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Chapter 101. Hemolytic Anemias and Anemia Due to Acute Blood Loss (Part 1) pptx
Ngày tải lên :
07/07/2014, 04:20
... more acute or more chronic, and they may vary from mild to very severe The site of hemolysis may be predominantly intravascular or extravascular With respect to mechanisms, HAs may be due to intracorpuscular ... Clinical and Laboratory Features The clinical presentation of a patient with anemia is greatly influenced by whether the onset is abrupt or gradual, and HA is no exception A patient with autoimmune ... mild hereditary spherocytosis or with cold agglutinin disease may be diagnosed after years This is due in large measure to the remarkable ability of the body to adapt to anemia when it is slowly...
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Chapter 101. Hemolytic Anemias and Anemia Due to Acute Blood Loss (Part 2) docx
Ngày tải lên :
07/07/2014, 04:20
... Increased (up to 10X normal with intravascular hemolysis) Haptoglobin Reduced to absent Note: MCV, mean corpuscular volume; MCH, mean corpuscular hemoglobin; LDH, lactate dehydrogenase The laboratory ... lactate dehydrogenase (LDH), increased aspartate transaminase, and reduced haptoglobin Urobilinogen will be increased in both urine and stool If hemolysis is mainly intravascular, the telltale sign ... about mM) goes hand in hand with the gradual loss of cellular organelles and of biosynthetic abilities In the end the erythroid cell undergoes a process that has features of apoptosis, including...
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Chapter 101. Hemolytic Anemias and Anemia Due to Acute Blood Loss (Part 3) pptx
Ngày tải lên :
07/07/2014, 04:20
... Chronic iron overload will cause secondary hemochromatosis; this will cause damage, particularly to the liver, eventually leading to cirrhosis, and to the heart muscle, eventually causing heart failure ... components in the red cell: (1) hemoglobin, (2) the membrane-cytoskeleton complex, and (3) the metabolic machinery necessary to keep (1) and (2) in working order Here we will discuss diseases of the ... pathophysiologic process common to all HAs is an increased red cell turnover The gold standard for proving that the life span of red cells is reduced (compared to the normal value of about 120...
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Chapter 101. Hemolytic Anemias and Anemia Due to Acute Blood Loss (Part 5) ppt
Ngày tải lên :
07/07/2014, 04:20
... a dimer of α-spectrin and β-spectrin The membrane is physically linked to the cytoskeleton by a third set of proteins (including ankyrin and the so-called band 4.1 and band 4.2), which thus connect ... glycosylated, and they carry antigenic determinants that correspond to blood groups Underneath the membrane, and tangential to it, is a network of other proteins that make up the cytoskeleton The main cytoskeletal ... of red cell membrane/cytoskeleton (For explanation see text.) (From N Young et al: Clinical Hematology Copyright Elsevier, 2006; with permission.) The membrane-cytoskeleton complex is indeed so...
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Chapter 101. Hemolytic Anemias and Anemia Due to Acute Blood Loss (Part 6) doc
Ngày tải lên :
07/07/2014, 04:20
... antigen nonspherocytic associated with hemolytic total loss of all anemia Rh antigens Note: HS, hereditary spherocytosis; HE, hereditary elliptocytosis ... Band HS (anion (dominant) channel) Mutations of this gene may account for ~25% of HS Southea st Polymorp Asian hic mutation ovalocytosis (deletion of (dominant) amino acids); clinically asymptomatic; ... Band 4.1 HE (dominant) Mutations of this gene account for about 5% of mostly HE, with prominent morphology but no hemolysis in heterozygotes; severe hemolysis in homozygotes EPB42 15q15-q21 Band...
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Chapter 101. Hemolytic Anemias and Anemia Due to Acute Blood Loss (Part 7) docx
Ngày tải lên :
07/07/2014, 04:20
... prophylaxis splenectomy is postsplenectomy is controversial HS patients often may require cholecystectomy It used to be considered mandatory to combine this procedure with splenectomy, but this may ... similar to that of HS However, an asymptomatic form, referred to as Southeast Asian ovalocytosis, has a frequency of up to 7% in certain populations, presumably as a result of malaria selection Stomatocytosis ... first approximation, has two important functions: (1) to provide energy in the form of ATP, and (2) to prevent oxidative damage to hemoglobin and to other proteins ...
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Chapter 101. Hemolytic Anemias and Anemia Due to Acute Blood Loss (Part 8) pdf
Ngày tải lên :
07/07/2014, 04:20
... neonatal jaundice; the jaundice persists and is usually associated with a very high reticulocytosis The anemia is of variable severity; sometimes it is so severe as to require regular blood transfusions; ... rare tosis rather than mutase (DPGM) Phosphog lycerate hemolysis Xq13 kinase Ver y rare CN S, NM May benefit (PGK) from splenectomy Pyruvate 1q21 kinase (PK) Rar May e (2) benefit from splenectomy ... the anemia is remarkably welltolerated because the metabolic block at the last step in glycolysis causes an increase in bisphosphoglycerate (or DPG), a major effector of the hemoglobinoxygen dissociation...
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Chapter 101. Hemolytic Anemias and Anemia Due to Acute Blood Loss (Part 9) ppsx
Ngày tải lên :
07/07/2014, 04:20
... system, or both The diagnosis of HA is usually not difficult, thanks to the triad of normo-macrocytic anemia, reticulocytosis, and hyperbilirubinemia Enzymopathies should be considered in the differential ... which, directly and via reduced glutathione (GSH), defends these cells against oxidative stress G6PD deficiency is a prime example of an HA due to interaction between an intracorpuscular and an extracorpuscular ... decrease in G6PD activity in most tissues, this is less marked than in red cells, and it does not seem to produce symptoms Figure 101-4 Diagram of redox metabolism in the red cell G6P, glucose 6-phosphate;...
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Chapter 101. Hemolytic Anemias and Anemia Due to Acute Blood Loss (Part 10) pps
Ngày tải lên :
07/07/2014, 04:20
... to extremely severe, usually normocytic and normochromic, and due partly to intravascular hemolysis; hence, it is associated with hemoglobinemia, hemoglobinuria, and low or absent plasma haptoglobin ... Mediterranean Sea, in the Middle East, and in India; G6PD A– in Africa and in Southern Europe; G6PD Vianchan and G6PD Mahidol in Southeast Asia; G6PD Canton in China; and G6PD Union worldwide The heterogeneity ... from acute HA in adults is the development of acute renal failure (exceedingly rare in children) Once the threat of acute anemia is over, and in the absence of comorbidity, full recovery from acute...
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Chapter 101. Hemolytic Anemias and Anemia Due to Acute Blood Loss (Part 11) doc
Ngày tải lên :
07/07/2014, 04:20
... Chronic Comple nocturnal with acute ment hemoglobinuria exacerbations mediated (PNH) Flow Exacerba (C)- cytometry display destruction of CD59(–) CD59(–) to tions due to C a activation red through ... cells Paroxysmal Acute Immune Test for Often cold lysis of normal Donath- triggered hemoglobinuria red cells viral infection (PCH) Landsteiner by antibody Septicemia Very acute Exotoxi Blood ns ... perfringens Microangio pathic Acute or chronic Red cell Red cell Different fragmentation morphology on causes ranging blood smear from endothelial damage to hemangioma to leaky prosthetic heart valve...
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Chapter 101. Hemolytic Anemias and Anemia Due to Acute Blood Loss (Part 12) doc
Ngày tải lên :
07/07/2014, 04:20
... due to other causes In cases with CNSHA, if the anemia is not severe, regular folic acid supplements and regular hematologic surveillance will suffice It will be important to avoid exposure to ... chronic in these patients, they are also vulnerable to acute oxidative damage, and therefore the same agents (see Table 101-5) that can cause acute HA in people with the ordinary type of G6PD deficiency ... gallstones later in life The spleen may be enlarged The severity of anemia ranges from borderline to transfusion-dependent The anemia is usually normo-macrocytic, with reticulocytosis Bilirubin and...
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Chapter 101. Hemolytic Anemias and Anemia Due to Acute Blood Loss (Part 13) pptx
Ngày tải lên :
07/07/2014, 04:20
... complement regulatory proteins: membrane cofactor protein, factor H, and factor I It is thought that when complement is activated through the alternative pathway following damage to endothelial ... enables them to squeeze through capillaries narrower than themselves thousands of times in their lifetime, there are at least two situations in which they succumb to shear, if not to wear and tear; ... in the peripheral blood smear, thrombocytopenia (usually mild), and acute renal failure An infection is usually the trigger of the syndrome, which tends to recur When it does, the prognosis is...
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Chapter 101. Hemolytic Anemias and Anemia Due to Acute Blood Loss (Part 14) pps
Ngày tải lên :
07/07/2014, 04:20
... produced responses Anecdotal reports suggest response to intravenous immunoglobulin In severe refractory cases, either auto- or allohematopoietic stem cell transplantation has been used, sometimes ... Clinical Hematology Copyright Elsevier, 2006; with permission.) Clinical Features The onset of AIHA is very often abrupt and can be dramatic The hemoglobin level can drop, within days, to as low ... general autoimmune disease, particularly systemic lupus erythematosus (SLE), of which sometimes it may be the first manifestation Therefore, when AIHA is diagnosed, a full screen for autoimmune...
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Chapter 101. Hemolytic Anemias and Anemia Due to Acute Blood Loss (Part 15) potx
Ngày tải lên :
07/07/2014, 04:20
... chronic AIHA that usually affects the elderly and has special clinical and pathologic features First, the term cold refers to the fact that the autoantibody involved reacts with red cells poorly ... I-positive and will be removed rapidly Immunosuppressive/cytotoxic treatment with prednisone, azathioprine, or cyclophosphamide can reduce the antibody titer, but clinical efficacy is limited, and in ... persistent intravascular hemolysis subject to recurrent exacerbations (Table 101-6; Fig 101-8) In addition to hemolysis, there is often pancytopenia and a risk of venous thrombosis This triad...
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Chapter 101. Hemolytic Anemias and Anemia Due to Acute Blood Loss (Part 16) ppt
Ngày tải lên :
07/07/2014, 04:20
... thrombosis followed by infection secondary to severe neutropenia and hemorrhage secondary to severe thrombocytopenia PNH may evolve into aplastic anemia (AA), and PNH may manifest itself in patients ... may produce acute hepatomegaly and ascites, i.e., a full-fledged Budd-Chiari syndrome, which, in the absence of liver disease, ought to raise the suspicion of PNH The natural history of PNH can ... vary dramatically from day to day, and even from hour to hour (Fig 101-8) The bone marrow is usually cellular with marked to massive erythroid hyperplasia, often with mild to moderate dyserythropoietic...
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Chapter 101. Hemolytic Anemias and Anemia Due to Acute Blood Loss (Part 17) potx
Ngày tải lên :
07/07/2014, 04:20
... globulin (ALG or ATG) and cyclosporine A may be indicated Although no formal trial has ever been conducted, this approach has helped particularly to relieve severe thrombocytopenia and/ or neutropenia ... may be lifelong and most patients receive supportive treatment only, including transfusion of filtered red cells whenever necessary Folic acid supplements (at least mg/d) are mandatory; the serum ... should be offered to any young patient with severe PNH Now that filters with excellent removal of white cells are routinely used, the traditional washing of red cells, which aimed to avoid white...
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Essential Guide to Acute Care - part 1 pdf
Ngày tải lên :
10/08/2014, 18:21
... Essential Guide to Acute Care Essential Guide to Acute Care Second edition Nicola Cooper Specialist Registrar in General Internal Medicine and Care of the Elderly Yorkshire, UK ... how to assess and manage an acutely ill patient using the ABCDE system • Understand the benefits and limitations of intensive care • Know how to communicate effectively with colleagues about acutely ... accompanies acute illness The result is that many doctors are unable to deal logically with patients in physiological decline and this often leads to suboptimal care In surveys of junior doctors of...
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Essential Guide to Acute Care - part 2 pps
Ngày tải lên :
10/08/2014, 18:21
... breathing into a paper bag) Fig 2.8 shows how respiratory muscle load and respiratory muscle strength can become affected by disease and an imbalance leads to alveolar hypoventilation and hypercapnia ... respiratory failure Non-invasive ventilation has been shown to be a very successful treatment for acute respiratory failure (or acute on chronic respiratory failure) in COPD, leading to a reduction ... meet high inspiratory demands Fig 2.4 shows the flow rates for various Venturi masks and Fig 2.5 shows the effect of lower total flow rates in patients with high inspiratory demands Venturi valve...
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Essential Guide to Acute Care - part 3 pot
Ngày tải lên :
10/08/2014, 18:21
... Traditionally, respiratory failure is divided into type and type 2, but these are not practical terms and it is better to think instead of: • Failure to ventilate • Failure to oxygenate • Failure to both ventilate ... muscles and the accessory muscles (e.g sternomastoids) Ventilation is sensed by central and peripheral chemoreceptors, and other receptors in the lungs Normally, PaCO2 is the most important factor ... able to: • • • • • • Understand basic pulmonary physiology Understand the mechanisms of respiratory failure Know when respiratory support is indicated Know which type of respiratory support to...
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Essential Guide to Acute Care - part 4 docx
Ngày tải lên :
10/08/2014, 18:21
... (60/30 mmHg) The patient is sedated and paralysed, and the ventilator is set to 12 breaths/min The inspiratory to expiratory ratio is 1:4, tidal volumes are 600 ml and peak airway pressures are 45 ... EPAP, backup respiratory rate (RR) and inspiratory time or inspiration to expiration (I:E) ratio Non-invasive BiPAP is used in certain patients with a mild -to- moderate acute respiratory acidosis (see ... adequately equipped in terms of monitoring and alarms when used in hospital The operator has to choose the appropriate type and size of mask and set basic ventilator controls: supplementary oxygen...
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