The Curbsiders Internal Medicine Podcast

#444 Macrocytosis, Hemolytic Anemia, Myelodysplastic Syndrome

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Jun 17, 2024

Exploring macrocytic anemia, hemolytic anemia, and myelodysplastic syndrome with a focus on diagnosis and management. Discussion on AIHA, folate supplementation, and the need for hematologist referrals. Case studies highlight lifestyle influences on macrocytosis resolution and treatment options for anemia. Special emphasis on autoimmune hemolytic anemia and MDS complications.

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ADVICE

Understanding Macrocytosis

Always consider the underlying mechanisms of macrocytosis: increased large normal cells, abnormal membrane lipids, or DNA issues.
These mechanisms help understand the causes and guide further testing.

ADVICE

Overlooked Macrocytosis Causes

Check for liver disease, which is often overlooked, when investigating macrocytic anemia.
Repeat CBC as macrocytosis sometimes resolves itself.

ADVICE

Medication-Induced Macrocytosis

Review patient medication lists as some drugs can interfere with DNA synthesis and cause macrocytosis.
Consider drugs like HIV medications, methotrexate, and chemotherapy.

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Recorded LIVE! At Johns Hopkins Internal Medicine Grand Rounds

Step up your anemia game as we explore the causes and diagnostic approach for macrocytic anemia, what to do with a reticulocyte count, the differential diagnosis for hemolytic anemia, the significance of the direct antiglobulin test, and diagnosis and management pearls for autoimmune hemolytic anemia (AIHA) and myelodysplastic syndrome (MDS). Plus, common questions and concerns regarding folate supplementation and the use of bone marrow biopsies. We’re joined by hematologist and pun enthusiast Dr. Rakhi Naik MD, MHS, @redcell_doc @hopkinsheme.

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Show Segments

00:00 Intro and Guest intro
05:53 Case 1: Elise - Macrocytic Anemia
14:59 Case 2: Jane - Hemolytic Anemia
23:24 Testing for Underlying Causes of Autoimmune Hemolytic Anemia
24:40 Association of Autoimmune Hemolytic Anemia with Lymphomas
25:10 Autoimmune Hemolytic Anemia: Diagnosis and Treatment
26:06 Management Approach for Autoimmune Hemolytic Anemia
27:30 Considerations for Outpatient Treatment of Autoimmune Hemolytic Anemia
28:18 Clotting Risk in Autoimmune Hemolytic Anemia
29:20 Treatment Options for Autoimmune Hemolytic Anemia
30:42 Long-Term Prognosis and Recurrence of Autoimmune Hemolytic Anemia
33:32 Diagnostic Challenges in Myelodysplastic Syndrome
35:00 Considerations for Folate Supplementation
36:24 Factors to Consider in the Management of Myelodysplastic Syndrome
39:30 When to Perform a Bone Marrow Biopsy in Myelodysplastic Syndrome
41:25 Shared Decision-Making in the Treatment of Myelodysplastic Syndrome

Credits

Writer and Producer: Matthew Watto MD, FACP
Show Notes: Matthew Watto MD, FACP
Cover Art and Infographic: Matthew Watto MD, FACP
Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP
Reviewer: Fatima Syed MD, MSc
Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP
Technical Production: PodPaste
Guest: Rakhi P. Naik MD, MHS

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