Pathogenesis of drug induced megaloblastic anaemia. Oct 24, 2015 drug induced megaloblastic anaemia posted on october 24, 2015 by ryanths folic food fortification tends to offset the hematological effect of vitamin b12, therefore there maybe neurological complications rather than anaemia. Druginduced hematologic disorders can affect any cell line, including white blood cells wbcs, red blood cells rbcs, and platelets. Laboratory sis was druginduced megaloblastic anemia due to tri tests revealed severe pancytopenia, with a hemoglobin of amterene. This paper aims to emphasize the broad range of druginduced hematological syndromes and to highlight some of the newer drugs and syndromes. Nov 17, 2018 megaloblastic anemia is a type of anemia decrease in red blood cell, decrease in hemoglobin in red blood cell, or decrease in blood volume. Drugs can induce almost the entire spectrum of hematologic disorders, affecting white cells, red cells, platelets, and the coagulation system. Additional studies are necessary on the mechanism of drug induced macrocytosis as well as the megaloblastic anemia. Druginduced immune hemolytic anemia is a blood disorder that occurs when a medicine triggers the bodys defense immune system to attack its own red blood cells.
Sep 15, 2018 hemolytic anemia is defined by the premature destruction of red blood cells, and can be chronic or lifethreatening. In addition, deficiencies of ascorbic acid, tocopherol. Megaloblastic anemia an overview sciencedirect topics. Druginduced megaloblastic anemia, digestive diseases and. However, if the druginduced megaloblastic anemia is.
Megaloblastic anemia ma is a form of anemia that is caused by suppression of dna synthesis in the production of red blood cells. Druginduced autoimmune hemolytic anemia is a form of hemolytic anemia in some cases, a drug can cause the immune system to mistakenly think the bodys own red blood cells are dangerous, foreign substances. If you need to print pages from this book, we recommend downloading it as a pdf. Megaloblastic anemia during anticonvulsant drug therapy. The signs and symptoms induced by megaloblastic anemia due to vitamin b12 deficiency are fatigue, headache, palpitations, and dyspnea, and neurological symptoms such as dysesthesia and hypoesthesia may also be present. Megaloblastic anemia is the second most common nutritional anemia in pregnancy. Bilateral macular hemorrhage is a rare ocular finding and to the best of our knowledge, this is the first report of such hemorrhages as a presentation of druginduced anemia. For example, heavy alcohol consumption can cause generalized. In some cases, a drug can cause the immune system to mistakenly think the bodys own red blood cells are dangerous, foreign substances. Unfortunately, this book cant be printed from the openbook. Review article druginduced megaloblastic, aplastic, and. Apr, 2017 megaloblastic anemia is caused by deficiency or impaired utilization of vitamin b12 andor folate, whereas nonmegaloblastic macrocytic anemia is caused by various diseases such as myelodysplastic syndrome mds, liver dysfunction, alcoholism, hypothyroidism, certain drugs, and by less commonly inherited disorders of dna synthesis.
Severe neurological compromise can lead to optic neuropathy, myelopathy and neuropsychiatric symptoms. Druginduced megaloblastic, aplastic, and hemolytic anemias. The mechanisms of druginduced anemia can be explained in terms of either direct immune reaction or drug or metabolite toxicity. Many common drugs induce megaloblastic anemia by interfering with folate or vitamin b 12 absorption, altering b 12 metabolism, or blocking pathways in which these vitamins play a role. Folate and its role in purine and pyrimidine synthesis. Some agents cause predictable hematologic disease eg, antineoplastics, but others induce idiosyncratic reactions not directly related to the drugs pharmacology.
Megaloblastic anemia is a type of anemia decrease in red blood cell, decrease in hemoglobin in red blood cell, or decrease in blood volume. Megaloblastic anemia possibly induced by triamterene in. Feb 02, 2018 hemolytic anemia is a normocytic anemia that occurs when red blood cells are prematurely destroyed hemolysis, which can occur either because of defective rbcs or abnormal changes in the rbcs. Druginduced folate deficiency the national academies press. Hemolytic anemia is a normocytic anemia that occurs when red blood cells are prematurely destroyed hemolysis, which can occur either because of defective rbcs or abnormal changes in the rbcs. Should we screen diabetic patients using biguanides for megaloblastic anaemia aust fam physician. When a drug causes decreases in all three cell lines accom panied by a hypoplastic bone marrow, the result is druginduced aplastic anemia. Oct 24, 2015 severe neurological compromise can lead to optic neuropathy, myelopathy and neuropsychiatric symptoms.
A large number of very commonly used drugs have been reported to induce anemias. Maternal stores of folate last for 34 months, and absorption is rapid and efficient, but levels are in constant need of replenishment as they are required for. However, because of the correction of most of the dietary causes of vitamin b12 and folate deficiency, drug induced megaloblastic anemia has. When the dna synthesis is hampered, cell cycle cannot proceed from g2 growth stage to mitosis or m stage. Many common drugs induce megaloblastic anemia by interfering with folate or vitamin b12 absorption, altering b12 metabolism, or blocking pathways in which these vitamins play a role. Additional studies are necessary on the mechanism of druginduced macrocytosis as well as the megaloblastic anemia. Megaloblastic, aplastic and hemolytic anemias are the most common druginduced anemias. Megaloblastic anemias are characterized by the presence of megaloblasts in the bone marrow and macrocytes in the blood. The following list of medications are in some way related to, or used in the treatment of this condition. Drugs cause megaloblastic anemia by impair ing the cellular availability or use of folic acid or vitamin b 12. List of anemia, drug induced medications 4 compared. Bilateral macular hemorrhage as a complication of drug. George garratty immune hemolytic anemia associated with drug therapy.
It is a potential but rare idiosyncratic effect with any other drug, but there is a recognised association with a number of higherrisk agents which justify additional vigilance. Feb 08, 2019 should we screen diabetic patients using biguanides for megaloblastic anaemia aust fam physician. Megaloblastic anemia is caused by deficiency or impaired utilization of vitamin b12 andor folate, whereas nonmegaloblastic macrocytic anemia is caused by various diseases such as myelodysplastic syndrome mds, liver dysfunction, alcoholism, hypothyroidism, certain drugs, and by less commonly inherited disorders of dna synthesis. Department of anesthesiology and critical care medicine, englewood hospital and medical center, 350 engle street, englewood, nj 07631, usa. Estimates of the annual incidence of druginduced hemolytic anemia in the general population range from 1. Many common drugs induce megaloblastic anemia by interfering with folate or vitamin b12 absorption, altering b12 metabolism, or blocking pathways in which. Myelosuppression is a common and anticipated adverse effect of cytotoxic chemotherapy. Alcohol has numerous adverse effects on the various types of blood cells and their functions. Megaloblastic and nonmegaloblastic macrocytic anemia causes. Proposed unifying hypothesis of druginduced antibody reactions. Diagnosis and treatment of macrocytic anemias in adults. However, if the drug induced megaloblastic anemia is. The antibodies attach to red blood cells and cause them to break down too early.
Druginduced megaloblastic anemia tion of serine hydroxymethyl transferase. It develops as a response by the body to deficiency in either vitamin b12 cobalamin or folate. Antibodies then develop against the red blood cells. The world health organization has defined anemia as a hemoglobin concentration below 7. Drug induced megaloblastic anemia tion of serine hydroxymethyl transferase. When anemia comes on slowly, the symptoms are often vague and may include feeling tired, weakness, shortness of breath, and a poor ability to exercise. Lebers congenital amaurosis as the retinal degenerative phenotype in thiamine responsive megaloblastic anemia. Medication causes of macrocytic anemia, medications affecting folate metabolism, medications affecting cobalamin, medication causes of marrow toxicity, druginduced macrocytic anemia. The inclusion of these drugs may change the multivariate analysis and ultimately the conclusion. Estimates of the annual incidence of drug induced hemolytic anemia in the general population range from 1. First, you have the megaloblastic macrocytic anemia, which is the more common type. Supplements to overcome these effects or discontinuation of the drug may be necessary.
Genetic risk factors are being identified which may predispose individuals to this reaction with. Document if the anemia is due to a neoplasm primary andor secondary document whether the anemia is related to or due to chemo or radiotherapy treatments document any causeandeffect relationship between the intervention and the blood or immune disorder document the specific drug if anemia is druginduced. Jan 01, 2005 laboratory sis was drug induced megaloblastic anemia due to tri tests revealed severe pancytopenia, with a hemoglobin of amterene. We describe the case of a 14yearold caucasian boy who presented with a toxoplasmic retinochoroiditis and was treated with sulfadiazine and pyrimethamine. Jun 14, 20 megaloblastic anemia ma is a form of anemia that is caused by suppression of dna synthesis in the production of red blood cells. Several medications have been linked to red blood cell rbc disorders. Acquired hemolytic, megaloblastic and sideroblastic anemias. The signs and symptoms induced by megaloblastic anemia due to vitamin. Anemia is a condition in which the body does not have enough healthy red blood cells.
Ingestion of any of a large number of drugs is followed by immunization and the formation of a soluble drugantidrug complex that adsorbs. Drug induced anaemia is a condition in which the body does not have enough healthy red blood cells resulting from the administration of a drug. Besides alcohol, druginduced causes of macrocytic anemia include sulphasalazine, methotrexate, hydantoins, valproate, and oral contraceptives. Longo, journalthe new england journal of medicine, year2015, volume373 17, pages 164958 many common drugs induce megaloblastic anemia by interfering with folate. If druginduced megaloblastic anemia results from cotrimoxazole, a trial course of folinic acid, 5 to 10 mg up to four times a day, can correct the anemia.
Megaloblastic anemia is a blood disorder characterized by anemia, with red blood cells that are larger than normal, usually resulting from a deficiency of folic acid or of vitamin b12. This causes red blood cells to break down earlier than normal, a process called hemolysis. Anemia, drug induced immune hemolytic medication list about anemia, drug induced. Druginduced aplastic anemia was initially reported in the 1930s. Drugs has become a more prominent cause of megaloblastic anemia because most of the dietary causes of folate and vitamin b12 defi ciency. Druginduced megaloblastic anemia article pdf available in new england journal of medicine 3747. This may occur because of interference with the absorption, plasma transport, or delivery of folate or vitamin b 12, competition for reducing enzymes, endproduct inhibition of cofactormediated reactions, or physical destruc. Megaloblastic anemia medication list about anemia, megaloblastic. Druginduced hemolytic anemia definition of druginduced.
Two patients are described who appeared to develop megaloblastic anemia during therapy with triamterene and hydrochlorothiazide, and both had low serum folate levels. Diagnosis and treatment of macrocytic anemias in adults ncbi. Then you have the nonmegaloblastic macrocytic anemia, which is usually associated with various serious medical problems, such as liver or bone marrow disease. Medication causes of macrocytic anemia, medications affecting folate metabolism, medications affecting cobalamin, medication causes of marrow toxicity, drug induced macrocytic anemia. In more than 95% of cases, megaloblastic anemia is a result of folate and vitamin b 12 deficiency. Megaloblastosis can be associated with severe anemia and. Druginduced megaloblastic anemia new england journal. It should be part of the differential diagnosis for any normocytic or.
Anemia also spelled anaemia is a decrease in the total amount of red blood cells rbcs or hemoglobin in the blood, or a lowered ability of the blood to carry oxygen. The condition is also known as megaloblastic anaemia. Drug induced autoimmune hemolytic anemia is a form of hemolytic anemia. In severe cases, ataxia, decreased proprioception, and vibratory sensation, collectively known as subacute. One of these two patients was critically ill with this complication but survived when triamterene was stopped and folic and folinic acids were administered. Anemia, hemolytic anemia, megaloblastic anemia, methemoglobinemia, polycythemia, red blood cells, side effects, sideroblastic anemia, drug induced immune hemolytic anemia, antineoplastics. The most common druginduced hematologic disorders include aplastic anemia, agranulocytosis, megaloblastic anemia, hemolytic anemia, and thrombocytopenia.
Management and treatment of drug induced megaloblastic anemia to manage and treat drug induced megaloblas tic anemia, it is necessary to determine the cause of megaloblastosis. Folic food fortification tends to offset the hematological effect of vitamin b12, therefore there maybe neurological complications rather than anaemia. The frequency of these side effects varies, depending on the. Macrocytic anemias can be classified further into two main groups. A drugs haptens bind loosely or firmly to cell membranes, and antibodies. Selective vitamin b12 malabsorption druginduced anemia, congenital anemia and juvenile megaloblastic. It is this crucial role of dihydrofolate reductase in thymidine nucleotide biosynthesis that makes it a target for antineoplastic thera. If dihy drofolate is not reduced and methylated, the cell is starved of thymidylate, and dna synthesis slows. Druginduced folate deficiency the national academies.
List of anemia, megaloblastic medications 5 compared. This page includes the following topics and synonyms. This paper aims to emphasize the broad range of drug induced hematological syndromes and to highlight some of the newer drugs and syndromes. Megaloblastic anemia may also result from rare inborn errors of metabolism of folate or vitamin b 12. Then you have the non megaloblastic macrocytic anemia, which is usually associated with various serious medical problems, such as liver or bone marrow disease.