This document discusses megaloblastic anemia caused by vitamin B12 or folic acid deficiency. It covers the absorption and causes of deficiencies of these vitamins, clinical features including hematological and bone marrow findings, and biochemical tests to diagnose the deficiencies. The key tests mentioned are serum B12, methylmalonic acid, homocysteine, Schilling test, and red blood cell and serum folate levels. Guidelines are provided on interpretation of the test results in the clinical context.
Information about megaloblastic anemia and it's etiology and its classification.
Vitmain b12 deficiencies
Folic acid deficiencies
Signs and symptoms of megaloblastic anemia
Neural tube defects
Haemolysis indicates that there is shortening of the normal red cell lifespan of 120 days. There are many causes.
To compensate, the bone marrow may increase its output of red cells six- to eightfold by increasing the proportion of red cells produced, expanding the volume of active marrow, and releasing reticulocytes prematurely. Anaemia occurs only if the rate of destruction exceeds this increased production rate.
causes of macrocytic anemia pathopysiology, sign and symptoms and the difference between macrocytic anemia megaloblastIc anemia. causes of hypersegmented neutrophils and its association between them. investigation and medical management plus pictures illustration.
Information about megaloblastic anemia and it's etiology and its classification.
Vitmain b12 deficiencies
Folic acid deficiencies
Signs and symptoms of megaloblastic anemia
Neural tube defects
Haemolysis indicates that there is shortening of the normal red cell lifespan of 120 days. There are many causes.
To compensate, the bone marrow may increase its output of red cells six- to eightfold by increasing the proportion of red cells produced, expanding the volume of active marrow, and releasing reticulocytes prematurely. Anaemia occurs only if the rate of destruction exceeds this increased production rate.
causes of macrocytic anemia pathopysiology, sign and symptoms and the difference between macrocytic anemia megaloblastIc anemia. causes of hypersegmented neutrophils and its association between them. investigation and medical management plus pictures illustration.
UAEU - CMHS - Hematology-Oncology Course - MMH 302 - HONC 320. Education material for medical students - It cover basic principles of hematology and oncology, including CAR-T and gene editing. It can be used for study and review. It illustrates main principles of hematology and oncology.
UAEU - CMHS - Hematology-Oncology Course - MMH 302 - HONC 320. Education material for medical students - It cover basic principles of hematology and oncology, including CAR-T and gene editing. It can be used for study and review. It illustrates main principles of hematology and oncology.
B12 metabolism..................................... and role of various proteins in b12 metabolism..... necessity of supplementation..........................................
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
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The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
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Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
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We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
8. ABSORPTION OF B12
COBALAMINE (RELEASED FROM FOOD BY PEPSIN)
↓
COMBINES WITH TRANSCOBALAMIN I/HAPTOCORRIN
(R BINDER)
↓ pancreatic enzymes
RELEASE OF COBALAMIN
↓
BINDS TO IF
9. IF COBALAMIN COMPLEX + CUBAM (ileum)
(cubilin+amnionless)
↓ endocytosis
ILEAL CELL
↓ cobalamin released
BINDS TO TRANSCOBALAMIN
↓
EXPORTED TO PORTAL CIRCULATION
Haptocorrin bound cobalamin-reservoir (70-90%)
Transcobalamin bound-5%
10. Daily intake : 2-5 µg/day
Body stores : 2-5 mg
DAILY EXCRETION IN BILE - 1.4µg/day
DAILY REABSORPTION - 1µg/day
20. Hyperplastic marrow
erythroid precursors(megaloblasts) : ↑
Myeloid erythroid ratio : ↓
delicate chromatin - more “open” chromatin pattern in erythroid
precursors
Giant metamyelocyte
Megakaryocytes are large and have separated nuclear lobes or nuclear
fragment.
Transfused patients: number of erythroid precursors diminishes but the
cytologic abnormalities persist
21.
22. HYPOGRANULAR NEUTROPHILS AND MONOCYTOSIS : MDS
Subclinical folate and cobalamin deficiency : Increased plasma
homocysteine and serum methyl malonic acid.
23. BIOCHEMICAL PARAMETERS
COBALAMIN
normal values:200-900ng/l
MICROBIOLOGICAL ASSAY – Euglena gracilis
Functional assay
Measure the ability of the test serum to stimulate growth of
an organism.
microbiological growth is directly proportional to the vitamin
content of the serum
25. LOW COBALAMN LEVELS: HIV infection or multiple
myeloma and those receiving megadose vitamin C therapy
Spuriously normal cobalamin :
cobalamin deficiency associated with overgrowth of
intestinal bacteria (produce biochemically inert B12
analogs)
autoimmune disorders
myeloproliferative neoplasms
active liver disease
30. SCHILLING TEST
0.5 to 2.0 μg of radioactive cobalamin is orally administered
↓ 2 HOURS
Flushing dose of nonlabeled cobalamin is given parenterally
more than 7% of LESS THAN 7%
ingested cobalamin in the urine
in 24 hours
( NORMAL) ( LACK OF IF)
31. Deoxyuridine Suppression Test: (OBSOLETE)
tritium-labeled thymidine
(3H-Tdr) is incorporated into DNA
↓
In megaloblastic marrows deoxyuridine cannot be efficiently
converted to thymidine
↓
more 3H-Tdr is taken up into DNA
↓
cobalamin and folate deficiency
32. If excretion is low
↓
hog IF orally along with labeled cobalamin
Normal 24 hour excretion Remains abnormal
↓ ↓
IF DEFICIENCY malabsorption due to
intestinal disease
Test to be repeated after 7-10 days of antibiotic therapy if bacterial
overgrowth syndrome is suspected
Pancreatic extracts may be added to investigate the possibility of
pancreatic dysfunction
33. Serum and Red Cell Folate
A microbiological assay for folic acid activity -
Lactobacillus casei
Radioisotopic
chemiluminescence methods
Serum - 5-methyltetrahydrofolate
red cell - heterogeneous mixture of different forms with
varying polyglutamate chain lengths.
34. The measurement of folate in red blood cells (RBCs) is
preferred since it reflects long-term folate status in the
body compared to plasma/serum folate which may be
influenced by recent dietary intake
35. fresh whole + freshly prepared 1% ascorbate
↓
Incubate at 37 ºC for 20 min
↓
converts RBC folate polyglutamates to assayable folates
36. ECLIA
25µl serum + pretreatment reagent 1 and 2
↓
Bound folate released from endogenus binding protein
↓
Incubate with ruthenium labelled folate binding protein
↓
folate complex
37. Add streptavidin coated microparticles and folate labelled with
biotic
↓
Ruthenium labelled folate binding protein-folate biotic
complex
Amount is proportional to the analyte concentration in the
sample
Reference range : 4.6-18.7ng/ml
38. BCSH RECOMMENDATIONS
A blood film showing oval macrocytes and hypersegmented
neutrophils in the presence of an elevated MCV - suspect
cobalamin or folate deficiency.
Cobalamin and folate assays should be assessed concurrently due
to the close relationship in metabolism.
A serum cobalamin cut-off level of either 148 pmol/l (200 ng/l)
should be used as evidence of cobalamin deficiency in the presence
of a strong clinical suspicion.
The report providing the result of a serum cobalamin assay should
include the following:
39. The interpretation should be considered in relation to the
clinical circumstances.
Falsely low serum cobalamin levels may be seen in the
presence of folate deficiency.
Neurological symptoms due to cobalamin deficiency may
occur in the presence of a normal MCV.
Plasma Hcy and/or plasma MMA, depending on availability,
be considered as supplementary tests to determine
cobalamin deficiency in the presence of clinical suspicion of
deficiency but an indeterminate serum cobalamin level.
plasma Hcy - sensitive marker; plasma MMA - more
40. HoloTC is suggested as a suitable assay for
assessment of cobalamin status
Currently there is no ‘gold standard’ test for
diagnosis of cobalamin deficiency
