Diseases and symptoms Expansion-1

Diseases and symptoms Expansion-1

Bright Zoom Doctor,

Anemia :

TIBC finding to differentiate iron deficiency vs. chronic disease

TIBC levels at the:

• Top=Iron deficiency.
• Bottom=Chronic disease.

Anemia causes (simplified)

ANEMIA:

• Anemia of chronic disease
• No folate or B12
• Ethanol
• Marrow failure & hemaglobinopathies
• Iron deficient
• Acute & chronic blood loss

Anemia (normocytic): causes

ABCD:

• Acute blood loss
• Bone marrow failure
• Chronic disease
• Destruction (hemolysis)

Anemia: non-megaloblastic causes of macrocytic anemia

HAND LAMP:

• Hypothyroidism
• Aplastic anaemia
• Neonates
• Drugs
• Liver disease
• Alcohol
• Myelodyplasia
• Pregnancy

Blood disorders: commoner sex

HE (male) gets:

• HEmophilia (X-linked)
• HEinz bodies (G6PD deficiency, causing HEmolytic anemia: X-linked)
• HEmochromatosis (male predominance)
• HEart attacks (male predominance)
• HEnoch-Schonlein purpura (male predominance)
• SHE (female) gets:
• SHEehan's syndrome

Haematology: key numbers

3 and 4 are key in in haematology:

• 1.34 cm3 of oxygen is carried by a gram of hemoglobin.
• There's 3.4mg of iron in each gram of hemoglobin.
• There's an average of 3.4 lobes per neutrophil.
• There's 34mg bilirubin from each gram of hemoglobin

Hemoglobin and myoglobin: 

binding strengths, sites

• "ABC" of glycosylated Hb (Hb1c):

  *Glucose binds to Amino terminal of Beta Chain.

"HbF binds Forcefully":

  *HbF binds oxygen more forcefully than HbA, so Oxy-Hb dissociation curve shifts to left.

Stored blood is SOS:

Stored blood Hb binds to Oxygen Strongly because of decrease in 2,3 BPG.

2,3 BPG binding site is BBC:

BPG binds to Beta Chain of Hb.

★ Myoglobin binding strength is MOM:

★Myoglobin binds Oxygen More strongly than Hb.

Hemolytic anemia: 

types

SHEEP TIT:

• Sickle cell
• Heriditary splenocytosis
• Enzyme deficiencies: [G6P, pyruvate kinase]
• Erythroblastosis fetalis
• Paroxysmal nocturnal hemoglobinuria
• Trauma to RBCs
• Immunohemolytics: [warm Ab, cold Ag]
• Thalassemias: [alpha, beta]

Hemophilia: type A factor

• Hemophilia A: problems with VIII factor (number V as an inverted A).

Hodgkin's lymphoma: classification

• A: Asymptomatic
• B: Bad

Leukemias: acute vs. chronic rules of thumb

ABCDE

• Acute is:
• Blasts predominate
• Children
• Drastic course
• Elderly
• Few WBC's (so Fevers)

  *Chronic is all the opposites:

• Mature cells predominate
• Middle aged
• Less debilitating course
• Elevated WBC's, so not a history of fevers and infections

Macrocytic anemia: causes

ABCDEF:

• Alcohol + liver disease
• B12 deficiency
• Compensatory reticulocytosis (blood loss and hemolysis)
• Drug (cytotoxic and AZT)/ Dysplasia (marrow problems)
• Endocrine (hypothyroidism)
• Folate deficieny/ Fetus (pregnancy)

Macrocytic anaemia: differential

FAT RBC:

• Fetus (pregnancy)
• Alcohol
• Thyroid disease(ie hypothyroidism)
• Reticulocytosis
• B12 and folate deficiency
• Cirrhosis and chronic liver disease

Marble bone disease: signs and symptoms

MARBLES:

• Multiple fractures
• Anemia
• Restricted cranial nerves
• Blind & deaf
• Liver enlarged
• Erlenmeyer flask deformity
• Splenomegaly

  *Eponymous name: Marbles = Albers-Schonberg (anagram).

Megaloblastic anemia: vitamin B12 deficiency vs. folate deficiency

★ Vitamin B12 deficiency also affects Brain (optic neuropathy, subacute combined degeneration, paresthesia).

★ Folate deficiency is not associated with neurological symptoms.

Microcytic anemia: causes

"Find Those Small Cells":

• Fe deficiency
• Thalassemia
• Sideroblastic
• Chronic disease

Pancytopaenia: differential

"All Of My Blood Has Taken Some Poison":

• Aplastic anaemias
• Overwhelming sepsis
• Megaloblastic anaemias
• Bone marrow infiltration
• Hypersplenism
• TB
• SLE
• Paroxysmal nocturnal haemoglobinuria

Polycythemia Rubra Vera (PRV): common symptoms

PRV:

• Plethora/ Pruritis
• Ringing in ears
• Visual blurriness

Sickle cell disease: complications

SICKLE:

• Strokes/ Swelling of hands and feet/ Spleen problems
• Infections/ Infarctions
• Crises (painful, sequestration, aplastic)/ Cholelithiasis/ Chest syndrome/ Chronic hemolysis/ Cardiac problems
• Kidney disease
• Liver disease/ Lung problems
• Erection (priapism)/ Eye problems (retinopathy)

Symptoms of TTP/HUS

"Nasty Fever Ruined My Tubes":

• Neurological symptoms
• Fever
• Renal failure
• Microangiopathic hemolytic anemia
• Thrombocytopenia

Thrombotic thrombocytopenic purpura: signs

FAT RN:

• Fever
• Anemia
• Thrombocytopenia
• Renal problems
• Neurologic dysfunction

TTP: clinical features

Thrombosis and thrombocytopenia PARTNER together:

• Platelet count low
• Anemia (microangiopathic hemolytic)
• Renal failure
• Temperature rise
• Neurological deficits
• ER admission (as it is an emergency)