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Pregnancy in SLE
Published in E. Nigel Harris, Thomas Exner, Graham R. V. Hughes, Ronald A. Asherson, Phospholipid-Binding Antibodies, 2020
Red blood cells—Anemia is common in patients with SLE. Most often this is the anemia of chronic disease; immune hemolysis may occur. In normal late pregnancy hemoglobin concentration drops to approximately 100 g/1. If pre-existing anemia of chronic disease is present the hemoglobin concentration may reach much lower levels. Although this may not cause maternal symptoms, severe anemia threatens fetal growth and maturation. Many women with SLE have Coombs’ antibodies; most do not have important hemolysis. Although maternal IgG antibody does pass through the placenta and might in theory cause hemolysis in the child, in practice this is not a frequent concern. Nutritional anemias are common in pregnancy independent of SLE. In particular, iron and folate deficiencies occur. Hyperemesis gravidarum increases the risk of nutritional anemia.
Unexplained Fever In Hematologic Disorders Section 1. Benign Hematologic Disorders
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Sometimes, as in malignancy, the anemia of “chronic disease” may be compounded by chronic blood loss or malabsorption leading to iron deficiency. Assessment of bone marrow iron stores is of additional help in the evaluation of the anemia. Normal or increased iron stores will be found in the anemia associated with chronic disease. The presence of ringed sideroblasts will establish the diagnosis of idiopathic sideroblastic anemia. This disease entity is not directly associated with pyrexia. However, it may sometimes be associated with neoplastic or inflammatory conditions, the latter being the cause of pyrexia.
Anemia: Approach to Diagnosis
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
Anemia of chronic disease is associated with a normal or low reticulocyte index in the patient with normocytic indices. The diverse etiologies of anemia of chronic disease include chronic inflammation and infection, collagen vascular diseases, malignancy, renal failure, endocrinopathy, and liver disease. The growth factor erythropoietin, responsible for regulating proliferation and maturation of the erythroid cell line, is depressed or rendered ineffective in a number of chronic illnesses.
Adrenocortical carcinoma arising from the colonic mesentery
Published in Baylor University Medical Center Proceedings, 2022
Samuel Z. See, Sinan Ali Bana, Nuvaira Ather, Amy Haberman
A 57-year-old woman presented to the emergency department with a 2-week history of left-sided abdominal pain. Physical examination demonstrated tenderness to palpation in the left upper quadrant. Laboratory findings were consistent with anemia of chronic disease. Computed tomography (CT) of the abdomen and pelvis showed a large retroperitoneal mass within the left hemiabdomen (Figure 1). Surgical excision showed a large mobile mass in the left upper quadrant attached to the colonic mesocolon and distinct from adjacent solid organs. Gross pathology demonstrated a 459 g, 11 cm lobulated yellow mass with a red rubbery outer surface and diffuse hemorrhage. Microscopy showed a hypercellular tumor composed of round to ovoid cells with focally microcystic patterns (Figure 2). The tumor cells showed uniform nuclei with vesicular chromatin and scant pale to amphophilic cytoplasm. Marked mitoses (up to 24 per 50 high-power fields), patchy tumor necrosis, focal capsular invasion, and vascular invasion were present with an overall Modified Weiss Criteria score of 5. Immunohistochemistry was positive for Melan-A, inhibin, synaptophysin, Cam 5.2, calretinin, and S100 and negative for chromogranin. Histopathologic findings were overall consistent with ACC. Magnetic resonance imaging (MRI) of the abdomen performed 6 months postoperatively showed new lesions in the liver concerning for metastases (Figure 3). Subsequent partial hepatic lobectomy was performed with histopathologic findings consistent with metastatic ACC. The patient is currently under close monitoring with serial imaging.
Perioperative anemia: clinical practice update
Published in Hospital Practice, 2021
Yogita Sharma Segon, Sara Dunbar, Barbara Slawski
Laboratory findings in anemia of chronic disease: Anemia of chronic inflammation is a diagnosis of exclusion and can be challenging to diagnose. It is usually characterized by: Low serum iron levelsLow to normal transferrin saturation levelsFerritin levels are typically elevated in anemia of inflammation, due to cytokines increasing ferritin production. However, decreased iron stores with concomitant inflammation may produce intermediate ferritin levels, 87 ± 167 [22].Soluble transferrin receptor (sTfR) levels increase with increased demand of the erythroid marrow for iron but inflammation may have a direct suppressive effect on sTfR. The use of sTfR in practice has been hampered by inadequate standardization and inconsistent reports of its clinical utility.
An unusual case of fungal ball on implantable cardioverter defibrillator wire and literature review
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Hiba Rauf, Waqas Ullah, Sohaib Roomi, Asrar Ahmad, Yasar Sattar, Zain Ali, Neethu Gopisetti
The laboratory studies revealed his Hb was 10.5, leukocytosis of 20,000 with platelet count of 26,000. His blood urea nitrogen (BUN) was 54 and creatinine was 1.47. Hepatic function panel revealed aspartate aminotransferase (AST) of 113, alanine aminotransferase (ALT) of 122, alkaline phosphatase (ALP) of 215 and albumin of 2.9. His lactate dehydrogenase (LDH) was also elevated. Coagulation profile was normal. Urinalysis was positive for leukocyte esterase, WBC and RBC. RBC indices and iron studies were suggestive of anemia of chronic disease. The stool examination was positive for fecal occult blood. The chest radiographs and electrocardiographic findings were normal. Urine culture reports came back positive for Candida with over 100 K colonies/ml. The blood was sent for cultures twice and was found positive for Candida Albicans.