All you need to Know about Anemia 0

When we think of Anemia, 2 structures come to mind: Hemoglobin and Red Blood Cells (Erythrocytes)

Red Blood Cells, produced continuously, in the Bone Marrow, contain Hemoglobin, the bright Red oxygen-carrier protein which gives blood its colour.

Red Blood Cells (RBC) deliver Oxygen to all the body cells and tissues.

The Term Anemia is used to describe the condition, in which there is a decrease in the number of circulating RBCs and/or a decrease in the haemoglobin content of the RBCs.

 

 

Anaemia is unnatural, it is a sign of an underlying medical problem.

Anaemia is diagnosed when the haemoglobin is <13.5 g/dl in men (<12.0g/dl in women)

CAUSES

Anaemia results from one of three situations:

. Blood Loss

. RBC Underproduction

. RBC Destruction

Reticulocytes are immature RBCs freshly released from the bone marrow.

It usually takes 1 day for reticulocytes to transform into matured RBCs.

In very severe anaemia, these immature RBCs could be recruited much earlier from the bone marrow, and it may take 2-3 days for them to reach maturity.

The Reticulocyte count is elevated when there is increased RBC destruction or Blood loss.

The reticulocyte count is low in RBC underproduction.

Under light microscopy, Reticulocytes are larger than mature RBCs and contain bluish strands

SIGNS & SYMPTOMS OF ANEMIA.

Commonest sign: Exhaustion

Symptoms of Anemia

. Weakness, Shortness of breath, Irritability, Dizziness, Palpitations, Headaches, Cold hands and feet

. Pale palms, skin and mucous membranes and Chest pain.

RISK FACTORS FOR ANEMIA

The risk of anaemia increases with age.

. Poor Diet

. Intestinal disorders: poor absorption, worm infestations like hookworm, bleeding

. Women: Menstruating and Pregnant women.

. Chronic medical conditions: Kidney, Liver, Thyroid Cancers, Arthritis and Autoimmune diseases

MEAN CELL VOLUME (MCV)

The sizes/volume of RBCs can be used to characterize certain Anemias.

The volume of normal RBCs ranges between 80-100 femtoliters (FL)

ANAEMIA ASSOCIATED WITH A MEAN CELL VOLUME LESS THAN 80 FL:

. Iron Deficiency Anemia.

. Thalassemia.

ANAEMIA ASSOCIATED WITH A MEAN CELL VOLUME GREATER THAN 100 FL

. Vitamin B12 or Folic Acid deficiency.

. Alcohol and Drugs toxicity.

. Liver diseases.

. Under-functioning Thyroid

ANAEMIA WITH NORMAL CELL VOLUME

. Kidney diseases.

. Sickle disease

. Anaemias associated with chronic inflammations.

We shall limit this anaemia discussion, to the Nutritional Anemias.

IRON DEFICIENCY ANEMIA.

Haemoglobin has 2-parts: a protein GLOBIN, and HEME, components.

Iron is required for heme synthesis.

Dietary Iron is absorbed from the duodenum in ferrous form, transported by a carrier protein transferrin in the ferric form, and stored in liver Spleen, Lymph nodes as Ferritin.

Iron is released from storage to the bone marrow when required.

Hepcidin is a peptide hormone produced by the liver in response to more than adequate body iron.

Hepcidin production is suppressed during iron deficiency.

Hepcidin regulates iron in one of 2 ways

Decreases iron absorption from the intestine

Decreases iron release from storage forms.

SPECIFIC SYMPTOMS OF IRON DEFICIENCY ANEMIA

. PICA: Craving for non-dietary substances, especially: ICE CUBES/CLAY/PAPER

. Restless Leg syndrome: nocturnal leg discomfort improved by moving the legs.

. Hair loss

DIAGNOSIS OF IRON DEFICIENCY ANEMIA.

The decrease in iron stores/levels precedes the Anemia. Anaemia precedes RBC morphological changes.

. Serum iron may be low or even normal

. Elevated TIBC. The Total Iron Binding Capacity (TIBC) measures available plasma transferrin level

. Transferrin Saturation of < 15%. [Transferrin saturation= Serum Iron/TIBC].

. Serum Ferritin <12ng/ml [Serum Ferritin is a measure of total iron stores].

. Microcytic and hypochromic (pale) RBCs on microscopy are the hallmarks of Iron Deficiency Anemia.

MANAGEMENT IRON DEFICIENCY ANEMIA.

For premenopausal women, menstrual blood loses are the usual causes. Uterine fibroids (sub-mucus) can cause excessive menstrual blood loss.

However, in post-menopausal women and in all adult men, a cause must be investigated.

A screening endoscopy/Colonoscopy for Cancers, polyps and haemorrhoids must be done.

IRON SUPPLEMENTS

ORAL IRON SUPPLEMENTS

FERROUS SULFATE tablets.

Ferrous sulfate tablets are cheap and they are as effective as the newer costly oral iron preparations.

Take the tablets 2-3 times a day to provide 150-200mg of elemental iron daily

When treatment is effective, Reticulocyte count improves within 1 week. Treatment must be continued until Ferritin levels have improved.

Treating H. pylori infections and hypothyroid conditions may improve the response to oral iron therapy.

PARENTERAL IRON TREATMENT

. Intravenous iron infusion for those intolerable to oral iron and those with poor iron absorption.

. Packed RBC Transfusion for severe and symptomatic anaemia, and in those with kidney damage.

ANEMIA DUE TO COBALAMIN (VITAMIN B12) DEFICIENCY.

Cobalamin is not produced in plants. It is found in animals. It is stored in the liver and adequate storage can last for 2-3 years

Cobalamin is a cofactor in 2 enzymatic reactions:

Addition of methyl group (-CH3) to Homocysteine to form Methionine (methionine synthetase)

Interchange of Methyl malonyl-CoA to Succinyl-CoA (methyl malonyl CoA mutase)

Deficiency of Cobalamin lead to rising levels of Homocysteine and Methylmalonic acids.

Cobalamin deficiency adversely affect

. Myelination of Nerves, leading nerves and psychiatric problems

. Abnormalities in the Marrow production of blood cells. RBCs become large, and disintegrate in the bone marrow, while the nuclei of granulated WBCs become hyper-segmented.

Pernicious Anemia

Severe cobalamin deficiency is due to the destruction of parietal cells in the stomach. Parietal cells produce intrinsic factor, which is required for cobalamin absorption.

Symptoms

Anaemia and RBCs destruction.

Nerves Abnormalities: Numbness, Loss of vibratory sense Gait abnormalities, and neuropsychiatry problems.

Autoimmune disorders: Diabetes, thyroid diseases and vitiligo

DIAGNOSIS:

Laboratory:

. MVC >100 FL, Decreased Reticulocyte counts, Neutrophils have >/= 6 lobes.

. Serum cobalamin level less than 200 picogram/ml is suggestive of Vitamin B12 deficiency.

. Elevated Methyl-malonic acid and Homocysteine levels

TREATMENT

High dose oral Vitamin B12 supplements 1000-2000 mcg/day. (This works for those with intrinsic factor deficiency too).

Parenteral B12 therapy is reserved for those with severe anaemia/ nerve abnormalities/ not responding to high dose oral supplements

FOLIC ACID DEFICIENCY

Folic acid abounds in animal and plants: Broccoli, spinach, cocoyam leaf, lemons and mushrooms.

Folic Acid is required for DNA synthesis.

Risk factors for folic acid deficiency: Alcoholic, Nursing home and older people, pregnancy and lactation, as well as taking some medications like Phenytoin, Trimethoprim and methotrexate.

Unlike Vitamin B12, Folic acid is not well stored in the body and deficiency may occur in weeks.

Folic acid deficiency leads to abnormalities in marrow cell lines and production

No associated Neurologic abnormalities in Folic acid deficiency. Symptoms are related to anaemia only.

LABORATORY:

Macrocytic Anemia (MCV >100 FL, Hyper-segmented Neutrophils

Elevated Homocysteine levels. (Methionine levels are normal in folic acid deficiency)

TREATMENT OF FOLIC ACID DEFICIENCY

Oral Folic acid 5mg/day

Before starting the folic acid supplements, exclude Cobalamin deficiency. The anaemia symptoms associated with cobalamin deficiency improves with folic acid supplements, but the nerve damage persists.

ANAEMIA ASSOCIATED WITH CHRONIC DISEASES/INFLAMMATION ANEMIA

In chronic diseases, the inflammation releases chemicals (cytokine-like: IL-6, IL-1) that induce HEPCIDIN production. Hepcidin blunts the Erythropoietin response to Anemia.

. The RBCs have normal structure

. Serum Iron and TIBC are low

Management include; Eliminating the underlying disorder, and maximizing the iron treatment.

ANAEMIA OF KIDNEY DISEASE.

In kidney diseases, the anemia is primarily due to decrease Erythropoietin production. Erythropoietin is produced by the kidneys. Erythropoietin signals to the Bone Marrow to make new RBCs.

Bone marrow suppression from Uremia and a decrease in the lifespan of RBCs, contribute to anemia.

Serum erythropoietin levels do not reflect the functional and absolute erythropoietin deficiencies, so measurement of erythropoietin levels is not helpful in diagnosing anemia of kidney diseases.

RBCs are morphologically normal in kidney diseases. The RBCs may morphologically change to ‘burr cells’ (echinocytes) in severe acidosis.

in The Reticulocyte count is low.

TREATMENT: Erythropoietin stimulating agents

Source: Dr Alex K Sarkodie

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Risk Factors of Cervical Cancer 0

Today, we are going to discuss some of the risk factors of cervical cancer. They are many that it will not be possible for us to exhaust all of them, but let us see how far we can go today.

1) HUMAN PAPILLOMAVIRUS INFECTION (HPV): This is the most important of all the risk factors associated with the cancer of the cervix. Doctors believe that before a woman can develop cervical cancer, she must have been infected by HPV. Some types of this HPV are classified as “high risk” because they are the main causes of cervical cancer. These types include HPV 6, HPV 18, HPV 31, HPV 35, and HPV 45 and many other. About two-thirds of all cervical cancers are caused by HPV 16-18.

2) Smoking: Women who smoke are more likely to get cervical cancer than women who don’t smoke. Smoking exposes the body to many cancer-causing chemicals that affect not only the lungs but other parts of the body. The lungs will, first of all, absorb these harmful substances, and later transfer it into the bloodstream throughout the body. The by-products of tobacco have been found in the cervical mucus of women who smoke. These substances damage the DNA of the cervix cells and may equally lead to the development of cervical cancer.

3) IMMUNOSUPPRESSION: Human immunodeficiency virus (HIV) is the virus that causes AIDS. This virus damages the immune system of the body completely and makes women be more at risk for HPV infection. This is one of the causes of an increased risk of cervical cancer in women with AIDS. The immune system is very important in destroying cancer cells, and slowing down their growth and spread. A cervical pre-cancer is likely to develop into invasive cancer faster in women with HIV.

4) CHLAMYDIA INFECTION: This is a very common bacterium that can infect the reproductive system. The spread is mainly through sexual contact. Women whose blood tests show past or present Chlamydia infection are at a higher risk of cervical cancer, as against women with normal test results. This type of infection often shows no symptoms in women. Unless a woman goes for the examination of her pelvic region, she may not know that she is infected with Chlamydia. When this stays long in the body, it leads to pelvic inflammation, which also leads to infertility.

5) DIETS: Diets low in fruits and vegetables can increase the risk of cervical cancer. Also, overweight can equally lead to cervical cancer.

6) BIRTH CONTROL PILLS: The usage of birth control pills for a long time increases the risk of cervical cancer in women. The longer these pills are used, the risk goes up and goes down after it is stopped.

7) MULTIPLE PREGNANCIES: Women with many full-time pregnancies have an increased risk of the cancer of the cervix. This may be because some of these women may have been exposed to unprotected sexual acts which have therefore exposed them to HPV infection. This is because the immune system of the pregnant woman is weak, which allows for HPV infection/ cancer growth.

8) LOW SOCIO-ECONOMIC STATUS: Many women with low income don’t have access to adequate health care services, including pap tests, and the implication of this is that they will not be screened or treated for pre-cancerous cervical diseases.

9) FAMILY HISTORY: Cervical cancer runs in some families. If your mother or sister has cervical cancer, your risk of developing this disease is higher. Women from the same family as a patient already diagnosed of cervical cancer may be more likely to have one or more of the other non-genetic risk factors previously described in this section.

I will love to hear what are your own views or opinions on this post

 

30 Things You Need to Know About Herpes 0

1. Genital herpes is caused by two forms of the herpes simplex viruses: HSV-1 or HSV-2.
2. Most oral herpes is caused by HSV-1, and most genital herpes is caused by HSV-2.
3. Most people do not show signs or symptoms from HSV-1 or HSV-2 infection.
4. At least 45 million people ages 12 and older, or 20% of U. S. adolescents and adults, have had genital herpes.
5. Genital HSV-2 infection is more common in women (approximately one out of four women) than in men (almost one out of eight).
6. Both herpes Type 1 and 2 can be transmitted by contact with the sores that the herpes viruses cause, but also between outbreaks (sometimes called OBs) via “shedding” from skin that does not have a sore on it. 
7. Herpes transmission frequently occurs from an infected partner who does not have a visible sore, and may not even know that he or she is infected with the virus.
8. Genital OBs of HSV-1 recur less frequently than genital outbreaks caused by HSV-2.
9. First symptoms of genital herpes, they can be quite intense. Subsequent OBs are milder. Symptoms can include:
10. A small area of redness, sometimes with raised bumps or fluid-filled blisters;
11. Itching, burning or tingling in the genital area;
12. Flu-like symptoms (a headache, swollen glands, fever);
13. Painful urination and/or discharge.
14. Initial herpes outbreak usually occurs within two weeks after the virus is transmitted, and the sores usually heal within two to four weeks.
15. Sometimes, a person does not become aware of the infection until years after it is acquired.
16. Do not squeeze OB blisters because that may cause infection to spread.
17. Genital herpes infection can be more severe in people with immune systems depressed due to other causes.

  1. Genital herpes can cause psychological distress in people who know they are infected, due particularly to the attached social stigma.

    19. Any area in the groin can be affected by genital herpes.

    20. Herpes is not the only infection that causes genital sores. Bacterial infections have also been known to cause sores that resemble herpes sores. So, it’s best to get tested.
    21. Genital herpes can lead to potentially fatal infections in babies.
    22. Genital herpes can sometimes be diagnosed by visual inspection of the outbreak, or by taking an actual sample from a sore.
    23. The only sure way to avoid getting herpes and other STDs is abstinence, or a long-term, mutually monogamous relationship with someone who is not infected.
    24. If you inform your partner of your herpes, you can discuss it instead of making excuses as to why you don’t want to have sex.
    25. Genital herpes caused by HSV-2 carries an 80-90% chance of OBs.
    26. Genital herpes caused by HSV-1 carries a 50% chance of OBs.
    27. OB sores can occur in areas that are not covered by a latex condom, so condoms are not fool-proof in protecting from contracting genital herpes.
    28. Even if a person does not have any symptoms he or she can still infect sex partners.
    29. You can’t get herpes from swimming pools, towels or toilet seats.
    30. Frequency and severity of herpes OBs vary between individuals.

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