-Severe thrombocytopenia (< 10 × 109/L) may result in retinal haemorrhage and potentially fatal intracranial bleeding, but this is rare.

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-In case of thrombocytopenia, Spontaneous bleeding does not usually occur until the platelet count falls below 20 × 109/L, unless their function is also compromised.

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-Apparent erythrocytosis with a raised Hct, normal red cell mass (RCM) and reduced plasma volume may be associated with hypertension, smoking, alcohol and diuretic use (Gaisböck’s syndrome).

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(Gaisböck’s syndrome):

-The presence of hypertension, smoking, excess alcohol consumption and/or diuretic use is consistent with low-volume polycythaemia.

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-In polycythaemia rubra vera (PRV), a mutation in a kinase, JAK-2 V617F, is found in over 90% of cases.

-Patients with PRV have an increased risk of arterial thromboses, particularly stroke, and venous thromboembolism.

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Symptoms/signs of possible acute transfusion reaction:

-Fever, chills, tachycardia, hyper- or hypotension, collapse, rigors, flushing, urticaria, bone, muscle, chest and/or abdominal pain, shortness of breath, nausea, generally feeling unwell, respiratory distress.


د. محمد قاسم في الراوند قال:
"Back pain is the first! ".

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-The most common reason for a raised platelet count is that it is reactive to another process, such as infection, inflammation, connective tissue disease, malignancy, iron deficiency, acute haemolysis or gastrointestinal bleeding.

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-Antiplatelet medications are of greater efficacy in the prevention of arterial thrombosis and of less value in the prevention of venous thromboembolism.

-Thus, antiplatelet agents, such as aspirin, clopidogrel and, increasingly, ticagrelor, are the drugs of choice in acute coronary events and in ischaemic cerebrovascular disease.


-While Warfarin and other anticoagulants are favoured in VTE " venous " and management of atrial fibrillation.

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-ESR: blood cells sediment in a period of one hour, Normally more in adult female.
-Increase in: - all collagen diseases (autoimmune), infection, malignancy.
-Decrease in: - polycythemia, congestive heart failure, sickle cell anemia, hereditary spherocytosis , Hyper viscosity.

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Anemia according to WHO:

• Hb <13 g/dL in adult male.
• Hb <12 g/dL in adult females.
• Hb <11 g/dl in pregnancy.

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-Iron is absorbed from the duodenum & upper jejunum.

-Serum ferritin is the best single test to confirm iron deficiency.

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•Anisocytosis: the RBCs are not of the same size.
•Poikilocytosis: the RBCs are not of the same shape.

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a)-Skin and mucous membranes pallor [hemoglobin level is 8-10 g/dL].

b)-Palmar creases pallor [hemoglobin level is <8 g/dL].

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Serum ferritin is the best single test to confirm iron deficiency

•Plummer-Vinson syndrome (PVS):

-Triad of iron deficiency anemia, postcricoid dysphagia, and upper esophageal webs.

-Associated with an increased risk of esophageal squamous cell carcinoma and glossitis.

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Pica: the craving to eat unusual substances such as dirt, clay, ice, or hair.

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In case of Iron deficiency anemia
Monitoring response to iron therapy:

1)-Reticulocytosis starts on 3rd day & peaks at 7th after starting treatment.
2)-Hemoglobin rises by rate of 1g/dl per week.
3)-Normalization of the hemoglobin level (1 month).
4)-Repletion of iron stores (2-4 months).

Note: - If the patient is not responding look for another cause of anemia.

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-Pernicious anemia is the most common cause of severe vitamin B12 deficiency worldwide and is due to autoimmune destruction of parietal cells and/or intrinsic factor. 

-Pernicious anemia is more in persons of blood group A.

-Diphyllobothrium latum (fish tapeworm) competes with the body for cobalamin.

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-In the blood film in case of vir.B12 and folate deficiency, Oval Macrocytosis , but other causes of Macrocytosis give round shape.

-Hypersegmented neutrophils (first sign in blood film).

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Ivabradine

Mechanism of action: selectively inhibits "funny channels" If channel in the pacemaker cells of the SA node → prolongs slowdepolarization (phase 4) → slows heart rate.

Indications:
-Symptomatic stable coronary heart disease and congestive heart failure (NYHA II-IV) in patients who cannot tolerate beta blockers.

Adverse effects:

1-Vision changes: luminous phenomena (enhanced visual brightness)
2-Bradycardia
3-Hypertension.

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What is Caplan’s syndrome?

Rheumatoid lung nodules with pneumoconiosis is called Caplan’s syndrome. Common in coalworkers pneumoconiosis, may occur in any pneumoconiosis. Nodules are rounded, 0.5 to 2.5 cm, present at periphery of the lung. These may rupture causing pneumothorax or may cavitate and cause hemoptysis. It may be confused with tuberculosis or neoplasm.

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