Your blood is living tissue made up of liquid and solids. The liquid part, called plasma, is made of water, salts and protein. Over half of your blood is plasma. The solid part of your blood contains red blood cells, white blood cells and platelets.

Blood disorders affect one or more parts of the blood and prevent your blood from doing its job. They can be acute or chronic. Many blood disorders are inherited. Other causes include other diseases, side effects of medicines, and a lack of certain nutrients in your diet.

Types of blood disorders include:

• Platelet disorders, excessive clotting, and bleeding problems, which affect how your blood clots
• Anemia, which happens when your blood does not carry enough oxygen to the rest of your body
• Cancers of the blood, such as leukemia and myeloma
• Eosinophilic disorders, which are problems with one type of white blood cell.

Platelet Disorder Medications

Antiplatelets can be classified based on the mechanism of action as follows:

• Platelet aggregation inhibitors such as;
  • Aspirin and related cyclooxygenase inhibitors
  • Oral thienopyridines such as clopidogrel, ticagrelor, ticlopidine, and prasugrel
• Glycoprotein platelet inhibitors
• Protease-activated receptor-1 antagonists (e.g., vorapaxar)
• Miscellaneous (e.g., dipyridamole – a nucleoside transport inhibitor and phosphodiesterase type 3

Aspirin is the most commonly used oral antiplatelet drug. It works by irreversibly inhibiting the cyclooxygenase enzyme (COX) activity in the prostaglandin synthesis pathway (PGH2).

Dipyridamole has antiplatelet and vasodilating properties and inhibits platelet cyclic nucleotide phosphodiesterase. Cilostazol is also reported to have vasodilatory, antiplatelet properties, and antiproliferative effects. It also reduces smooth muscle cell hyperproliferation and intimal hyperplasia after an injury to the endothelium.

Anemia Medications

Management depends primarily on treating the underlying cause of anemia.

1) Anemia due to acute blood loss- Treat with IV fluids, crossmatched packed red blood cells, oxygen. Always remember to obtain at least two large-bore IV lines for the administration of fluid and blood products.

2) Anemia due to nutritional deficiencies: Oral/IV iron, B12, and folate. 

• Oral supplementation of iron is by far the most common method of iron repletion. The dose of iron administered depends on the patient’s age, calculated iron deficit, the rate of correction required, and the ability to tolerate side effects. The most common side effects include metallic taste and gastrointestinal side effects such as constipation and black tarry stools. For such individuals, they are advised to take oral iron every other day, in order to aid in improved GI absorption. The hemoglobin will usually normalize in 6-8 weeks, with an increase in reticulocyte count in just 7-10 days.  

3) Anemia due to defects in the bone marrow and stem cells: Conditions such as aplastic anemia require bone marrow transplantation.

4) Anemia due to chronic disease: Anemia in the setting of renal failure, responds to erythropoietin. Autoimmune and rheumatological conditions causing anemia require treatment of the underlying disease. 

5) Anemia due to increased red blood cell destruction:

• Hemolytic anemia caused by faulty mechanical valves will need replacement.
• Hemolytic anemia due to medications requires the removal of the offending drug.
• Persistent hemolytic anemia requires splenectomy.
• Hemoglobinopathies such as sickle anemia require blood transfusions, exchange transfusions, and even hydroxyurea to decrease the incidence of sickling. 
• DIC, which is characterized by uncontrolled coagulation and thrombosis, requires the removal of the offending stimulus. Patients with life-threatening bleeding require the use of antifibrinolytic agents. 

Leukemia Drugs

Chemotherapy

Chemotherapy drugs are designed to kill cancer cells. They work by attacking cells that divide quickly. Chemotherapy is typically given in cycles, with each period of treatment followed by a rest period.  Standard chemotherapy drugs that doctors use to treat CLL as a single agent or in combination include:

Antimetabolites

• Cladribine (Leustatin®)
• Fludarabine (Fludara®)
• Pentostatin (Nipent®)

Alkylating agents

• Bendamustine hydrochloride (Bendeka®, Treanda®)
• Chlorambucil (Leukeran®)

DNA-Damaging Agent

• Cyclophosphamide (Cytoxan®) 

Corticosteroids may also be given with chemotherapy drugs. Corticosteroids include:

• Prednisone
• Dexamethasone.

Eosinophilic disorders

Management depends on the underlying cause. The goal of the therapy is to mitigate end-organ damage from eosinophilia. In mild cases without any symptoms or signs of organ involvement, a conservative approach can be undertaken. In emergency conditions with hemodynamic instability or organ failure, treatment with IV steroids is important. 

For some conditions like drug and food allergies or infections, treatment can be simple, like withdrawing the offending agent or treating with antibiotics. But in some conditions, due to the varying clinical manifestations and multi-systemic involvement, a multidisciplinary approach involving hematologist, pulmonologist, infectious diseases, might be necessary.