Anemias excluding cobalamin and folate deficiencies.

Anemias are one of the commonest maladies affecting humans. They result from either a failure of production by the bone marrow (hypoproliferative), or from premature destruction or loss (hyperproliferative) of red cells. Hypoproliferative anemias typically result from deficiencies of essential nutrients, stem cell abnormalities or deficiency, and infiltrative processes of the bone marrow. In the hyperproliferative forms, the bone marrow function is normal and anemia results from bleeding or shortened erythrocyte lifespan due to hemoglobinopathies, red cell enzyme disorders, membrane defects, or external factors such as antibodies, trauma, or heat injury. The etiology of anemia is frequently obvious, but when obscure, a systematic diagnostic approach frequently yields the answer. It is important to realize that anemias are usually a consequence of another disease process, which must be identified. Without correction of the underlying disease process, the treatment is likely to fail.

Commonly used drugs in hematologic disorders.

The drugs used to treat hematologic disorders constitute an extraordinary array of agents and include therapy for anemias, bleeding diatheses, thromboembolism and hematologic malignancies. Within many of these categories, hematologic therapies represent molecular understanding of the disease pathophysiology and a treatment targeted precisely at the known aberration. In this chapter we discuss these treatments, with greater emphasis on the most commonly used agents and the latest advances in the specific field. The chapter includes discussion on old (cyclooxygenase inhibitors) and new antiplatelet agents (ADP receptor P2Y12 inhibitors), newly described oral thrombin inhibitors such as dabigatran, treatment targeted at the bcr-abl tyrosine kinase in chronic myeloid leukemia and demethylating agents in myelodysplasia. The discussion is also oriented towards neurologic implications, both therapeutic and toxic, for each therapy or therapeutic group.