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Chapter 098. Iron Deficiency and Other Hypoproliferative Anemias (Part 1) pps
Ngày tải lên :
07/07/2014, 04:20
... shown in Table 98 -1 Without iron, cells lose their capacity for electron transport and energy metabolism In erythroid cells, hemoglobin synthesis is impaired, resulting in anemia and reduced O delivery ... tissue Table 98 -1 Body Iron Distribution Iron Content, mg Adult Male, 80 kg Adult Female, 60 kg Hemoglobin 2500 17 00 Myoglobin/enzymes 500 300 Transferrin iron 3 Iron stores 600 10 00 0–300 The ... iron in the presence of iron deficiency is as short as 10 15 With suppression of erythropoiesis, the plasma iron level typically increases and the half-clearance time may be prolonged to several...
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Chapter 103. Polycythemia Vera and Other Myeloproliferative Diseases (Part 1) potx
Ngày tải lên :
07/07/2014, 04:20
... consequence of the balanced translocation between chromosomes and 22 [t(9;22)(q34 ;11 )]; CNL has been associated with a t (15 :19 ) translocation, and CEL with a deletion or balanced translocations involving ... capable of transforming into each other Table 10 3 -1 WHO Classification of Chronic Myeloproliferative Disorders Chronic myelogenous leukemia, [Ph chromosome t(9;22)(q34 ;11 ), BCR/ABL-positive] Chronic ... 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...
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Chapter 135. Gas Gangrene and Other Clostridial Infections (Part 1) pps
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08/07/2014, 02:20
... by boiling C tetani and C botulinum are discussed in detail in Chaps 13 3 and 13 4, respectively Clostridia are present in the normal colonic flora at concentrations of 10 9– 10 10/g Of the ≥30 species ... strains induce less leukocyte aggregation when α toxin is absent and none when θ toxin is missing The other major toxins—β, ε, and 1 are known to increase capillary permeability ... difficile is discussed in Chap 12 3 Etiology In humans, clostridia normally reside in the gastrointestinal tract and in the female genital tract, although they occasionally are isolated from the...
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Chapter 098. Iron Deficiency and Other Hypoproliferative Anemias (Part 2) pot
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 ... of the red cell mass and will not become available for reutilization until the red cell dies In a normal individual, the average red cell life span is 12 0 days Thus, 0.8– 1. 0% of red cells turn ... about mg/d is required from the diet in men, 1. 4 mg/d in women to maintain homeostasis As long as transferrin saturation is maintained between 20–60% and erythropoiesis is not increased, iron stores...
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Chapter 098. Iron Deficiency and Other Hypoproliferative Anemias (Part 3) ppsx
Ngày tải lên :
07/07/2014, 04:20
... deficiency and accounts for around 8 41, 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 ... United States, the average iron intake in an adult male is 15 mg/d with 6% absorption; for the average female, the daily intake is 11 mg/d with 12 % absorption An individual with iron deficiency can ... 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...
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Chapter 098. Iron Deficiency and Other Hypoproliferative Anemias (Part 4) docx
Ngày tải lên :
07/07/2014, 04:20
... this point is 10 15 % When moderate anemia is present (hemoglobin 10 13 g/dL), the bone marrow remains hypoproliferative With more severe anemia (hemoglobin 7–8 g/dL), hypochromia and microcytosis ... 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 ... 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...
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Chapter 098. Iron Deficiency and Other Hypoproliferative Anemias (Part 5) ppsx
Ngày tải lên :
07/07/2014, 04:20
... serum ferritin falls to
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Chapter 098. Iron Deficiency and Other Hypoproliferative Anemias (Part 6) doc
Ngày tải lên :
07/07/2014, 04:20
... 800 10 00 3+ 60 15 0 1 2 g 4+ >15 0 Iron overload — >500 10 00 mg Red Cell Protoporphyrin Levels Protoporphyrin is an intermediate ... increasingly available and, along with the serum ferritin, has been proposed to distinguish between iron deficiency and the anemia of chronic inflammation (see below) Differential Diagnosis Other than iron ... targeting SI
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Chapter 098. Iron Deficiency and Other Hypoproliferative Anemias (Part 7) pdf
Ngày tải lên :
07/07/2014, 04:20
... Content), mg in mL 325 (65) 300 (60) 19 5 (39) 90 (18 ) Extended release 525 (10 5) Ferrous fumarate 325 (10 7) 19 5 (64) Ferrous 10 0 (33) 325 (39) 300 (35) 15 0 (15 0) 10 0 (10 0) gluconate Polysaccharide iron ... to repair the anemia, but also to provide stores of at least 0.5 1. 0 g of iron Sustained treatment for a period of 6 12 months after correction of the anemia will be necessary to achieve this ... 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...
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Chapter 098. Iron Deficiency and Other Hypoproliferative Anemias (Part 8) pdf
Ngày tải lên :
07/07/2014, 04:20
... divided into four categories: (1) chronic inflammation, (2) renal disease, (3) endocrine and nutritional deficiencies (hypometabolic states), and (4) marrow damage (Chap 10 2) With chronic inflammation, ... 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 ... latter approach is common in dialysis centers, where it is not unusual for 10 0 mg of elemental iron to be given weekly for 10 weeks to augment the response to recombinant EPO therapy The amount of...
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Chapter 098. Iron Deficiency and Other Hypoproliferative Anemias (Part 9) pot
Ngày tải lên :
07/07/2014, 04:20
... well tolerated, and symptoms, if present, are associated with the underlying disease Occasionally, in patients with preexisting cardiac disease, moderate anemia (hemoglobin 10 11 g/dL) may be ... patients with vasculitis and rheumatoid arthritis include interleukin (IL -1) and IFN-γ The red arrows indicate sites of inflammatory cytokine inhibitory effects Interleukin (IL -1) directly decreases ... (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...
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Chapter 098. Iron Deficiency and Other Hypoproliferative Anemias (Part 11) pps
Ngày tải lên :
07/07/2014, 04:20
... homeostasis N Engl J Med 352 :17 41, 2005 [PMID: 15 85 818 1] Ganz T: Hepcidin, a key regulator of iron metabolism and mediator of inflammation Blood 10 2:783, 2003 [PMID: 12 663437] Hillman RS et al: ... disease patients Am J Kidney Dis 35 :1, 2000 [PMID: 10 620537] Brugnara C: Iron deficiency and erythropoiesis: New diagnostic approaches Clin Chem 49 :15 73, 2003 [PMID: 14 500582] Fleming RE, Bacon BR: ... alfa, permitting weekly or every other week dosing Acknowledgment Dr Robert S Hillman was the author of this chapter in the 14 th edition, and material from his chapter has been retained Further...
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Chapter 103. Polycythemia Vera and Other Myeloproliferative Diseases (Part 2) doc
Ngày tải lên :
07/07/2014, 04:20
... JAK2 V 617 F heterozygotes become homozygotes, but usually not after 10 years of the disease PV patients who not express JAK2 V 617 F are not clinically different than those who do, nor JAK2 V 617 F heterozygotes ... of the malignant clone express JAK2 V 617 F Fifth, JAK2 V 617 F has been observed in patients with long-standing idiopathic erythrocytosis However, while JAK2 V 617 F alone may not be sufficient to cause ... the erythropoietinindependent erythroid colony formation, and the hypersensitivity of PV erythroid progenitor cells to erythropoietin and other hematopoietic growth factors, their resistance to...
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Chapter 103. Polycythemia Vera and Other Myeloproliferative Diseases (Part 3) pptx
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 ... evaluation of suspected erythrocytosis Table 10 3-2 Causes of Erythrocytosis Relative erythrocytosis: Hemoconcentration secondary to dehydration, androgens, or tobacco abuse Absolute erythrocytosis ... 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...
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Chapter 103. Polycythemia Vera and Other Myeloproliferative Diseases (Part 5) pot
Ngày tải lên :
07/07/2014, 04:20
... nucleated red cells, myelocytes, and promyelocytes; myeloblasts may also be present (Fig 10 3 -1) Anemia, usually mild initially, is the rule, while the leukocyte and platelet counts are either normal ... sufficiently rapid to cause splenic infarction with fever and pleuritic chest pain Hyperuricemia and secondary gout may ensue Figure 10 3 -1 Teardrop-shaped red blood cells indicative of membrane ... Etiology The etiology of chronic IMF is unknown Nonrandom chromosome abnormalities such as 9p, 20q–, 13 q–, trisomy or 9, or partial trisomy 1q are common, but no cytogenetic abnormality specific...
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Chapter 103. Polycythemia Vera and Other Myeloproliferative Diseases (Part 6) ppt
Ngày tải lên :
07/07/2014, 04:20
... disorders PV and ET, express the JAK2 V 617 F 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 ... cells, myelocytes, and promyelocytes establishes the presence of extramedullary hematopoiesis, while the presence of leukocytosis, thrombocytosis with large and bizarre platelets, and circulating ... myelofibrosis (Table 10 3-3) Marrow is usually not aspirable due to increased marrow reticulin, but marrow biopsy will reveal a hypercellular marrow with trilineage hyperplasia and, in particular,...
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Chapter 103. Polycythemia Vera and Other Myeloproliferative Diseases (Part 7) pdf
Ngày tải lên :
07/07/2014, 04:20
... Hemoglobin >10 gm% Karyotype: Normal 70 Abnormal 78 a From B Dupriez et al Blood 88 :10 13, 19 96 b From F Cervantes et al Br J Haematol 10 2:684, 19 98 c From JT Reilly et al Br J Haematol 98:96, 19 97 ... Low 93 1 2 High 17 Risk group Median survival B Prognostic factorsb Hemoglobin < 10 gm% Constitutional symptoms Blast cells > 1% Number of prognostic factors (months) 0 1 Low 99 2–3 High 21 C Prognostic ... Hemoglobin 10 gm% Karyotype: Normal 54 Abnormal 22 Age 10 gm% Karyotype: Normal 18 0 Abnormal 72 Age >65 years Hemoglobin 10 gm% Karyotype: Normal 44 Abnormal 16 Age >65...
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Chapter 103. Polycythemia Vera and Other Myeloproliferative Diseases (Part 8) potx
Ngày tải lên :
07/07/2014, 04:20
... definable cause ET is an uncommon disorder, with an incidence of 1 2 /10 0,000 and a distinct female predominance, in contrast to the other chronic myeloproliferative disorders No clonal marker is ... autoimmune complications and may ameliorate anemia alone or in combination with low dose thalidomide (50 10 0 mg/d) Allogeneic bone marrow transplantation is the only curative treatment and should be considered ... 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...
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Chapter 103. Polycythemia Vera and Other Myeloproliferative Diseases (Part 9) docx
Ngày tải lên :
07/07/2014, 04:20
... chromosomes and 1, where the genes for thrombopoietin and its receptor Mpl, respectively, are located Diagnosis Thrombocytosis is encountered in a broad variety of clinical disorders (Table 10 3-5) ... distinguishing between benign and clonal causes of thrombocytosis About 50% of ET patients express the JAK2 V 617 F mutation When JAK2 V 617 F is absent, cytogenetic evaluation is mandatory to determine ... 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...
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