Which of the following drugs can cause severe hematologic disorders?

Overview

Blood disorders are when something in your blood prevents it from doing its job. While some blood disorders are caused by genes, some can develop as a result of other diseases, medications or a lack of nutrients in your diet.

There are several different types of blood disorders. Some resolve completely with therapy, or do not cause symptoms and do not affect overall lifespan (they are benign). Some are chronic and lifelong but do not affect how long you live. Other blood disorders, like sickle cell disease and blood cancers, can be fatal. The blood disorder list includes:

• Anemia.
• Hemophilia.
• Leukocytosis.
• Polycythemia vera.
• Sickle cell disease.
• Thalassemia.
• Von Willebrand disease.

How do blood disorders affect my body?

Your blood is made of both liquids and solids. The liquid part (plasma) contains water, proteins and salt. When a part of your blood doesn’t do its job, a blood disorder can develop. Blood disorders tend to involve:

• The red blood cells, white blood cells or platelets that make up the solid part of your blood.
• The blood proteins that play a role in clotting.

People with red blood cell disorders don’t have enough healthy red blood cells to carry oxygen to their organs. They may feel cold, tired or weak.

People with white blood cell disorders may feel ill and are at increased risk of developing infections.

People with platelet disorders have trouble with bleeding or clotting.

What are the most common types of blood disorders?

Benign blood disorders include bleeding (platelet) disorders, red blood cell disorders like anemia, and white blood cell disorders. Other blood disorders can cause chronic illness or are life-threatening like sickle cell anemia, leukemia and lymphoma.

Bleeding (platelet) disorders

Platelets form clots and help control bleeding. Bleeding (platelet) disorders are uncommon. If you have a bleeding disorder, you may have too much bleeding during or after injury or surgery. Bleeding disorders can be acquired, or caused by medications or medical conditions. Some are caused by your genes. Sometimes, there is no known cause for bleeding disorders.

Red blood cell disorders

Red blood cells transport oxygen throughout the body. You can develop a red blood cell disorder if a component of these blood cells is not working properly. Red blood cell disorders include:

• Anemia.
• Polycythemia vera.
• Sickle cell disease.
• Thalassemia.

White blood cell disorders

White blood cells are mainly produced in the bone marrow. Unless you have an infection or a blood disorder, you produce about 100 billion white blood cells each day. There are five types of white blood cells: basophils, eosinophils, lymphocytes, monocytes and neutrophils. Each type of white blood cell has its own special function in your blood.

Blood disorders involving abnormally low levels of white blood cells are called leukopenias. If you have leukopenia, you are at increased risk for infections.

A blood disorder involving abnormally high levels of white blood cells is called leukocytosis.

Symptoms and Causes

What causes the condition?

Bleeding disorders can be acquired, or caused by medications or medical conditions. Many run in families. Sometimes, there is no known cause for bleeding disorders.

Causes of low levels of white blood cells (leukopenias) include:

• Acute viral infections.
• Fasting.
• Severe physical stress.
• Corticosteroids.
• Cancer therapies like chemotherapy and radiation therapy.
• Malnutrition.

Causes of high levels of white blood cells (leukocytosis) include:

• Infection.
• Inflammation.
• Excessive physical or emotional stress.
• Burns.
• Immune system disorders, including lupus and rheumatoid arthritis.
• Thyroid problems.

Can blood disorders be hereditary?

Many blood disorders are passed along in families (inherited). Others occur spontaneously, or are a result of illness, medication or malnutrition.

What are the common symptoms of blood disorders?

Common symptoms of red blood cell disorders include:

• Feeling tired.
• Feeling weak.
• Shortness of breath.
• Headache.

Common symptoms of white blood cell disorders include:

• Fever.
• Frequent infections.

Common symptoms of platelet disorders include:

• Excessive bleeding after injury.
• Excessive bleeding during or after dental or medical procedures.
• Blood clots.
• Heavy menstrual bleeding.
• Easy bruising.
• Skin rash.

Can blood disorders cause hair loss?

Everyone loses hair. Experts say that you should expect to lose about 50-150 hairs each day. That said, some medical problems can increase hair loss. For example, autoimmune diseases — like lupus — that cause some blood disorders can also be responsible for hair loss. In addition, iron deficiency anemia is also associated with hair loss (diffuse alopecia).

If you feel like you’re losing an excessive amount of hair, talk to your provider.

Can blood disorders cause itchy skin?

Some blood disorders cause itchy skin (pruritus), including the following:

• Iron deficiency anemia.
• Polycythemia vera.
• Blood cancers like leukemia and lymphoma.

If you have itchy skin, it’s a good idea to look at your skin care routine. Ensure that you use moisturizers regularly, especially in the winter. Talk with your provider if you have itchy skin that lasts for a few weeks despite good skin care.

Diagnosis and Tests

Who specializes in the diagnosis and treatment of blood disorders?

Hematologists are medical doctors with expertise in blood health and disease. They treat patients with blood disorders.

How are blood disorders diagnosed?

Your hematologist uses your medical history, a physical examination and laboratory testing to assess blood disorders. Your provider may order several blood tests, including a complete blood count (CBC) to measure how much hemoglobin is in your blood, the shape and size of red blood cells, and how many different types of white blood cells and platelets that are in your blood.

Your provider may order other, more specific tests to check for specific blood disorders like von Willebrand disease and polycythemia vera.

In rare cases, your provider may order a bone marrow biopsy.

Sometimes diagnosing clotting disorders can be difficult. You may have bleeding symptoms, but even after extensive testing no abnormalities can be identified. This can be frustrating for you and your healthcare provider, especially when deciding whether or not it's safe to proceed with surgery. Despite these difficulties, coagulation medicine is an area of intense research and much progress has been made in just the last decade.

Management and Treatment

Can blood disorders be cured?

Some blood disorders may be cured with treatment. For others, treatment may help you feel better and prevent complications even if it doesn’t cure the disorder. Talk with your healthcare provider to learn more about your outlook and what treatment is right for you.

What treatments are there for blood disorders?

Treatments vary depending on the type of disease, and can include simple observation, use of steroids and other immune-modulating therapies, transfusions or coagulation factor support, growth factor supplementation, chemotherapy and bone marrow transplantation. As with any medication, it is important to know how and when to take your medication according to your provider’s guidelines, and to have frequent blood tests, as ordered by your provider.

Anemia

• Autoimmune hemolytic anemia: When your body makes autoantibodies against your own red blood cells, you have a condition known as autoimmune hemolytic anemia. Steroids can suppress the immune system and interrupt the destruction of red blood cells. But you can’t take steroids indefinitely without causing long-term side effects such as osteoporosis. Most people respond to steroid treatment. If you relapse, your provider may try other agents such as intravenous immunoglobulin (IVIG), cyclophosphamide or cyclosporine. Your spleen may need to be removed.
• Chronic anemia: For chronic anemia, you may see improvement from treatment of the underlying disease (infection, arthritis, heart, lung or kidney disease). If that's not possible and your anemia is causing symptoms, a red blood cell transfusion may be necessary. Your healthcare provider may also prescribe a hormone (recombinant human erythropoietin). The erythropoietins are also useful in other types of anemia when there aren’t enough red blood cells in the bone marrow, such as chemotherapy-induced anemia, myelodysplastic syndrome and aplastic anemia. They are particularly useful in the anemia of kidney disease, which is caused by an underproduction of erythropoietin in certain specialized cells of the kidney.
• Nutritional deficiency anemia: For anemia caused by nutritional deficiencies, your healthcare provider may prescribe oral iron tablets, vitamin B12 injections or an oral folic acid.
• Sickle cell anemia: Sickle cell anemia can be tough to treat. If an underlying cause of a sickle cell crisis (such as infection) can be identified, prompt treatment can make the crisis less severe and get you feeling better faster. Managing a severe pain episode requires potent pain-relieving narcotic medications. Your provider may also order blood transfusions if you have severe anemia that impacts heart and lung function, or when you are going into surgery. Regular transfusion or exchange transfusion can also prevent recurrence of stroke in people with sickle cell disease. Unfortunately, chronic transfusion leads to problems with iron overload, which results in extra iron deposits in the liver, heart and other sites. This can cause problems with those organs. Your provider may use desferrioxamine or deferasirox (Exjade®) to help avoid these problems. Another drug, hydroxyurea, has been found to lessen the frequency and severity of sickle cell crises.

Low platelet count (thrombocytopenia)

Unlike anemia, there is no agent available that reliably increases the platelet count for conditions involving underproduction of platelets in the bone marrow. However, even a relatively low number of platelets may not require treatment if it does not cause life-threatening bleeding. For bone marrow conditions that result in severely low platelet counts or when severe thrombocytopenia and bleeding occur after chemotherapy, platelet transfusions must be given to either lessen the risk of bleeding or stop bleeding. Because transfused platelets only circulate for about 3-4 days and anti-platelet antibodies can develop upon repeated exposure to transfused cells, platelet transfusion is only used briefly to see you through a period of highest risk.

Bleeding disorders

In mild forms of hemophilia and in most types of von Willebrand disease, you may not be diagnosed until adulthood, when you have a pre-operative assessment for elective surgery that shows abnormal clotting times. Your surgery may be delayed until you can see a hematologist. If an underlying abnormality is found, you may be given a test dose of desmopressin, which causes an increase in proteins that help with clotting (factor VIII or von Willebrand factor) levels. If enough of an increase is demonstrated, then this agent can be used to support hemostasis during a minor surgical procedure. If not, or if it is a major operation (cardiac or brain surgery), factor VIII or von Willebrand factor concentrates must be given immediately before the procedure and continued for several days afterward.

Clotting disorders

Certain blood clotting (coagulation) disorders are inherited, but usually don't manifest themselves until later in life. Some clots can occur spontaneously or without obvious cause. But blood clots that develop after surgery or prolonged periods without moving are more common. No matter what the setting, the treatment is anticoagulant therapy. After certain types of surgery, such as orthopedic procedures on the lower extremities or surgery on the spine, your risk of developing a clot is high. Clinical trials have shown the benefit of giving anticoagulants (heparin or warfarin) to patients who have these surgeries to reduce the incidence of blood clots.

Anticoagulants also are used to treat established blood clots. Therapy consists of intravenous heparin, followed by oral warfarin. In simple blood clots, you may be able to self-administer medications at home. Usually anticoagulant therapy is continued for 3 to 6 months. If you have recurrent episodes of thrombosis, especially pulmonary emboli, or have laboratory markers of thrombophilia, your treatment may last longer and may be indefinite.

Prevention

Are blood disorders preventable?

Some blood disorders cannot be prevented, but there are steps you can take to reduce your risk of experiencing complications. This is why early diagnosis and management are important.

How can I reduce my risk?

Although blood disorders can’t be prevented, you can decrease your risk of developing complications by taking good care of yourself. This means:

• Eat a healthy diet rich in vitamins and minerals, including iron like the following eggs, turkey, lean beef, organ meet such as kidney and liver, legumes like black beans, leafy green vegetables and brown rice.
• Stay active with regular exercise.
• Avoid sitting still for long periods of time.
• Maintain a healthy weight.
• Drink plenty of water.
• Get regular check-ups with your healthcare provider and be sure to get any blood tests they order.
• Take steps to prevent infection. Be sure to wash your hands well and often. Talk with your provider about the seasonal flu shot (vaccine).

Outlook / Prognosis

What can I expect if I have a blood disorder?

If your healthcare provider thinks that you may have a blood disorder, you will need to have blood tests. If the blood tests confirm a blood disorder, you will need to take good care of yourself, including eating a balanced, health diet and getting enough exercise. You may need medications or other treatments, and may be referred to a hematologist.

How long will I have a blood disorder?

Some blood disorders go away with treatment, while others can last for the rest of your life. The good news is that treatment often relieves symptoms and helps to manage complications.

What are the complications of blood disorders?

• Anemia: If your anemia is not treated, it could lead to an irregular heartbeat (arrhythmia), an enlarged heart or heart failure. You are also at greater risk of getting infections and becoming depressed.
• Clotting disorders: People with clotting disorders have a higher risk of developing blood clots in the blood vessels that carry blood away from the heart (arteries) and the blood vessels that carry blood to the heart (veins). Blood clots in the arteries can increase your risk for stroke, heart attack, severe leg pain, difficulty walking or even the loss of a limb. Blood clots in the veins can travel through the bloodstream and cause partially or completely block veins deep inside the body (deep vein thrombosis) or a blood clot in the lungs (pulmonary embolism).
• Hemophilia: Some people with hemophilia develop inhibitors (antibodies) against treatment. This means that the medication you take to stop bleeding may not work. You will need to take care to avoid injury. Hemophilia can also lead to joint damage and arthritis pain.
• Sickle cell anemia: Sickle cell complications begin early and continue throughout life. You may have an acute pain crisis or chronic pain, lung damage, neurologic problems or vision loss. You are also at increased risk of developing blood clots that can partially or completely block the veins deep in your body (deep vein thrombosis) or blood clots in your lungs (pulmonary embolism). Pregnant women with sickle cell disease are at higher risk for high blood pressure, blood clots, miscarriage, low birth weight and premature birth. Men with sickle cell disease may develop a condition that happens when deformed cells block flow out of an erect penis (priapism). The penis may stay erect for long periods of time, causing pain and sometimes impotence.
• Thrombocytopenia: You are at risk for significant internal and external blood loss (hemorrhage). Internal bleeding into the digestive tract or brain (intracranial hemorrhage) can be life-threatening. If you’ve had your spleen removed, you are also more likely to get infections. You should be sure to follow your healthcare provider’s instructions about taking your medications and getting vaccinated.
• Von Willebrand disease: Women are more likely than men to experience complications from von Willebrand disease. Abnormal bleeding can cause problems in menstrual cycles and after childbirth. It can hurt a lot if you have bleeding in the joints or soft tissues. In some cases, without treatment, excessive bleeding can lead to death.

What is the outlook for blood disorders?

The outlook for people with blood disorders depends on which blood disorder you have.

Some blood disorders get better completely with therapy, or they do not cause symptoms and do not affect overall lifespan. Some are chronic and lifelong but do not affect how long you live. These include bleeding (platelet) disorders, red blood cell disorders like anemia, and white blood cell disorders. Other blood disorders can cause chronic illness or are life-threatening like sickle cell anemia, leukemia and lymphoma.

The good news is that early detection and treatment can help you feel better. Follow your healthcare provider’s advice about diet, exercise, sleep and drugs to help prevent complications.

Are blood disorders fatal?

Blood disorders can lead to fatal complications if left untreated. Many improve with treatment and regular medical care. Blood cancers (leukemia, lymphoma, multiple myeloma) and sickle cell anemia can be fatal. But treatment can improve help the quality and length of a person’s life.

Can blood disorders be cured?

Some blood disorders may be cured with treatment. Even if your blood disorder can’t be cured, you can still live a good life with treatment and reduce your risk of complications by taking good care of yourself.

Living With

How do I take care of myself?

Taking good care of yourself can improve your quality of life. Steps you can take to reduce your risk of developing complications from blood disorders include:

• Avoid injury. To reduce your risk of injuries that may cause bleeding, always wear a seat belt, wear a bike helmet, consider elbow and knee pads for activities like skating.
• Treat your bleeding quickly. If you have a bleeding disorder, your provider may prescribe a medication (factor) to help your blood clot. Generally, people should take these drugs as soon as possible after they notice bleeding. Take these medications according to your provider’s recommendations.
• Get regular exercise. Exercise improves cardiovascular health. It also makes bones healthier and strengthens muscles, which can lower your risk of falls and help with pain from arthritis. Exercise can also help your mood and give you more energy.
• Eat a healthy, vitamin-rich diet. Foods like leafy green vegetables and organ meats are full of iron that can help manage anemia. Foods with vitamin C help your body absorb the iron in your meals.
• Follow your dentist’s recommendations about oral hygiene. Brush and floss your teeth regularly.
• Educate your family and friends about your blood disorder so they know what to do if you are injured.
• Consider wearing a medical alert bracelet. In the event of severe illness or injury, wearing this bracelet tells your healthcare providers about your condition so they can give you the healthcare you need.

A note from Cleveland Clinic

The field of hematology comprises a broad spectrum of blood disorders and bone marrow disorders. Because problems in other organs often affect the blood, deciding whether a blood abnormality is a result of another illness or is a disorder on its own can be a very hard. Your healthcare provider will order a series of blood tests to find out what’s going on.

With most blood disorders, people can expect to have a lifespan and lifestyle that’s relatively normal. Early detection and treatment can make a big difference in your quality of life. It’s important to be educated about your condition and follow the recommendations of your healthcare provider. You should also contact your provider or go to the ER if you have bleeding that cannot be easily controlled with your medication and local measures.

Which of the following is hematologic disorders cause by drug?

What are hematological drugs?

What drugs cause severe anemia?

What is the most common hematological disorder?