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... alfa, permitting weekly or every other week dosing Acknowledgment Dr Robert S Hillman was the author of this chapter in the 14th edition, and material from his chapter has been retained Further ... disease, nutritional deficiencies are common and complicate the management Folate deficiency from inadequate intake, as well as iron deficiency from blood loss and inadequate intake, can alter the red ... with endstage kidney disease, cancer, and chronic inflammatory diseases—symptomatic anemia requires treatment The two major forms of treatment are transfusions and EPO Transfusions Thresholds for...

Ngày tải lên: 07/07/2014, 04:20

... Pearson Addison- 11- 25 Class Namespace Example: Display 11. 6 Placing a Class in a Namespace (Header File) Copyright © 2006 Pearson Addison- 11- 26 Class Namespace Example: Display 11. 7 Placing a ... © 2006 Pearson Addison- 11- 12 Other Library Files ♦ Libraries not just for classes ♦ Related functions ♦ Prototypes  header file ♦ Definitions  implementation file ♦ Other type definitions ♦ ... redefine cout, cin ♦ Can redefine any others Copyright © 2006 Pearson Addison- 11- 15 Namespace std ♦ We’ve used namespace std ♦ Contains all names defined in many standard library files ♦ Example:...

Ngày tải lên: 10/03/2014, 00:20

... Hypoproliferative anemias are the most common anemias, and anemia associated with acute and chronic inflammation is the most common of these The anemia of inflammation, ... to be made available for physiologic functions while at the same time conserving this element and handling it in such a way that toxicity is avoided The major role of iron in mammals is to carry ... cells lose their capacity for electron transport and energy metabolism In erythroid cells, hemoglobin synthesis is impaired, resulting in anemia and reduced O delivery to tissue Table 98-1 Body...

Ngày tải lên: 07/07/2014, 04:20

... system, and the cell undergoes phagocytosis Once within the RE cell, the hemoglobin from the ingested red cell is broken down, the globin and other proteins are returned to the amino acid pool, and ... into circulation and the transferrin receptor reanchors into the cell membrane At this point a certain amount of the transferrin receptor protein may be released into circulation and can be measured ... presented to circulating transferrin It is the efficient and highly conserved recycling of iron from senescent red cells that supports steady state (and even mildly accelerated) erythropoiesis Since...

Ngày tải lên: 07/07/2014, 04:20

... liver iron one-half, and heme iron one-half to two-thirds Infants, children, and adolescents may be unable to maintain normal iron balance because of the demands of body growth and lower dietary ... deficiency and accounts for around 841,000 deaths annually worldwide Africa and parts of Asia bear 71% of the global mortality burden; North America represents only 1.4% of the total morbidity and mortality ... amounts of dietary iron Over time, this may lead to iron overload and tissue damage In iron deficiency, hepcidin levels are low and iron is much more efficiently absorbed from a given diet; the...

Ngày tải lên: 07/07/2014, 04:20

... are present and can be mobilized, the serum iron, total iron-binding capacity (TIBC), and red cell protoporphyrin levels remain within normal limits At this stage, red cell morphology and indices ... 7–8 g/dL), hypochromia and microcytosis become more prominent, target cells and misshapen red cells (poikilocytes) appear on the blood smear as cigar- or pencilshaped forms, and the erythroid marrow ... increase demand for iron, increase iron loss, or decrease iron intake or absorption can produce iron deficiency (Table 98-2) Table 98-2 Causes of Iron Deficiency Increased demand for iron and/ or hematopoiesis...

Ngày tải lên: 07/07/2014, 04:20

... of absent body iron stores Figure 98-3 Serum ferritin levels as a function of sex and age Iron store depletion and iron deficiency are accompanied by a fall in serum ferritin level below 20 µg/L ... is blocked, RE iron will be detectable, and there will be few or no sideroblasts In the myelodysplastic syndromes, mitochondrial dysfunction can occur, and accumulation of iron in mitochondria ... is stored complexed to protein as ferritin or hemosiderin Apoferritin binds to free ferrous iron and stores it in the ferric state As ferritin accumulates within cells of the RE system, protein...

Ngày tải lên: 07/07/2014, 04:20

... deficiency and lead poisoning Serum Levels of Transferrin Receptor Protein Because erythroid cells have the highest numbers of transferrin receptors on their surface of any cell in the body, and because ... Another condition in which TRP levels are elevated is absolute iron deficiency Normal values are 4–9 µg/L determined by immunoassay This laboratory test is becoming increasingly available and, ... ferritin, has been proposed to distinguish between iron deficiency and the anemia of chronic inflammation (see below) Differential Diagnosis Other than iron deficiency, only three conditions need to be...

Ngày tải lên: 07/07/2014, 04:20

... again reveal normal stores and more than an adequate supply to the marrow, despite the microcytosis and hypochromia Iron-Deficiency Anemia: Treatment The severity and cause of iron-deficiency ... majority of cases of iron deficiency (pregnant women, growing children and adolescents, patients with infrequent episodes of bleeding, and those with inadequate dietary intake of iron), oral iron therapy ... blood loss or malabsorption, specific diagnostic tests and appropriate therapy take priority Once the diagnosis of iron-deficiency anemia and its cause is made, there are three major therapeutic...

Ngày tải lên: 07/07/2014, 04:20

... years with the recognition that recombinant erythropoietin therapy induces a large demand for iron—a demand that frequently cannot be met through the physiologic release of iron from RE sources ... if chest pain, wheezing, a fall in blood pressure, or other systemic symptoms occur, the infusion of iron should be stopped immediately Other Hypoproliferative Anemias In addition to mild to ... categories: (1) chronic inflammation, (2) renal disease, (3) endocrine and nutritional deficiencies (hypometabolic states), and (4) marrow damage (Chap 102) With chronic inflammation, renal disease,...

Ngày tải lên: 07/07/2014, 04:20

... (TNF) and interferon γ (IFNγ), neoplasms and bacterial infections suppress erythropoietin (EPO) production and the proliferation of erythroid progenitors [erythroid burst-forming units and erythroid ... the severity and characteristics of the anemia For instance, many patients with cancer also have anemia that is typically normocytic and normochromic In contrast, patients with long-standing active ... the response to EPO Hepcidin, made by the liver, is increased in inflammation and acts to suppress iron absorption and iron release from storage sites The overall result is a chronic hypoproliferative...

Ngày tải lên: 07/07/2014, 04:20

... as hypothyroidism and starvation) where metabolic activity, and thus O2 demand, is decreased Endocrine Deficiency States The difference in the levels of hemoglobin between men and women is related ... men and women is related to the effects of androgen and estrogen on erythropoiesis Testosterone and anabolic steroids augment erythropoiesis; castration and estrogen administration to males decrease ... Red cells are typically normocytic and normochromic, and reticulocytes are decreased The anemia is primarily due to a failure to produce adequate amounts of EPO and a reduction in red cell survival...

Ngày tải lên: 07/07/2014, 04:20

... CNL, and CEL, which is usually measured in years, and their high rate of transformation into acute leukemia By contrast, the natural history of PV, IMF, and ET is usually measured in decades, and ... mutagenic agents This chapter, therefore, will focus only on PV, IMF, and ET, because their clinical overlap is substantial and their clinical courses are distinctly different Other chronic myeloproliferative ... leukemia (CNL) and chronic eosinophilic leukemia (CEL) express primarily a myeloid phenotype, while in others, such as polycythemia vera (PV), idiopathic myelofibrosis (IMF), and essential thrombocytosis...

Ngày tải lên: 07/07/2014, 04:20

... the erythropoietinindependent erythroid colony formation, and the hypersensitivity of PV erythroid progenitor cells to erythropoietin and other hematopoietic growth factors, their resistance to ... induced in the erythropoietin and thrombopoietin receptors following binding to erythropoietin or thrombopoietin leads to JAK2 autophosphorylation, receptor phosphorylation, and phosphorylation of proteins ... terminal differentiation, and their increase in Bcl-XL expression, all of which are characteristic in PV Importantly, the JAK2 gene is located on the short arm of chromosome 9, and loss of heterozygosity...

Ngày tải lên: 07/07/2014, 04:20

... previous hemoglobin levels and a family study are important Other laboratory studies that may aid in diagnosis include the red cell count, mean corpuscular volume, and red cell distribution width ... erythropoietin production, in which case assessment of pulmonary function and an abdominal CT scan to evaluate renal and hepatic anatomy are appropriate A normal erythropoietin level does not ... erythrocytosis: β-thalassemia trait, hypoxic erythrocytosis, and PV With β-thalassemia trait the RDW is normal, whereas with hypoxic erythrocytosis and PV, the RDW is usually elevated due to iron deficiency...

Ngày tải lên: 07/07/2014, 04:20

... of myelofibrosis and the extent of extramedullary hematopoiesis are also not related Fibrosis in this disorder is associated with overproduction of transforming growth factor and tissue inhibitors ... IMF are polyclonal and not part of the neoplastic clone Clinical Features No signs or symptoms are specific for chronic IMF Many patients are asymptomatic at presentation, and the disease is ... of splenic enlargement and/ or abnormal blood counts during a routine examination However, in contrast to its companion myeloproliferative disorders, night sweats, fatigue, and weight loss may be...

Ngày tải lên: 07/07/2014, 04:20

... disorders PV and ET, express the JAK2 V617F mutation, often as homozygotes Such patients had a poorer survival in one retrospective study but not in another, where they were found to be older and to ... extramedullary hematopoiesis, while the presence of leukocytosis, thrombocytosis with large and bizarre platelets, and circulating myelocytes suggests the presence of a myeloproliferative disorder as ... will reveal a hypercellular marrow with trilineage hyperplasia and, in particular, increased numbers of megakaryocytes in clusters and with large, dysplastic nuclei However, there are no characteristic...

Ngày tải lên: 07/07/2014, 04:20

Ngày tải lên: 07/07/2014, 04:20

... is, at best, temporarily palliative and associated with a significant risk of neutropenia and infection Allopurinol can control significant hyperuricemia, and hydroxyurea has proved useful for ... undefined and its side effects are more pronounced in the older individuals who are usually afflicted with this disorder Glucocorticoids have been used to control constitutional symptoms and autoimmune ... autoimmune complications and may ameliorate anemia alone or in combination with low dose thalidomide (50–100 mg/d) Allogeneic bone marrow transplantation is the only curative treatment and should be considered...

Ngày tải lên: 07/07/2014, 04:20

... erythropoietin, thrombopoietin is produced in both the liver and the kidneys, and an inverse correlation exists between the platelet count and plasma thrombopoietic activity Like erythropoietin, plasma ... informative women patients, and by the expression in patients of nonrandom, though variable, cytogenetic abnormalities Although thrombocytosis is its principal manifestation, like the other chronic myeloproliferative ... hyperplasia and hypertrophy, as well as an overall increase in marrow cellularity If marrow reticulin is increased, another diagnosis should be considered The absence of stainable iron demands an...

Ngày tải lên: 07/07/2014, 04:20