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Grand Rounds 09/10/14 @ BID-Needham: Dr. Reed E. Drews  

Clinical Challenges in Hematology - Anemia
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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

    dyoung3@bidmc.harvard.edu

     

        

      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.

          

        WebEx Video of the Presentation

         

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