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Assessment – Nutrition-Focused Physical Exam to Detect Micronutrient Deficiencies
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
Pallor, or abnormally pale skin color, is commonly associated with anemia and may indicate an iron, folate or vitamin B12 deficiency.4,10 Possible non-nutrient causes include a low perfusion state, shock, stress, sickle cell anemia, cancer, and genetic conditions which affect pigmentation, such as albinism and vitiligo.4 An in-depth patient interview is recommended to differentiate between pallor and naturally pale skin. Pallor may be more challenging to identify in darker-skinned individuals; the appearance of the conjunctiva of the eye (see Figure 7.1), nail beds, and the oral mucosa can provide additional evidence of deficiency.
Anemia (Normochromic and Normocytic)
Published in Charles Theisler, Adjuvant Medical Care, 2023
In normocytic and normochromic anemia, blood cells are of normal size and have adequate hemoglobin concentration, but are present in insufficient quantities to transport normal amounts of oxygen to the tissues. Normocytic anemia has many causes, the most common being anemia of chronic diseases (e.g., kidney disease, cancer, RA, and thyroiditis), but also includes blood loss or hemolysis, bone marrow suppression, man-made heart valves, or drug therapy. Normocytic anemia also commonly develops due to aging and is more likely to affect women over the age of 85.1 Normocytic anemia symptoms are not very prominent as the condition will usually tend to build up gradually over a period of time. However, when it has fully progressed, the condition will present with typical symptoms of pallor, tiredness, and weakness, etc.1
3-Hydroxy-3-methylglutarylCoA lyase deficiency
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop
Persistent vomiting may be an early symptom. There is rapid progression from lethargy and hypotonia to coma. Pallor and dehydration are commonly present. There may be seizures, including myoclonus. Hypothermia has been reported [11]. Apnea is followed by death unless the patient is artificially ventilated. Clinical chemical evaluation reveals hypoglycemia, metabolic acidosis, and, in some, hyperammonemia. For this reason, a number of patients have initially been diagnosed as Reye syndrome [6]. Presentation with life-threatening acidosis is common [4, 8, 11]. Infants may present in the first days of life with seizures, lethargy, or tachypnea. This may follow the first feeding or may precede it, an index that birth itself maybe a catabolic experience. Lactic acidemia maybe prominent. The initial episode may be fatal [8, 11].
Non-Arteritic Anterior Ischaemic Optic Neuropathy with Progressive Macular Ganglion Cell Atrophy due to COVID-19
Published in Neuro-Ophthalmology, 2022
Bora Yüksel, Faruk Bıçak, Fatih Gümüş, Tuncay Küsbeci
Rho et al. reported the first case of non-arteritic anterior ischaemic optic neuropathy (NAION) following COVID-19 infection in a patient with diabetic retinopathy.11 NAION is caused by occlusion of the short posterior ciliary arteries resulting in partial or total infarction of the optic nerve head.6 Major risk factors include crowded optic discs, hypertension, diabetes mellitus, and hyperlipidaemia.11 The usual presentation is in the 6th-7th decades with sudden, painless vision loss and mostly inferior altitudinal visual field defects. Diffuse or sectorial hyperaemic optic disc swelling with a few peri-papillary splinter haemorrhages may be seen. The swelling gradually resolves and pallor develops 3–6 weeks after onset.12 The optic nerve damage is usually severe and irreversible, depending on the extent of the occluded arteries.6 The usual duration of mild COVID-19 symptoms is reported as two weeks.13 Here we report a diabetic patient who developed NAION on the 13th day after contracting COVID-19.
Lichen sclerosus of the vulva
Published in Climacteric, 2021
The recommended maintenance or long-term follow-up is not clearly defined. Consensus suggests that patients should be seen at intervals of 6–12 months and it is advisable to continue with some topical steroid medication at least two or three times per week to contain symptoms and clinical response of the vulval skin. Invariably, regression of plaque, ecchymosis, fissuring and hyperkeratosis are seen in the responsive vulva. Pallor of the skin, however, seems to persist. Features suggestive of malignant transformation must be looked for, and if there is any concern, a biopsy must be taken. Subjective improvement will accompany the improvement of the vulval skin. Superpotent to mid-potency agents are recommended either intermittently when symptoms or features arise locally, or more preferably two or three times per week indefinitely. Of note, long-term treatment with these steroid preparations does inhibit the development of malignant transformation. It appears that, in women who remain on constant long-term therapy, the likelihood is lower than in women using therapy according to reoccurrence of symptoms [11]. As long as the skin color and texture remain normal, with no sign of atrophy or erythema, there is no need to reduce topical corticosteroids potency; however, if hyperkeratosis returns, potency should be increased [11,51].
Update on diagnosis and treatment of immune thrombocytopenia
Published in Expert Review of Clinical Pharmacology, 2021
Rajeev Sandal, Kundan Mishra, Aditya Jandial, Kamal Kant Sahu, Ahmad Daniyal Siddiqui
A detailed history of bleeding manifestations (especially menorrhagia in females), severity of bleeding, prior blood transfusion, and any recent drug intake is essential. Severity of bleeding is graded with standard scales like the ITP Bleeding Scale (IBLS), ITP-specific Bleeding Assessment Tool (ITP-BAT), and WHO bleeding Scale. Although more precise, the clinical applicability of ITP-BAT is difficult in the day-to-day practice due to the complexity of this scale. Contrarily, the WHO bleeding scale is simple to use and is validated for use in ITP patients [10,11]. A family history of thrombocytopenia should be inquired to rule out familial thrombocytopenia. Many such patients with familial thrombocytopenia also have associated physical abnormalities and mental retardation. History of alcohol consumption, toxin exposure, and jaundice should be documented to rule out underlying chronic liver disease [7,12,13]. Physical examination is crucial to diagnose specific disorders which can present with isolated thrombocytopenia (secondary ITP). Wet purpura may be the only sign of underlying thrombocytopenia [14]. Pallor may be present due to underlying anemia caused by blood loss. Jaundice may suggest underlying chronic liver disease or autoimmune hemolytic anemia (Evans syndrome). The presence of lymphadenopathy, hepatosplenomegaly may be suggestive of lymphoproliferative disorders or acute leukemia [7,8].