Internal Medicine

0521779407-21 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:59

Unstable Hemoglobins 1483

➣Complications: increased risk of infection with encapsulated

bacteria (immunize patient against pneumococcus,Haemo-

philus influenzae, and meningococcus prior to splenectomy,

prophylactic penicillin)

■General measures:

➣Folic acid, 1 mg po qd

➣Avoidance of oxidant drugs

Antimalarials (primaquine, quinacrine, pentaquine, pama-

quine)

Sulfonamides

Acetanilide

Nalidixic acid

Nitrofurantoin

Toluidine blue

specific therapy

n/a

follow-up

■Monitor CBC, MCV (increases in MCV may indicate folate defi-

ciency), reticulocyte count, bilirubin (frequency determined by rate

of hemolysis)

■Children: monitor growth, development, and energy level

■Monitor spleen size

■Check CBC, reticulocyte count, bilirubin if patient develops

increased pallor, jaundice, dark urine

complications and prognosis

■Hypersplenism

■Cholecystitis

■Hemolytic crisis: increased rate of hemolysis may be precipitated by

illness or oxidant drugs

➣Treatment:

Treat underlying infection

Stop oxidant drugs

Supportive care

Transfusion if symptomatic anemia

➣Prognosis: hematocrit improves with resolution of infections or

discontinuation of inciting medication

■Aplastic crisis: transient decrease in red cell synthesis may accom-

pany certain infections (eg: parvovirus B19)

➣Treatment: supportive care, monitor for symptomatic anemia

➣Prognosis: hematocrit improves as infection resolves