Part 2 book “Basic & clinical pharmacology” has contents: Agents used in dyslipidemia, drugs used in disorders of coagulation, hypothalamic & pituitary hormones, thyroid & antithyroid drugs, adrenocorticosteroids & adrenocortical antagonists, cancer chemotherapy, antimycobacterial drugs, and other contents. | SECTION VI DRUGS USED TO TREAT DISEASES OF THE BLOOD, INFLAMMATION, & GOUT 33 C Agents Used in Cytopenias; Hematopoietic Growth Factors H A P T E R James L. Zehnder, MD* C ASE STUDY A 25-year-old woman who has been on a strict vegan diet for the past 2 years presents with increasing numbness and paresthesias in her extremities, generalized weakness, a sore tongue, and gastrointestinal discomfort. Physical examination reveals a pale woman with diminished vibration sensation, diminished spinal reflexes, and extensor plantar reflexes (Babinski sign). Examination of her oral cavity reveals atrophic glossitis, in which the tongue appears deep red in color and abnormally smooth and shiny due to atrophy of the lingual papillae. Laboratory testing reveals a macrocytic anemia based on a hematocrit of 30% (normal for Hematopoiesis, the production from undifferentiated stem cells of circulating erythrocytes, platelets, and leukocytes, is a remarkable process that produces more than 200 billion new * The author acknowledges contributions of the previous author of this chapter, Susan B. Masters, PhD. women, 37–48%), a hemoglobin concentration of g/dL, an erythrocyte mean cell volume (MCV) of 123 fL (normal, 84–99 fL), an erythrocyte mean cell hemoglobin concentration (MCHC) of 34% (normal, 31–36%), and a low reticulocyte count. Further laboratory testing reveals a normal serum folate concentration and a serum vitamin B12 (cobalamin) concentration of 98 pg/mL (normal, 250–1100 pg/mL). Once megaloblastic anemia was identified, why was it important to measure serum concentrations of both folic acid and cobalamin? Should this patient be treated with oral or parenteral vitamin B12? blood cells per day in the normal person and even greater numbers of cells in persons with conditions that cause loss or destruction of blood cells. The hematopoietic machinery resides primarily in the bone marrow in adults and requires a constant supply of three essential .
