Speaker: Date: Topic
Reed E. Drews, MD
Sep 10, 2014
Clinical Challenges in Hematology-Anemia
Responsibility for Content
The WebEx video, PowerPoint presentation, take-away points and article links were sent by the Medical Library and the CME Committee.
Diane E. Young, Information Specialist
Take-Away Points of the Presentation
· Key Point 1: H pylori, autoimmune gastritis, celiac disease, and gastric by-pass are common causes of refractory iron deficiency anemia.
· Key Point 2: In addition to hereditary and acquired TTP, other primary thrombotic microangiopathy (TMA) syndromes to consider when evaluating microangiopathic hemolytic anemia and thrombocytopenia are: hereditary and acquired complement-mediated TMA; drug-mediated TMA (toxic dose-related reaction), Shiga toxin-mediated TMA (ST-HUS); metabolism-mediated TMA (due to homozygous mutations in MMACHC encoding methylmalonic aciduria and homocystinuria type C protein); drug-mediated TMA (immune reaction); and coagulation-mediated TMA.
· Key Point 3: Low-normal cobalamin levels (250-350 ng/L) need not be pursued without clinical evidence of deficiency. The corollary, however, is that a clinically justified suspicion of deficiency must be pursued, whatever the cobalamin level. The focus must always stay fixed on why the patient’s cobalamin level was measured in the first place. A therapeutic trial with appropriate endpoints is sometimes justified.