Answer to Question 1
Anemia is among the adverse effects that may result from medication use. Various medications can disrupt nutrient metabolism, impair blood coagulation and erythropoiesis, or increase red blood cell destruction. Because the life span of red blood cells is about 120 days, the long-term use of such medications is more likely to result in anemia than short-term use. Anticoagulants, which are prescribed specifically to reduce blood clotting, sometimes lead to excessive bleeding. The anticoagulant effects may be augmented if several of these drugs are used simultaneously. The slow, chronic bleeding that sometimes develops may go unnoticed until excessive blood loss has occurred. Many classes of drugs are associated with aplastic anemia, the anemia that occurs when the bone marrow fails to produce adequate numbers of blood cells. The categories of drugs that can inhibit erythropoiesis include antibiotics, anticancer agents, anticonvulsants, antihistamines, anti-inflammatory drugs, and diuretics. Aplastic anemia can also be caused by viral infections, exposure to toxins, and genetic defects. Some patients may develop hemolytic anemia as a result of drug interactions with red blood cells. For example, a drug may bind to the red blood cell membrane and elicit an antibody response that destroys the cell. Drugs that may cause this response include cephalosporin and fludarabine. Withdrawal of these drugs can eventually reverse the anemia, and sometimes medications are given to suppress the immune response.
Answer to Question 2
B
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