- Normocytic anaemia is associated with systemic inflammation and poorer survival in patients with colorectal cancer treated with curative intent. [Journal Article]
- IJInt J Colorectal Dis 2018 Dec 04
- CONCLUSIONS: Normocytic anaemia was associated with systemic inflammation and poorer CSS. Inflammation may drive both anaemia and disease recurrence in these patients, and targeting this process may improve both.
- Multiple fractures of different ages. [Journal Article]
- ADArch Dis Child Educ Pract Ed 2018 Nov 24
- A 2-year-old boy, who was previously well, was admitted for limping associated with left knee pain of 1 month duration. There was no history of witnessed trauma or significant infective symptoms. Sys...
A 2-year-old boy, who was previously well, was admitted for limping associated with left knee pain of 1 month duration. There was no history of witnessed trauma or significant infective symptoms. Systemic review was otherwise unremarkable. Prior to his onset of signs, he was able to cruise with support, and had some mild isolated speech delay. There was no significant family history of medical conditions. His main caregivers on weekdays were two sets of grandparents when his parents were working, while his parents took over his care on weekends. Physical examination was normal, except for tenderness of his left knee joint and his inability to weight-bear.An X-ray of his left knee joint showed a healing fracture of the left distal femoral metaphysis with associated bony sclerosis at the fracture margins, as well as periosteal reaction in the distal femur. In addition, there were also areas of lucencies in the left proximal tibia metaphysis (figure 1). edpract;archdischild-2018-316074v1/F1F1F1Figure 1Left distal femur healing fracture with surrounding sclerosis. QUESTION 1: What are the possible causes of his current presentation?Non-accidental injuryVitamin D deficiencyOsteogenesis imperfectaLeukaemiaAll of the above His full blood count revealed mild normochromic normocytic anaemia (haemoglobin 10.9 g/L), total white cell count of 6.70×109/L and platelet count of 144×109/L. The peripheral blood film did not show any blast cells. His liver function test showed mild transaminases (aspartate aminotransferase 106 U/L, alanine aminotransferase 244 U/L). His renal function test, bone panel, uric acid and lactate dehydrogenase levels were all normal. A skeletal survey showed presence of metaphyseal fractures of different ages at several sites, as well as subtle areas of lucencies in the right proximal tibia metaphysis (figures 2 and 3).edpract;archdischild-2018-316074v1/F2F2F2Figure 2Right distal femur healing fracture with surrounding sclerosis.edpract;archdischild-2018-316074v1/F3F3F3Figure 3Possible healing fracture in right proximal humerus, with surrounding sclerosis.He was managed conservatively and subsequently discharged back home to the same caregivers with plans for home monitoring visits by social services.He was readmitted 1 month later for worsening symptoms of 1 week duration. He was unable to crawl and had developed a fever over 1 day. Systemic review was otherwise unremarkable. Other than a mild normochromic, normocytic anaemia, the full blood count was normal.Physical examination was normal, except for a slightly swollen right knee joint.A right knee X-ray showed worsening osteopenia and sclerosis in keeping with a healing fracture. An MRI showed diffuse marrow changes in the femur with patchy enhancement. QUESTION 2: Which further investigation(s) would be useful in establishing his diagnosis?Bone marrow biopsyGenetic testing for osteogenesis imperfectaVitamin C levelBone mineral density test Answers can be found on page 3.
- TREX1 D18N mice fail to process erythroblast DNA resulting in inflammation and dysfunctional erythropoiesis. [Journal Article]
- AAutoimmunity 2018 Nov 13; :1-12
- Anaemia is commonly observed in chronic inflammatory conditions, including systemic lupus erythematosus (SLE), where ∼50% of patients display clinical signs of anaemia. Mutation at the aspartate resi...
Anaemia is commonly observed in chronic inflammatory conditions, including systemic lupus erythematosus (SLE), where ∼50% of patients display clinical signs of anaemia. Mutation at the aspartate residue 18 of the three prime repair exonuclease 1 (TREX1) gene causes a monogenic form of cutaneous lupus in humans and the genetically precise TREX1 D18N mice recapitulate a lupus-like disease. TREX1 degrades single- and double-stranded DNA (dsDNA), and the link between failed DNA degradation by nucleases, including nucleoside-diphosphate kinases (NM23H1/H2) and Deoxyribonuclease II (DNase II), and anaemia prompted our studies to investigate whether TREX1 dysfunction contributes to anaemia. Utilizing the TREX1 D18N mice we demonstrate that (1) TREX1 mutant mice develop normocytic normochromic anaemia and (2) TREX1 exonuclease participates in the degradation of DNA originating from erythroblast nuclei during definitive erythropoiesis. Gene expression, hematocrit, hemoglobin, immunohistochemistry (IHC) and flow cytometry were used to quantify dysfunctional erythropoiesis. An altered response to induced anaemia in the TREX1 D18N mice was determined through IHC, flow cytometry, and interferon-stimulated gene (ISG) expression analysis of the liver, spleen and erythroblastic islands (EBIs). IHC, flow cytometry, and ISG expression studies were performed in vitro to determine the role of TREX1 in the degradation of erythroblast DNA within EBIs. The TREX1 D18N mice exhibit altered erythropoiesis including a 20% reduction in hematocrit, 10-20 fold increased erythropoietic gene expression levels in the spleen and phenotypic signs of normocytic normochromic anaemia. Anaemia in TREX1 D18N mice is accompanied by increased erythropoietin (Epo), normal hepcidin levels and the TREX1 D18N mice display an inappropriate response to anaemic challenge. Enhanced ISG expression results from failed processing and subsequent sensing of undegraded erythroblast DNA in EBIs. TREX1 participates in the degradation of erythroblast DNA in the EBI and TREX1 D18N mice exhibit a normocytic normochromic anaemia.
- Macrocytic anemia is associated with the severity of liver impairment in patients with hepatitis B virus-related decompensated cirrhosis: a retrospective cross-sectional study. [Journal Article]
- BGBMC Gastroenterol 2018 Nov 01; 18(1):161
- CONCLUSIONS: Macrocytic anemia was found to be associated with the severity of liver impairment and might be a predictor for short-term mortality in patients with HBV-related decompensated cirrhosis.
- Hematological responses to iron-folate supplementation and its determinants in pregnant women attending antenatal cares in Mekelle City, Ethiopia. [Journal Article]
- PlosPLoS One 2018; 13(10):e0204791
- CONCLUSIONS: Our study revealed poor hemoglobin responses in nearly half of the study participants and a high proportion of anemias morphologically atypical of iron deficiency anemia. There is a need to consider anemia attributable to etiologies other than an iron deficiency in anemia intervention programs.
- Acute coumaphos organophosphate exposure in the domestic dogs: Its implication on haematology and liver functions. [Journal Article]
- IJInt J Vet Sci Med 2018; 6(1):103-112
- Indiscriminate use of organophosphate acaricides especially among livestock and dog owners in the control of ticks and other ectoparasites has taken a worrisome dimension. In the present study, we in...
Indiscriminate use of organophosphate acaricides especially among livestock and dog owners in the control of ticks and other ectoparasites has taken a worrisome dimension. In the present study, we investigated, the effects of acute dermal exposure in the form of acaricides baths of coumaphos at different concentrations on the haematology, blood pressure and liver functions in local mongrel dogs. Twenty-four, male mongrel dogs of about 8 months of age with an average weight of 9.88 ± 0.4 kg were used for the study. The dogs were divided into four groups consisting of six dogs per group. Group A (control) was bathed with ordinary water, while group B was bathed with the recommended concentration of 0.016% (160 ppm) Coumaphos in water. Groups C and D were bathed with 10 and 20 times the recommended dose (1600 ppm and 3200 ppm), respectively. Significant leucopenia, increased plasma urea and decreased low density lipoprotein (LDL) values were observed at 8 h post exposure, which worsened with time. At 24 and 36 hrs post exposure, normochromic normocytic anaemia, pan leucopenia, bloody diarrhoea, retching, vomiting and paddling were observed in affected animals. Post mortem examination revealed severe lungs, liver and stomach congestion. Multifocal areas of necrosis in the liver and kidney, serosal and mucosal haemorrhages and haemorrhagic meningitis were also observed. The use of excessively high concentration of organophosphate as acaricides bath is associated with severe anticholinesterase poisoning, which may result in death of affected animals.
- Anemia in Older Adults. [Journal Article]
- AFAm Fam Physician 2018 Oct 01; 98(7):437-442
- Anemia is associated with increased morbidity and mortality in older adults. Diagnostic cutoff values for defining anemia vary with age, sex, and possibly race. Anemia is often asymptomatic and disco...
Anemia is associated with increased morbidity and mortality in older adults. Diagnostic cutoff values for defining anemia vary with age, sex, and possibly race. Anemia is often asymptomatic and discovered incidentally on laboratory testing. Patients may present with symptoms related to associated conditions, such as blood loss, or related to decreased oxygen-carrying capacity, such as weakness, fatigue, and shortness of breath. Causes of anemia in older adults include nutritional deficiency, chronic kidney disease, chronic inflammation, and occult blood loss from gastrointestinal malignancy, although in many patients the etiology is unknown. The evaluation includes a detailed history and physical examination, assessment of risk factors for underlying conditions, and assessment of mean corpuscular volume. A serum ferritin level should be obtained for patients with normocytic or microcytic anemia. A low serum ferritin level in a patient with normocytic or microcytic anemia is associated with iron deficiency anemia. In older patients with suspected iron deficiency anemia, endoscopy is warranted to evaluate for gastrointestinal malignancy. Patients with an elevated serum ferritin level or macrocytic anemia should be evaluated for underlying conditions, including vitamin B12 or folate deficiency, myelodysplastic syndrome, and malignancy. Treatment is directed at the underlying cause. Symptomatic patients with serum hemoglobin levels of 8 g per dL or less may require blood transfusion. Patients with suspected iron deficiency anemia should be given a trial of oral iron replacement. Lower-dose formulations may be as effective and have a lower risk of adverse effects. Normalization of hemoglobin typically occurs by eight weeks after treatment in most patients. Parenteral iron infusion is reserved for patients who have not responded to or cannot tolerate oral iron therapy.
- Hemolytic Anemia: Evaluation and Differential Diagnosis. [Journal Article]
- AFAm Fam Physician 2018 Sep 15; 98(6):354-361
- Hemolytic anemia is defined by the premature destruction of red blood cells, and can be chronic or life-threatening. It should be part of the differential diagnosis for any normocytic or macrocytic a...
Hemolytic anemia is defined by the premature destruction of red blood cells, and can be chronic or life-threatening. It should be part of the differential diagnosis for any normocytic or macrocytic anemia. Hemolysis may occur intravascularly, extravascularly in the reticuloendothelial system, or both. Mechanisms include poor deformability leading to trapping and phagocytosis, antibody-mediated destruction through phagocytosis or direct complement activation, fragmentation due to microthrombi or direct mechanical trauma, oxidation, or direct cellular destruction. Patients with hemolysis may present with acute anemia, jaundice, hematuria, dyspnea, fatigue, tachycardia, and possibly hypotension. Laboratory test results that confirm hemolysis include reticulocytosis, as well as increased lactate dehydrogenase, increased unconjugated bilirubin, and decreased haptoglobin levels. The direct antiglobulin test further differentiates immune causes from nonimmune causes. A peripheral blood smear should be performed when hemolysis is present to identify abnormal red blood cell morphologies. Hemolytic diseases are classified into hemoglobinopathies, membranopathies, enzymopathies, immune-mediated anemias, and extrinsic nonimmune causes. Extrinsic nonimmune causes include the thrombotic microangiopathies, direct trauma, infections, systemic diseases, and oxidative insults. Medications can cause hemolytic anemia through several mechanisms. A rapid onset of anemia or significant hyperbilirubinemia in the neonatal period should prompt consideration of a hemolytic anemia.
- Differential diagnosis of anemia. [Journal Article]
- VLVnitr Lek 2018; 64(5):468-475
- Anemia, defined as hemoglobin level under lower normal limit, is a symptom of different pathologic conditions and the accurate differential diagnosis is necessary to determine the cause of anemia. Th...
Anemia, defined as hemoglobin level under lower normal limit, is a symptom of different pathologic conditions and the accurate differential diagnosis is necessary to determine the cause of anemia. The article uses the morphological classification of anemia to distinguish macrocytic, normocytic and microcytic types of anemias and divides anemias with increased amount of peripheral blood reticulocytes as a special group. It describes commonly known clinical units as iron deficiency anemia or anemia of chronic disease, as so as rare clinical units, which are always need to think about in a differential diagnosis of an anemic patient. There is an increasing incidence of rare blood disorders due to introduction of molecular genetics methods into diagnostics, prolonged overall survival of patients and increasing migration from areas with endemic occurrence of these diseases. Etiology, basic pathophysiological mechanisms, main clinical features together with important diagnostic examinations are described by each clinical unit. Due to the differential diagnostic focus of the article only basic knowledge about therapy is mentioned. The authors are members of the IHBT Center for Rare Disorders of Hematopoiesis, which is focused mainly on congenital and acquired disorders of red blood cell. Key words: anemia - differential diagnosis - enzymopathies - hemoglobinopathies - iron - macrocytosis - microcytosis - rare blood disorders - reticulocytosis.
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- Pure red cell aplasia caused by azathioprine: case report and review of the literature. [Journal Article]
- CHCardiovasc Hematol Disord Drug Targets 2018 Aug 28
- Pure red cell aplasia (PRCA) is a clinical entity comprising severe normochromic normocytic anemia, reticulocytopenia, erythroblastopenia in the bone marrow, with normal leukocyte and platelets count...
Pure red cell aplasia (PRCA) is a clinical entity comprising severe normochromic normocytic anemia, reticulocytopenia, erythroblastopenia in the bone marrow, with normal leukocyte and platelets count. PRCA can be classified into congenital and acquired, with the latter characterized as idiopathic or secondary to various infections, hematological malignancies, collagen vascular diseases, thymoma, and exposure to a variety of drugs and other chemical substances. Herein, we present a female patient, who presented with PRCA due to azathioprine treatment. Prompt discontinuation of the drug together with red blood cells transfusions led to complete recovery in this young patient, without any addition of immunosuppressive regimen.