Internal Medicine

P1: SBT

0521779407-03 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:6

122 Anaphylaxis Anemias Secondary to Systemic Disease

Special Situations

■Pregnancy

➣Severe uterine cramping may accompany anaphylaxis

➣Miscarriage or premature delivery is uncommon

➣Epinephrine remains treatment of choice

■Operating room

➣Hypotension or difficulty ventilating may be only signs

➣Many sources of exposure

■Pts on beta-blockers

➣May be unresponsive to epinephrine

➣Administer glucagon

■Exercise-induced

➣May be associated w/ specific food allergy or to ingestion of any

food w/in 4 hours prior to exercise; caution pt not to exercise

alone

complications & prognosis

■Further events can be eliminated when precipitating factors are

identified & avoided

■Idiopathic reactions may require chronic oral corticosteroids

Anemias Secondary to Systemic Disease...................

LAWRENCE B. GARDNER, MD

history & physical

■Most common anemia seen in hospitalized patients not bleeding or

hemolyzing. Common in outpatient rheumatologic conditions.

■Associated primarily with inflammatory states: infection, rheumato-

logic diseases, vasculitis, cancer, inflammatory bowel disease, renal

failure

■Pathophysiology includes increased cytokines, which inhibit hema-

topoiesis, interfere with iron utilization, decrease red survival, and

diminish erythropoietin levels and function.

■Severity of anemia correlates with severity of underlying condition.

■History and physical most significant for underlying condition, not

the anemia

■Anemia is usually mild and chronic, so generally compensated. Pal-

lor, fatigue and poor exercise tolerance common.

■Note: Anemia may occur with thyroid disorders, malabsorption

(e.g., sprue, achlorhydria), liver disease±1 – hypersplenism, and