selection of a specific and effective therapy. For example, corticosteroids are useful in the treatment of autoimmune hemolytic anemia. Therapy and medical care vary considerably in the group of hereditary disorders. Splenectomy has been advantageous (...) . Surgery is useful to control bleeding in patients who are anemic. Most commonly, bleeding is from the GI tract, uterus, or bladder. Patients should be hemodynamically stable before and during surgery. A blood transfusion may be needed. Management of beta-thalassemia major and major hemoglobinopathies Patients with beta-thalassemia major and the major hemoglobinopathies associated with sickle hemoglobin (Hb) usually require medical attention at frequent intervals for the treatment of anemia, infection

2014 eMedicine.com

19. Pernicious Anemia (Treatment)

with both folic acid and cobalamin until pernicious anemia has been ruled out. The reason is that folic acid restores blood counts but does not prevent the development of subacute combined system degeneration in patients with pernicious anemia. To determine the cause of the failure to absorb cobalamin (This goal is somewhat controversial. Not all hematologists work to establish the precise cause of low vitamin B12 levels. The nuclear medicine tests are expensive and cumbersome, and as a result, many (...) curtail strenuous physical activity until they develop an adequate hematologic response after treatment. Previous Next: Prevention Because an increased familial incidence of pernicious anemia exists, family members should be aware that they are at greater risk of developing this disease and should seek medical attention promptly if they develop anemia or mental and neurologic symptoms. Monitor siblings and children of patients with a hereditary abnormality of cobalamin deficiency for evidence

2014 eMedicine.com

20. Pernicious Anemia (Overview)

: Pathophysiology Classic pernicious anemia is caused by the failure of gastric parietal cells to produce sufficient IF (a gastric protein secreted by parietal cells) to permit the absorption of adequate quantities of dietary vitamin B-12. Other disorders that interfere with the absorption and metabolism of vitamin B12 can produce cobalamin deficiency, with the development of a macrocytic anemia and neurologic complications. Cobalamin is an organometallic substance containing a corrin ring, a centrally located (...) development, mental retardation, and a macrocytic anemia. Certain defects cause methylmalonic aciduria and homocystinuria. See the image below. Pernicious anemia. Inherited disorders of cobalamin (Cbl) metabolism are depicted. The numbers and letters correspond to the sites at which abnormalities have been identified, as follows: (1) absence of intrinsic factor (IF); (2) abnormal Cbl intestinal adsorption; and (3) abnormal transcobalamin II (TC II), (a) mitochondrial Cbl reduction (Cbl A), (b) cobalamin

2014 eMedicine.com

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