3. Introduction
• Drug induced hematologic disorders are rare adverse effects
associated with drug therapy
• The mechanisms are 1- drug toxicity (high dose) 2- immune
reaction
5. Aplastic anemia
Aplastic anemia is a rare, serious disease of unclear etiology
Characterized by pancytopenia, hypocellular bone marrow and
increase fat cells
6. Causative agents
• Cytotoxic chemotherapy and radiation by bone marrow suppression
• Phenytoin by toxic metabolite
• The antineoplastic agents by dose-dependent mechanism
7. Managment
1- remove the offending agent
2 – supportive care :
Infections (bacteria or fungal ) by antibiotic
Low erythrocytes by erythrocytes transfusion
9. Hemolytic Anemia
The process of premature RBC destruction is referred to as
hemolysis, result from RBC defect or change in intravascular
environment.
Drugs are able to induce hemolytic anemia by both processes
10. Causative agents
• The most common agent is piperacillin
• Methyldopa
• Levodopa
• NSAIDS
• Mechanism :
13. Megaloblastic anemia
• Characterized by impairment DNA synthesis that leads to
abnormal morphology changes , including large red cells
• The main causes are deficiency of vitamin B12 and folic acid
14. Causative agents
• Phenytoin by decrease the absorption and storage of folic acid in
tissues, Folic acid deficiency
• Methotrexate by decreasing in dihydrofolate reductase (essential
enzyme for DNA synthesis ) Folic acid deficiency
• Metformin and proton pump inhibitors, B12 deficiency
17. Iron def.anemia
• Anemia due to lack of iron, blood loss and pregnancy are common
causes
• NSAIDS can induce anemia by decreasing PGs synthesis
• Management: remove offending agent + Iron supplement
18. Sideroblastic anemia
• Characterized by overload of iron in the mitochondria of
erythroblast
• Alcohol and isoniazid are able to induce sideroblastic anemia
• Management : remove offending agent + VB6 supplement
19. G6P-dehydrogenase Def.
• Genetic disease which result in hemolysis due to low level of
G6P-dehydrogenase enzyme.
• Aspirin (high doses) Sulphonamides and NSAIDS are examples to
induce anemia
• Management : remove offending agent + supportive care
20. Summary
• Drug induce hematologic disorders are rare but potentially life-
threating conditions
• Aplastic anemia e.g. phenytoin
• Megaloblastic anemia e.g. methotrexate
• Hemolytic anemia e.g. piperacillin
21. Quiz
• Which of the following drugs is able to induce megaloblastic
anemia ?
• A- oxaliplatin
• B- fludarabine
• C- methotrexate
• D-diclofenac
22. Quiz
• Which of the following drugs is able to induce megaloblastic
anemia ?
• A- oxaliplatin
• B- fludarabine
• C- methotrexate
• D-diclofenac
