Based on the FBC results provided:
- The low MCV and Hb along with normal iron studies is consistent with thalassaemia trait
- The elevated HbA2 and HbF levels provide further support for beta thalassaemia minor
- The absence of HbH inclusions makes alpha thalassaemia less likely
- The findings of basophilic stippling, though nonspecific, can occur in beta thalassaemia minor
- Therefore, the most likely diagnosis is beta thalassaemia minor based on the haematological and biochemical investigation results.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
fbce.ppt
1. THALASSAEMIA
A group of chronic, inherited anemias
characterised by defective Hemoglobin (Hb)
synthesis and ineffective erythropoiesis,
particularly common in persons of Mediterranean,
African and Southeast Asian ancestry.
Thalassaemia results from unbalanced Hb
synthesis caused by production of at least one
globin polypeptide chain (α, β, γ, δ).
There are 2 forms of thalassaemia
Thalassaemia major
Thalassaemia minor (trait)
2. THALASSAEMIA MAJOR
Thalassaemia major is sometimes known
as Cooleys Anaemia, Homozygous, Bete
Thalassaemia or Mediterranean Anaemia. Is
a serious inherited childhood anaemia.
Children with Thalassaemia major cannot
make enough haemoglobin. Because of this,
their bone marrow cannot produce enough
red blood cells. The red blood cells that are
produced are nearly empty.
3. THALASSAEMIA MINOR
People with Thalassaemia Minor, sometimes
known as Trait, carry Thalassaemia but they are
not ill. They are completely healthy and normal but
some of them have slight anaemia. Most people
with Thalassaemia Minor do not even know that
they have it. It is only discovered if the person has
a special blood test or if they have a child with
Thalassaemia Major. It is important to know if you
have Thalassaemia Minor later in life. The reason
for this is that it may cause some problems if the
person and their partner wants to start a family.
Thalassaemia minors red blood cell are also
different from normal blood cells.
4. CLINICAL FEATURES
MINOR - clinically asymptomatic
MAJOR
Severe anemia
Expanded marrow space
Jaundice
Leg ulcers
Cholelithiasis
Splenomegaly
Bone changes and fractures
Growth failure
5. HAEMOGLOBIN
Hb is most commonly measured to detect
anaemia. Low Hb indicates anaemia
(various types) and blood loss.
In some relatively rare genetic diseases, the
alterations in the structure of the Hb
molecule can be detected by
electrophoresis.
6. HAEMOGLOBIN cont..
Hb 120g/L 130-180 LOW
Hb
electrophoresis
Normal
Hb A2 4.8% 1.8-3.5 HIGH
Hb F 1.5% 0.5-0.8 HIGH
Hb inclusions not seen in red cells
7. HAEMOGLOBIN cont…
HbA2 - The haemoglobin is composed of two alpha chains
and two delta chains. HbA2 is usually raised in the β
thalassaemias, and in unstable haemoglobinopathies
where the amino acid substitution is on the β chain.
HbF - is the primary hemoglobin produced by the fetus
during gestation. The determination of fetal hemoglobin is
an aid in evaluating low concentrations of hemoglobin in
the blood (anemia). HbF may be raised in various
haematological conditions among which are the
thalassemias.
HbH inclusions - Performed as part of a
haemoglobinopathy/thalassaemia screen. For diagnosis of
alpha thalassaemia.
8. Mean cell volume (MCV) - the average
volume of a single red cell.
Terms such as `microcytic' and `macrocytic'
are descriptive of low and high MCV,
respectively.
LOW MCV- Microcytic/hypochromic anaemia
Iron deficiency
Thalassaemia
Anaemia of chronic disease (uncommonly microcytic)
Sideroblastic anaemia (uncommon: acquired forms more
often macrocytic)
Lead Poisoning (uncommon)
Hb E trait or disease
MCV 65 f/L 80-100 LOW
9. Could The Near Normal Hb and Low
MCV be Due to Other Conditions?
- Hb 120g/L (130-180)
- MCV 65fL (80-100)
- Blood film shows mild hypochromic,
microcytic cells with occasional target cells
and basophilic stippling
10. Potential Causes of Anaemia
1) Blood loss
2) Reduced red cell life span (haemolytic
anaemia)
- consequent on an intrinsic abnormality of red cells either inherited or
acquired
- consequent on extrinsic factors
3) Inadequate production of red cells
- deficiency in iron, vitamin B12 or folic acid; aplastic or hypoplastic
anaemias; ineffective red cell production; bone marrow infiltration by
malignant cells; bone marrow fibrosis
4) Low-affinity haemoglobin
5) Abnormal distribution of red cells within the
vasculature
- hypersplenism
11. Causes of Microcytic Anaemia
- Microcytosis is a highly prevalent finding during
blood examination and is detected in ~3% of
patients admitted to hospital
- Microcytosis occurs when the number of
abnormally small RBCs in the blood is such that
the mean corpuscular volume (MCV) drops to
below the normal range
- The investigation of microcytosis/microcytic
anaemia is often a challenge for the clinician and
in most cases is related to impaired hemoglobin
synthesis
12. Causes of Microcytic Anaemia cont…
- Non-thalassemic causes of microcytic
anaemia include
1) Iron deficiency anaemia
2) Anaemia of chronic disease /
inflammation
3) Congenital sideroblastic anaemia
13. Iron Deficiency Anaemia
- Iron deficiency is the primary cause of microcytosis
and therefore a complete iron-status analysis should
always be undertaken.
- In severe cases the MCV can be in the range of 50-
60fL
- A blood smear will typically show erythrocytes that are
microcytic and hypochromic as well as poikilocytes
and occasional target cells
14. Iron Deficiency Anaemia cont.
- Low serum ferritin (indication of iron stores) and
serum iron (indication of iron available for Hb
synthesis) as well as an increased TIBC are
consistent with this diagnosis
- Potential sources of blood loss should be
investigated including occult bleeding, worm
infestation and gum disease
- Once the primary cause of the deficiency has
been corrected, treatment may involve 6-12
months of oral iron supplementation to
replenish iron stores and should involve regular
Hb monitoring
15. Anaemia of Chronic Inflammation
- Associated with conditions such as rheumatoid arthritis
and malignancy
- is most often normochromic-normocytic with low serum
iron and adequate reticulo-endothelial stores
- May progress to become hypochromic-microcytic in
nature with MCV frequently in the range of 70-80fL
- A decrease in serum iron and TIBC is typical although
serum ferritin remains normal
- An inflammatory state should be looked for in those
patients with microcytosis and normal iron status whom
belong to ethnic groups with a low incidence of inherited
hemoglobinopathies.
- If an inflammatory state is present it should be treated
and MCV monitored.
16. Sideroblastic Anaemias
- Hereditary forms show a hypochromic-microcytic
picture but serum iron is raised and TIBC saturated
- In primary acquired forms the peripheral blood film is
characteristically dimorphic with some hypochromic
cells and a raised MCV
- Bone marrow examination is essential and may show
erythroid hyperplasia, excess iron and a large number
of sideroblasts
- Treatment may involve the exclusion of precipitating
drugs and toxins, pyridoxine and/or folic acid
supplementation as well as blood transfusions in
refractory cases.
- Tranfusions have the potential to increase the already
significant serum iron burden
18. HOW DOES IT OCCUR?
Beta thalassemia is caused by mutations in the
in haemoglobin beta gene which prevents the
production of the beta chains in haemoglobin.
This causes an increased alpha to beta chain
ratio and precipitation of alpha ribosomal DNA
resulting coarse basophilic stippling.
The stippling effect is aggregations of the
ribosomal DNA or protein granulations in the
cytoplasm of erythrocytes
19. IDENTIFICATION
The granulations are usually variable in
size and number. An identification
technique named the Ramanowsky stain
is used to confirm basophilic stippling as it
stains the particles a violet blue colour.
The RNA is not blue, it is only the stain
required for identification that causes it to
appear this way
20. CONDITIONS CAUSING STIPPLING
Coarse stippling is characteristic of lead
poisoning and thalassemia.
In thalassemia it is most commonly
stippling in the cytoplasm of younger cells.
Lead poisoning often presents as stippling
in the cytoplasm of nucleated red blood
cells
24. BETA THALASSEMIA MINOR
The usual haematological characteristics
of beta thalassemia minor include
-hypochromia
-microcytosis
-diminished osmotic fragility
-erythrocytes with basophilic stippling
25. STIPPLING IN THALASSEMIA
Basophilic stippling is not a definitive
technique to distinguish between the
different forms of thalassemia. It has been
found to occur in both beta thalassemia
minor and major, although it may be more
prevalent in minor.
26. TECHNIQUES
More reliable identification techniques for the
various thalassemias include:
-Complete blood count (CBC) - a measurement
of the size, number and maturity of different
blood cells in a specific volume of blood.
-Haemoglobin electrophoresis with A2
quantitation - a lab procedure that differentiates
the types of haemoglobin present.
27. BLOOD SMEAR DIAGNOSIS
Previous profiles show basophilic stippling is not
the only abnormality present on a blood smear
Merck manual states that a blood smear is
almost diagnostic for beta thalassemia major
due to many nucleated erythroblasts, target
cells, small pale RBC and punctuate and diffuse
basophilia.
Basophilic stippling alone is not enough to
diagnose and differentiate between the types of
thalassemias.
28. β-Thalassaemia
The globin part of haemoglobin A1 has 4
protein sections, two of these are alpha
and two are beta-chains.
In β-thalassaemia minor you have only
one normal β-chain instead of two.
Β-thalassaemia major occurs when you
have no functional beta chains
29. α-thalassaemia
The heterozygous form of α-thalassaemia
means there is only one alpha chain
whereas the homozygous form occurs when
there is no functional alpha chain.
Usually the synthesis of alpha and beta
globins is very tightly regulated to produce
equal numbers in both.
30. Beta Thalassaemia
In the case of beta thalassaemia with the
decrease in β-globin it means that the
haemoglobin molecules contain more
alpha globin than beta globin.
31. Pathology of β-thalassaemia
Iron levels are normal
The concentration of HbA2 is increased
HbF is increased both are trying to
compensate for the decrease in HbA1
Low MCV, hypochromic, microcytosis and
basophillic stippling
32. Pathology of α-thalassaemia
HbA2 and HbF are normal in most cases
Decreased or absent alpha-chains production
results in excess gamma chains during foetal life
and excess beta chains later. This causes the
tetramers, Hb Barts and Hb H which precipitate in
red cells and decrease red cell survival.
Tests for Hb H inclusions are used to detect it
DNA analysis may be required for definitive
diagnosis of alpha thalassaemia
33. Case E FBC Results
Ferritin 55µg/L 30-330
Hb electrophoresis Normal
Hb A2 4.8% 1.8-3.5
Hb F 1.5% 0.5-0.8
Hb H inclusions not seen in red cells