From the Guidelines
The patient's mild anemia, as indicated by low red blood cell count, hemoglobin, and hematocrit, should be further investigated to determine the underlying cause, and iron studies, vitamin B12, and folate levels should be checked, as recommended by the guidelines for managing anemia 1.
Current Medications and Blood Work
The patient is currently taking multiple medications, including buspirone for anxiety, famotidine for acid reduction, lamotrigine for mood stabilization, lorazepam for anxiety, nystatin topical powder for fungal infections, and tadalafil possibly for erectile dysfunction or benign prostatic hyperplasia. Their blood work shows mild anemia with low red blood cell count, hemoglobin (12.7 g/dL), and hematocrit (37.2%), while other blood parameters, including white blood cells and platelets, are normal.
Anemia Evaluation
The anemia appears to be normocytic (normal MCV of 89.9) and normochromic (normal MCH and MCHC), suggesting it could be due to chronic disease, recent blood loss, or nutritional deficiencies. According to the guidelines for managing anemia and iron deficiency in patients with cancer 1, the patient's hemoglobin level is below the recommended target of 12 g/dL, but not low enough to consider erythropoiesis-stimulating agent (ESA) therapy or red blood cell transfusions at this time.
Recommendations
- Continue current medications as prescribed, as none are likely causing the anemia.
- Check iron studies, vitamin B12, and folate levels to determine the underlying cause of anemia.
- Consider oral iron replacement therapy if iron deficiency is detected, as recommended by the guidelines for hereditary hemorrhagic telangiectasia 1.
- Ensure adequate hydration and a balanced diet rich in iron while awaiting further testing.
- Consider hematology consultation if anemia persists or worsens, to evaluate for alternative or complicating etiologies of anemia.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Medication Regimen
The patient is taking the following medications:
- Buspirone 10 mg tablet: 1/2-1 tablet, 3 times daily as needed for anxious ruminations for 30 days
- Famotidine 40 mg tablet: 1 tablet every day by oral route
- Lamotrigine 200 mg tablet: 1 tablet every day by oral route in the morning for 30 days
- Lorazepam 1 mg tablet: 1 tablet every day by oral route as needed for 28 days
- Nystatin 100,000 unit/gram topical powder: apply to the affected area(s) by topical route, 2 times per day as needed
- Tadalafil 5 mg tablet: 1 tablet every day by oral route for 90 days
Blood Test Results
The patient's blood test results are as follows:
- White blood cell count: 4.7 (normal)
- Red blood cell count: 4.14 (low)
- Hemoglobin: 12.7 (low)
- Hematocrit: 37.2 (low)
- MCV: 89.9 (normal)
- MCH: 30.7 (normal)
- MCHC: 34.1 (normal)
- RDW: 12.9 (normal)
- Platelet count: 197 (normal)
- MPV: 10.3 (normal)
- Absolute neutrophils: 3032 (normal)
- Absolute lymphocytes: 1227 (normal)
- Absolute monocytes: 367 (normal)
- Absolute eosinophils: 38 (normal)
- Absolute basophils: 38 (normal)
- Neutrophils: 64.5 (normal)
- Lymphocytes: 26.1 (normal)
- Monocytes: 7.8 (normal)
- Eosinophils: 0.8 (normal)
- Basophils: 0.8 (normal)
Relevant Studies
- Buspirone's mechanism of action is not clear, but it is thought to be mediated via the 5-HT(1A) receptors 2
- There is no direct evidence from the provided studies that links the patient's medication regimen to their blood test results
- A study on patient understanding of newly prescribed medications found that patients often correctly identify information related to directions for taking a medication, but may assume a medication has no side effects if the physician does not convey this information 3