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Describe causes of low ESR.
Low ESR is due to low plasma protein or abnormal red cells making rouleaux formation impossible, and is due to: – Polycythemia – Congestive cardiac failure (CCF) – Sickle cell anaemia – Spherocytosis – Congenital fibrinogen deficiency Enumerate causes of elevated ESR.
Normal ESR in male is 0–15 mm/hr and in women it is 0–20 mm/hr. ESR is increased in: – All acute and chronic infections (particularly tuberculosis) – Inflammatory disorders e.g., collagen vascular diseases (SLE), rheumatoid arthritis, vasculitis (e.g, temporal arteritis) – Severe anaemia due to any cause – Advanced malignancy – Multiple myeloma – Pregnancy – Old age – Acute rheumatic carditis (i.e., from acute rheumatic fever). Why there is anaemia in cirrhosis, malaria, kala-azar and chronic renal failure
(CRF)? Cirrhosis of liver: – Haematemesis and/or melaena – Anorexia developing into malnutrition – Malabsorption – Hypersplenism – Haemolysis in alcoholic cirrhosis. Malaria: – Haemolysis – Impaired erythropoiesis – Splenomegaly with hypersplenism – Folate deficiency (increased demand). Kala-azar: – Hypoproteinaemia (malnutrition), bleeding, haemodilution – Bone marrow depression (due to proliferation of reticulo-endothelial cells) – Haemolysis (rare) – Hypersplenism. Chronic renal failure (CRF): – Decreased erythropoiesis due to relative deficiency of erythropoietin – Anorexia-induced reduced dietary intake – Decreased red cell survival – Reduced intestinal absorption of iron – Diminished erythropoiesis as a result of uraemic toxins – Increased blood loss due to abnormal platelet function and increased capillary fragility – Vitamin B12 and folic acid deficiency. What are the cardiovascular features in severe anaemia?
The features are: Tachycardia, capillary pulsation Water-hammer pulse Cervical venous hum Cardiomegaly (cardiac enlargement) and signs of heart failure (later), hyperdynamicapex, haemic murmur over pulmonary area, mitral systolic murmur due to functionalmitral regurgitation (MR), rarely mid-diastolic murmur in mitral area secondary toincreased blood flow.NB: Tachycardia and systolic flow murmur are usually evident when Hb <7.5 g/dL. What is dimorphic anaemia?
When microcytes and macrocytes both are circulating in the blood, it is known as dimorphic anaemia. It is due to: – Combined iron and vitamin B12/folic acid deficiency – Pregnancy – Hookworm anaemia with nutritional deficiency. What are the clinical features of iron deficiency
anaemia? Common clinical features of iron deficiency anaemia are: 1. H/o pica (eating of non-nutrient items like clay, ice, cornstarch) 2. Pallor 3. Glossitis (pale and smooth tongue) 4. Angular stomatitis, cheilosis (Fig. 2.9) 5. Brittle nails/hairs, koilonychia 6. Dysphagia (Plummer-Vinson syndrome or Patterson-Kelly syndrome) 7. Mild splenomegaly. NB: In iron deficiency anaemia: Serum iron as well as ferrtin is reduced, and TIBC (total iron binding capacity) is increased. What is refractory anaemia?
When anaemia is unresponsive to specific treatment given for optimal period is known as refractory anaemia. The common causes are: – Aplastic anaemia – Sideroblastic anaemia – Myelodysplastic syndrome resulting in refractory anaemia – Anaemia due to leukaemia or aleukaemic leukaemia – Thalassaemia. Causes of iron deficiency anaemia.
Iron deficiency anaemia results from: Nutritional deficiency (i.e., dietary iron deficiency) Bleeding peptic ulcer/haemorrhoids/menorrhagia Gastric erosion (NSAID-induced) Hookworm infestation (schistosomiasis too) Malabsorption syndrome Anaemia of chronic diseases (autoimmune diseases, malignancy) Carcinoma of stomach, lung, colon; ulcerative colitis Pregnancy, lactation and adolescence. Common causes of anaemia
Common causes of anaemia in this part of the world are: Nutritional anaemia Chronic blood loss (bleeding peptic ulcer/haemorrhoids/fibroid)—commonest cause globally Chronic malaria, chronic kala-azar, tuberculosis Thalassaemia Hookworm infestation Tropical sprue. |