liveonearth (liveonearth) wrote,

Grand Rounds (week 7): Dr Kate Wiggin on Hematology

I'm not taking notes on the cases themselves, just on factoids.

TBI-->3x greater risk if 2nd injury, 8x more subsequent

high dose vit C negates these 4 UA values: gluc, blood, bili, nitrates
see hematuria 3x-->get more dx, cystoscopy

strep in GI: requires blood to live, no blood, no strep
Klebsiella found in 40% of human guts, if moderate then slight concern

dx = ferritin over 200 in menstruating women, over 300 in men or postmeno female
TIBC tends to decrease, serum Fe is high, saturation is high
iron storage in: RBCs, Liver, macrophages, BM, myoglobin
DDX: infx lowers serum Fe: if IL1 and IL6 are elevated then ferritin is moved into macrophages (sequestration)
DDX: ferritin = acute phase reactant prot, increased with liver dz, infx, inflam, malig
DDX for high iron with overload: hemochromatosis, alcohol excess, porphyria cutanea tarda (enz in heme catab malfx)
GENETICS: HFE gene on Xsm 6 has 11 products, expressed in liver, intestine and immune system cells
who gets HH: males 40-60, northern Eur descent
incidence in US: 5/1000 genetic
C282Y genotype carries dz, H63D mutation not associated with hemochromatosis unless heterozygous with 282Y
DDX: incr Fe without overload: NASH, hep B/C, alc, chronic infx, RA, IBD, hematologic malig, thyrotoxicosis
IL4 and IL13 enhance Fe uptake and storage (Th2)

maintaining healthy BMI increases prognostic status
stages: 0-4, 4 is advanced/mets

topical ferrous sulfate compounded at 200mg/gram
sig: apply 1g qd x3mo to wrists, thighs, armpits
SE: may turn teeth/fingernails gray, brush with baking soda
good for peds or people with constip prob
has a scent

rubriblast-->pro-->cyte (makes HGB)-->meta (looses nucleus)-->reticulocyte (matures in 24 hours)-->erythrocyte (lives 120 days)

esp in ca pt who has been txd with chemo, rad?
RI, retic index is caculated to assess bone marrow fx in anemia
RI = retic% x pt's HCT/normal HCT x 1.1.85
normal HCT for females given as 45
(in case calculated value is 0.29, less than 2 means not enough bone marrow prolif)

vit D comes in 100,000 IU/ml compounded D2 for injx
she injx 1/2 ml/week for pts in need

gives weekly shots to pts with bone marrow probs
if serum level is high with little response: test to see if it is utilized: MMA in urine
gives breakdown products to know if it's being used

icterus intermittentus
mc hereditary cause of incr bili
~5% of pop, dental journals say up to 10%
elevated unconjugated bili
decr glucuronyl transferase enzyme which solubilizes bili in liver
20% conjugated in intestine, spike in tbil after round of abx kill off gut bugs?
sx: fatigue, poor concentration, loss of appetitie, abd pain, wt loss
assoc c decreased coronary artery disease
watch bili, indirect bili, and MCV
tx: consider LDN to decrease inflammation (upregs enkephalins during sleep)
naltrexone at 100-200mg/d is addicting, she uses doses of 2-4mg qhs
tx: B12 and folate galore

consider LDN for this too
iodine and selenium needed by thyroid
heavy metals can interfere with uptake and integration
Tags: blood, iron, labs, vit b, vit d

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