when and how often to check blood pressure

... regions, overseas doctors comprise up to 50% of all junior doctors [2]. General Medical Council (GMC), the United King- dom's regulatory and licensing body for doctors, had a total of 239 661 doctors registered ... Changes to immigration policy that fail to factor in the aspirations and needs of doctors who have already migrated to the UK are likely to disrupt the career paths of many non-European doctors, ... Access Research Non-European Union doctors in the National Health Service: why, when and how do they come to the United Kingdom of Great Britain and Northern Ireland? Jyothis T George* 1 , Kavitha...

Ngày tải lên: 18/06/2014, 17:20

... 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 ... Defects Extracorpuscular Factors Hereditary Hemoglobinopathies Familial hemolytic uremic syndrome (HUS) Chapter 101. Hemolytic Anemias and Anemia Due to Acute Blood Loss (Part 1) Harrison's ... 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...

Ngày tải lên: 07/07/2014, 04:20

... aspartate transaminase, and reduced haptoglobin. Urobilinogen will be increased in both urine and stool. If hemolysis is mainly intravascular, the telltale sign is hemoglobinuria, often associated ... pyknosis and actual loss of the nucleus. Reticulocytes Increased Bilirubin Increased (mostly unconjugated) LDH Increased (up to 10X normal with intravascular hemolysis) Haptoglobin Reduced to ... 5 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...

Ngày tải lên: 07/07/2014, 04:20

... needs frequent blood transfusions. Chronic iron overload will cause secondary hemochromatosis; this will cause damage, particularly to the liver, eventually leading to cirrhosis, and to the heart ... 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 ... place in the spleen, as is often the case, splenomegaly may become a prominent feature and hypersplenism may develop, with consequent neutropenia and/ or thrombocytopenia. The increased red...

Ngày tải lên: 07/07/2014, 04:20

... 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 ... (including ankyrin and the so-called band 4.1 and band 4.2), which thus connect these two structures intimately. Figure 101-2 Diagram of red cell membrane/cytoskeleton. (For explanation ... cytoskeleton. The main cytoskeletal protein is spectrin, the basic unit of which is a dimer of α-spectrin and β-spectrin. The membrane is physically linked to the cytoskeleton by a third set of...

Ngày tải lên: 07/07/2014, 04:20

... Anemias and Anemia Due to Acute Blood Loss (Part 6) Peripheral blood smear from patients with membrane-cytoskeleton abnormalities. A. Hereditary spherocytosis. B. Hereditary elliptocytosis, ... elliptocytosis, heterozygote. C. Elliptocytosis, with both alleles of the α-spectrin gene mutated. [From L Luzzatto, in J Gribben and D Pravan (eds): Molecular Hematology, 2d edition. Oxford, Blackwell, ... Blackwell, 2005; with permission.] Table 101-3 Inherited Diseases of the Red Cell Membrane- Cytoskeleton Gene Chromoso mal Location Protei n Produced Disease( s) with Certain Mutations Comment s...

Ngày tải lên: 07/07/2014, 04:20

... prophylaxis postsplenectomy is controversial. 4. HS patients often may require cholecystectomy. It used to be considered mandatory to combine this procedure with splenectomy, but this may not ... HE causing clinical disease is 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 ... first diagnosed when anemia is investigated during pregnancy. The main clinical findings are jaundice, an enlarged spleen, and often gallstones; frequently it is the finding of gallstones in a young...

Ngày tải lên: 07/07/2014, 04:20

... 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; sometimes ... Chapter 101. Hemolytic Anemias and Anemia Due to Acute Blood Loss (Part 8) Abnormalities of the Glycolytic Pathway (Fig. 101-1) Since ... be delayed, and in some cases it is made in young adults—for instance, in a woman during her first pregnancy, when the anemia may get worse. In part the delay in diagnosis is due to the fact...

Ngày tải lên: 07/07/2014, 04:20

... later in life or may even remain asymptomatic and be detected incidentally when a blood count is done for unrelated reasons. The spleen is often enlarged. When other systemic manifestations occur, ... 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 ... 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...

Ngày tải lên: 07/07/2014, 04:20

... 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 ... anemia is over, and in the absence of comorbidity, full recovery from acute HA associated with G6PD deficiency is the rule. Chapter 101. Hemolytic Anemias and Anemia Due to Acute Blood Loss ... remain clinically asymptomatic throughout their lifetime. However, all of them have an increased risk of developing neonatal jaundice (NNJ) and a risk of developing acute HA when challenged by...

Ngày tải lên: 07/07/2014, 04:20

... blood smear Different causes ranging from endothelial damage to heman gioma to leaky prosthetic heart valve March hemoglobinuria Abrupt Mechan ical destruction Targete d history ... of large dish of fava beans; but t rigger can be Chapter 101. Hemolytic Anemias and Anemia Due to Acute Blood Loss (Part 11) Table 101- 5 Drugs that Carry Risk of Clinical Hemolysis in ... Primaquine Chloroq uine Quinine Dapsone/chlorp roguanil Sulphonamides/s ulphones Sulphametoxaz ole Sulfasala zine Sulfisoxaz ole Phenazopyridin e (Pyridium) Acetamino phen Phenacetin ...

Ngày tải lên: 07/07/2014, 04:20

... exposure to potentially hemolytic drugs, and blood transfusion may be indicated when exacerbations occur, mostly in concomitance with intercurrent infection. In rare patients, regular blood transfusions ... increased susceptibility to bacterial infections. Laboratory Diagnosis The suspicion of G6PD deficiency can be confirmed by semiquantitative methods often referred to as screening tests, which ... of NNJ 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...

Ngày tải lên: 07/07/2014, 04:20

... due to a contaminated blood unit. Occasionally HA is seen, especially in children, with sepsis or endocarditis from a variety of organisms. Chapter 101. Hemolytic Anemias and Anemia Due to ... prosthetic heart valves, especially when paraprosthetic regurgitation is present. If the hemolysis consequent to mechanical trauma to the red cells is mild, and provided the supply of iron is ... hemolysis is due to an inherited defect, but this is external to drumming. The other situation, which has been called microangiopathic hemolytic anemia, (Table 101-6) is chronic and iatrogenic;...

Ngày tải lên: 07/07/2014, 04:20

Ngày tải lên: 07/07/2014, 04:20

Ngày tải lên: 07/07/2014, 04:20

Ngày tải lên: 07/07/2014, 04:20

Ngày tải lên: 07/07/2014, 04:20

Ngày tải lên: 10/08/2014, 10:23

Ngày tải lên: 12/08/2014, 22:22

Ngày tải lên: 13/08/2014, 11:22