There is a saying about surgeons, meant as a reproof: “Sometimes wrong; never in doubt.” But this seemed to me their strength. Every day, surgeons are faced with uncertainties. Information is inadequate; the science is ambiguous; one’s knowledge and abilities are never perfect. Even with the simplest operation, it cannot be taken for granted that a patient will come through better off—or even alive.

- Complications: A surgeon's notes on an imperfect science

🐈‍⬛ INH (isoniazid) is similar to B6 structure, thus it can bind and inhibit pyridoxine phosphokinase (which makes active B6 - pyridoxal phosphate (PLP); thus Niacin cannot be synthesized from Tryptophan (requires PLP)

- carcinoid Tumors use massive amounts of tryptophan to make serotonin, stealing tryptophan away from making niacin

Okay, wait
So INH can cause pellagra cuz it inhibits the enzyme that makes active B6, which is required for making niacin?

Yeah 😂

I know a guy who knows a guy who knows another guy

Exactlyyy😂
+ That's exactly what I love about medicine

That’s why TB patients who are given INH should also be supplemented with pyridoxine.

تشوفون الخلايا اللي كلها أشواك؟ هن ذني Acanthocytes

"Acantha" is a Greek word for "thorns."

ولهنا تنتهي معرفتي بيهن :")
اليعرف عنهن أكثر هلا بيه 🍻

RBCs abnormalities seen in blood film of anemic patients due to chronic diseases especially Liver and renal fauilre.

Huntington disease-like 2 👁️

There’s a whole entity of diseases called: “Neuroacanthocytosis”

Philadelphia chromosome :The reciprocal translocation commonly found in people with chronic myeloid leukemia
In healthy individuals, the abl gene is located on chromosome 9, and bcr gene is on chromosome 22.
In certain forms of myelogenous leukemia, a reciprocal translocation causes the abl gene to fuse with bcr gene.
This combined gene, under the control of the bcr promoter, encodes an abnormal fusion protein that overexpresses the tyrosine kinase function of the ABL protein in white blood cells leads to leukemia.

لذلك بالعلاج ينطوهم tyrosine kinase inhibitors
مثل الـ imatinib

This blood film is crying

Teardrop cells or Dacryocytes

Characteristically seen in Extramedullary hematopoiesis
◦ Conditions associated with bone marrow infiltration (e.g., myelofibrosis)
◦ Thalassemia
◦ Splenomegaly

Bot:
كملاحظة جانبية:
Spur cell (acanthocyte) should be distinguished from burr cell (echinocyte).
Both are spiculated but,
Spur cell have irregularly spaced thorn-like projections and little or no central pallor, seen in abetalipoproteinemia and liver disease.
In burr cell, projections are rounded and evenly spaced around the cell and the cell has a central pallor, seen in uremia & pyruvate kinase deficiency.