Blood dyscrasias

drug induced anemia,thrombocytopenia,neutropenia,aplastic anemia,hemolytic anemia,methemoglobinemia

1. DRUG-INDUCED BLOOD DYSCRASIAS Dr. Ch.Pavani

2. Introduction… Dyscrasias – “Morbid general state resulting from the presence of abnormal material in the blood. Applied to disease affecting blood cells or platelets”

3. Introduction… Toxic doses/sometimes even in therapeutic doses leads to various blood dyscrasias Impaired production of blood cells Aplastic anaemia Increased destruction of blood cells Hemolytic anaemia Derangement of blood cell functions Methaemoglobinemia

4. Drug induced anemias Folic acid inhibitors: DHF reductase inhibitors or folic acid antagonists: Associated with impaired absorption or utilization of folic acid Those which cause vitamin B 12 malabsorption

5. Drug induced anemias NSAIDS and Anticoagulants -“ Iron deficiency anemia ”. Pyridoxine responsive anemia – caused by Isoniazid - Hypochromic microcytic anemia. Probably due to inability of iron to get incorporated in hemoglobin

6. Aplastic anemia

7. Aplastic anemia

8. Allogenic bone marrow transplant

9. Immunosuppression effective in 70-80% of patients. GCSF, erythropoietin and large doses of androgen may help some patients Glucocorticoids such as prednisolone 20-40mg/day, may control hemorrhage

10. Hemolytic reactions Occur with drugs which oxidize hemoglobin Glutathione in reduced form protects RBC from oxidizing agents. Glucose 6 phosphate de hydrogenase maintains Glutathione in reduced form. Drug damaged RBC show precipitated denatured Hemo globin - Heinz bodies

11. G6PD DEFICIENCY

12. Drugs causing hemolysis in G6PD deficiency Antibacterial agents: Sulphonamides,Furozolidone,Nitrofurantoin , Chloramphenicol,Fluoroquinolones Anti leprosy drugs ( sulphones ): Diaminodiphenyl sulphone , Sulphoxone Antimalarials : Primaquine, Quinine Miscellaneous : Salicylates,Naphthalene,Methylene blue

13. G6PD DEFICIENCY

14. G6PD DEFICIENCY

15. Methemoglobinemia

16. METHEMOGLOBINEMIA

17. Neutropenia Specific depression of leucocytes , particularly granulocytes, Drugs known to cause it do so relatively frequently (1:1000-1:100) Amidopyrine and Dipyrone cause it by immune mechanism Patient’s serum with specific antibodies lyses granulocytes in the presence of the drug With drugs like Phenothiazines and AntiThyroid compounds , exact mechanism is unknown

18. drugs causing neutropenia and agranulocytosis Tranquilizers : Chlorpromazine and related drugs, Meprobamate Analgesics :Amidopyrine , Phenylbutazone , Oxyphenbutazone, Indomethacin Antibacterial : Chloramphenicol, Sulfonamides, Streptomycin, Cotrimoxazole Antithyroid drugs: Propylthiouracil , Methimazole, Potassium perchlorate

19. Neutropenia

20. Neutropenia

21. Thrombocytopenia Less frequent, in most cases due to immune mechanism. Quinidine is most commonly involved All drugs causing aplastic anemia also cause thrombocytopenia

22. Demonstration fresh normal blood with patient’s serum clot retraction is prevented.

23. drugs causing thrombocytopenia Anti arrhythmics – quinidine, procainamide Antibacterials :Sulfonamides,Penicillin,Rifampicin Antiepileptics : Phenytoin, Carbamazepine, Valproic acid Diuretics :Thiazides,Furosemide,Acetazolamide H1receptorantagonists :Cimetidine, Ranitidine` Miscellaneous :Alpha methyl dopa, Goldcompounds , Danazol, Heparin, Quinine