International Journal of Preventive Medicine Research
Articles Information
International Journal of Preventive Medicine Research, Vol.1, No.1, Apr. 2015, Pub. Date: Apr. 8, 2015
Characteristics of Ischemic Heart Disease Patients Dying with Drug Induced Bone Marrow Suppression
Pages: 12-16 Views: 1359 Downloads: 2361
Authors
[01] Muhammad Irfan, Medicine department, Services Institute of Medical Sciences, Services Hospital, Lahore, Pakistan.
[02] Ghulam Mustafa Aftab, Medical Student, CMH Medical College, Lahore, Pakistan.
[03] Muhammad Arif Nadeem, Medicine department, Services Institute of Medical Sciences, Services Hospital, Lahore, Pakistan.
[04] Irfan Bhatti, Medicine department, Services Institute of Medical Sciences, Services Hospital, Lahore, Pakistan.
[05] Tariq Suleman, Medicine department, Services Institute of Medical Sciences, Services Hospital, Lahore, Pakistan.
[06] Khalil Ahmed, Medicine department, Services Institute of Medical Sciences, Services Hospital, Lahore, Pakistan.
[07] Muhammad Naseem Akhtar, Medicine department, Services Institute of Medical Sciences, Services Hospital, Lahore, Pakistan.
[08] Attique Abou Bakr, Medicine department, Services Institute of Medical Sciences, Services Hospital, Lahore, Pakistan.
Abstract
Objective: To determine characteristics of Ischemic Heart Disease (IHD) patients dying with drug induced bone marrow suppression. Study Design: Cross-sectional Study. Place and Duration of Study: Medical Unit 3, Services Hospital Lahore, from December 2011 to February 2012. Methodology: Patients of IHD taking medication from Punjab Institute of Cardiology (PIC), Lahore presented with mucosal bleeding (PIC syndrome). The clinical data and laboratory assessment was made, analyzed and Fisher exact test applied to find any significance at 5% level. Results: Amongst 86 patients with Platelet count <100,000/mm3, 25.6% patients died while 74.4% discharged. Death group of patients had statistically significant association with Fever (p = 0.002), Diabetes Mellitus (p = 0.002), abnormal ALT (p = 0.000) and abnormal serum creatinine (p = 0.026), while recovered group had significant association with current no use of clopidogrel (p = 0.000), calcium channel blockers (p = 0.000) and nitrates (p = 0.017). However, gender, age, bleeding, past history of Dengue, Hemoglobin, White cell count, Platelet count, INR, current use of aspirin, beta-blockers, ACE inhibitors and statins had no significance with hospitalization outcome. The risk of bleeding was >4.115 times in patients using calcium channel blockers. Conclusion: A large number of IHD patient had died during the epidemic of drug induced bone marrow suppression and death was common among patients with diabetes, fever, abnormal ALT and abnormal creatinine. However recovery was more among patients not using clopidogrel, calcium channel blockers and nitrates. The risk of bleeding was positively correlated with use of calcium channel blockers.
Keywords
Ischemic Heart Disease, PIC Syndrome, Bone Marrow Suppression, Death
References
[01] Bunch C. Bone marrow failure. Medicine International 1995; 10: 495-9.
[02] Rehman H, Fazil M, Khan FM. The etiological pattern of pancytopenia in children upto 15 years. Pak armed forces med J 2003; 53: 183-7.
[03] Guinan EC. Acquired aplastic anemia in childhood. Hematol Oncol Clin North Am 2009; 23:171.
[04] Handoko KB, Souverein PC, van Staa T. Risk of aplastic anemia in patients using antiepileptic drugs. Epilepsia 2006; 47:1232.
[05] Powars D. Aplastic anemia secondary to glue sniffing. N Engl J Med 1965; 273:700.
[06] Lange RD, Wright SW, Tomonaga M. Refractory anemia occurring in survivors of the atomic bombing in Nagasaki, Japan. Blood 1955; 10:312.
[07] Hadzic N, Height S, Ball S. Evolution in the management of acute liver failure-associated aplastic anaemia in children: a single centre experience. J Hepatol 2008; 48:68.
[08] Wilson A, Trumpp A. Bone-marrow haematopoietic-stem-cell niches. Nat Rev Immunol 2006; 6:93.
[09] Young NS, Kaufman DW. The epidemiology of acquired aplastic anemia. Haematologica 2008; 93:489.
[10] Cox A. Pyrimethamine Poisoning in Pakistan. Available at: http://www.blacktriangle.org/blog/pag 2420.
[11] Young NS, Bacigalupo A, Marsh JC. Aplastic anemia: pathophysiology and treatment. Biol Blood Marrow Transplant 2010; 16:S119.
[12] Wallerstein RO, Condit PK, Kasper CK, et al. Statewide study of chloramphenicol therapy and fatal aplastic anemia. JAMA 1969; 208:2045.
[13] Kay AG. Myelotoxicity of gold. Br Med J 1976; 1:1266.
[14] Brodie MJ, Pellock JM. Taming the brain storms: felbamate updated. Lancet 1995; 346:918.
[15] Laporte JR, Ibanez L, Ballarin E. Fatal aplastic anaemia associated with nifedipine. Lancet 1998; 352:619.
[16] Unena SG, Molina JF, Garcia CD. Espinoza LR. Pancytopenia secondary to methotrexate therapy in rheumatoid arthritis. Arthritis Rheum 1996; 39 (2): 272-6.
[17] Waxman S, Herbert V. Mechanisms of pyrimethamine-induced megaloblastosis in human bone marrow. N Engl J Med 1969; 28: 1316–1319.
[18] Chute JP, Decker CF, and Cotelingam J. Severe Megaloblastic Anemia Complicating Pyrimethamine Therapy. Ann Intern Med 1995; 122(11):884-5.
[19] Limdi J K, Hyde G M. Evaluation of abnormal liver function tests. Postgrad Med J 2003; 79: 307–12
[20] Carrier B. Data Analysis. In: File System Forensic Analysis. 1st ed. Indiana: Crawfordsville; 2005:16-7.
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