Archer medicine question 268 - misshyd

[ArchivalUser]

A 62 year old man with history of chronic alcohol abuse, Hepatitis C and gout is admitted for nausea, vomiting and diarrhea. His medications include colchicine for gout prophylaxis and multivitamins. The patient admits that he has increased his alcohol intake to about 4 pints vodka per day over the past two weeks. He has not been drinking or eating adequately. On physical examination, his vitals reveal a heart rate of 110 and blood pressure of 90/60. Oral mucosa are dry with poor skin turgor. Abdominal examination is benign. Laboratory investigations reveal acute renal insufficiency with a creatinine of 4mg% and BUN of 90mg%. His liver functuion tests are elevated with an AST of 160U/L, ALT 70U/L and ALP 240U/L. Total bilirubin is 2.0mg%. Complete blood count shows hemoglobin of 8.6gm%, WBC count of 1.6k/µl with absolute neutrophil count of 500/µl and Platelets 56k/μl. His laboratory investigations three months ago were with in normal limits. CT scan of the abdomen does not show any evidence of liver cirrhosis or Splenomegaly. The patient is started on intravenous hydration, thiamine and folic acid. Which of the following is the most appropriate next step in managing this patient”s pancytopenia?
A) Renal biopsy
B) Liver Biopsy
C) Stop colchicine
D) Bone marrow biopsy
E) Parvo virus RNA

[ArchivalUser]

CCC

[ArchivalUser]

c.

[ArchivalUser]

C.

[ArchivalUser]

E

[ArchivalUser]

e..

[ArchivalUser]

EE.

Misshyd, Answer Please.

[ArchivalUser]

C. it's toxic to blood marrow especially in case of poor renal function.
What is the answer, Mysshyd?

[ArchivalUser]

Thats correct. Colchicine toxicity can precipitated by renal and hepatic insufficiency. Colchicine must not be used in presence of hepatic or renal failure. Colchicine can cause BM toxicity by BM suppression and can lead to cytopenias and sometimes, can cause aplastic anemia.
Parvo virus often leads to pure red cell aplasia in immunocompromised individuals and in those with chronic hemolytic anemias.Patients often have viral like illness with fever and constitutional symptoms. Rash may appear 2 to 3 weeks after initial infection. Hemoglobin may fall to very low levels and reticulocyte counts become undetectable ( profound reticulocytopenia) but usually, wbc count and platelets are with in normal range. Hgb usually recovers within 1 week.
The more obvious etiology here is colchicine and the first step should focus on discontinuing the offending drug which is not supposed to be used in the background of hepatic and renal insufficiency.

[ArchivalUser]

Thanks Misshyd.