FEATURE
IMMUNOLOGY
cells, depleting ATP and lead to membrane damage. The effect of ribavirin can be moderated by erythropoietin.
CLINICAL FINDINGS Signs and symptoms of hemolysis may include: Dark urine Fatigue Pale skin color Rapid heart rate Shortness of breath Jaundice Large spleen Lab testing for patients suspected of
hemolysis may include: elevated absolute reticulocyte count, elevated indirect bilirubin, low RBC, abnormal haptoglobin, and abnormal urine anaylsis.
UNUSUAL PRESENTATIONS OFANEMIAS We recently treated a patient who had all signs of immune hemolytic anemia. The clinical course was complicated by thrombocytopenia and renal failure. Rarely cases that present as hemolytic uremic syndrome (HUS) or its related entity
thrombotic thrombocytopenia purpura (TTP) may overlap with drug induced anemias. TTP was first described in 1924 by Dr. Eli Moschcowitz. His patient was a 16-year old female in a coma with kidney failure. She died within 2 weeks. Description of TTP was based on his patient’s post mortem results. In 1966 the pentad of fever, anemia, thrombocytopenia, renal impairment, and neurological findings were the defining elements of TTP. In 1975 plasma exchange was found helpful in treating these patients and is often the mainstay of treatment. Most cases of TTP/HUS are idiopathic, and some are drug induced (typically quinine), and a subset, mostly HUS are caused by toxin producing bacteria. In recent years the enzyme ADAMTS13 (A Disintegrin-like And Metalloprotease with Thrombospondin type 1 repeats) has been associated with decrease activity or an inhibitor in TTP but not HUS. ADAMTS13 is a protease that cleaves unusually Large Von Willebrand factor fragments in the circulation. Its dysregulation results in lack of control of thrombotic pathways. In addition to plasma exchange and steroids, in recent years, treatment of
TTP/HUS has included using monoclonal antibody treatment against B-cells (Rituxan) and complement (Eculizumab). Specifically, Eculizumab which is FDA- approved for use in treating paroxymal nocturnal hematuria (PNH) was shown to improve LDH and platelet count in patients with TTP or atypical HUS. ■
ML
REFERENCES References available on request (
magazine@informa.com)
LEARN MORE
Dr Han is speaking at the Histopathology track as part of the Medlab Congress on January 24th
2012.
The Medlab Congress is part of the Arab Health Exhibition & Conference that is taking place at the Dubai World Trade Centre between 23-26th
January. MEDLAD PRODUCTS
To find out more information about how to register as a delegate at this very popular conference, visit the website
www.arabhealthonline.com and click on the Medlab tab. Alternatively, you can call +971 4 336 5161 and speak to one of the team.
MEDSOL DIAGNOSTICS
Medsol Diagnostics is a part of Gulf Healthcare International. It is a specialist Laboratory and Radiology network, currently spread across 15 locations throughout the GCC region.
We are the leading network of this kind, providing efficient and reliable solutions for doctors, hospitals and private healthcare providers who require a broad range of accurate diagnostic testing and health screening services.
LI
Wi pro in t qu spe
m
DOTHEALTH
MedLab Issue 3 2011
29
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40