Neurology
Faye Hill, Sash Noor, Neel Sharma, Tiago Villanueva in Medical and Surgical Emergencies for Students and Junior Doctors, 2021
The primary investigations of choice are typically imaging based. An Magnetic resonance imaging (MRI) or Computed tomography (CT) scan of the spine is essential, with a standard spinal X-ray being less valuable. A CT myelograph may demonstrate an hourglass-type pattern of the contrast medium in such cases. Blood investigations should be requested, such as a full blood count and C-reactive protein to exclude infection, as well as blood cultures in the case of a suspected abscess, discitis or osteomyelitis. First-line treatment involves immobilisation and urgent neurosurgical intervention. High-dose steroids have been shown to be of benefit, particularly in cases of malignancy, to help with pain relief and reduction of tumour-associated oedema. In cases of an epidural abscess, surgery in addition to antibiotic therapy, usually in the form of vancomycin, metronidazole and cefotaxime, is required. Blood investigations can help to determine cause such as evidence of polycythaemia, thrombocytosis, thrombocytopenia or deranged coagulation.
Haematological problems
Catherine Nelson-Piercy in Handbook of Obstetric Medicine, 2020
Iron deficiency is by far the commonest cause of anaemia and iron deficiency anaemia is the commonest haematological problem in pregnancy. Pernicious anaemia is associated with other autoimmune conditions (Addison's disease, vitiligo) and is caused by intrinsic factor antibodies, leading to vitamin B 12 malabsorption. Essential thrombocythaemia, causing an isolated thrombocytosis, is a myeloproliferative disorder and is rare in women of childbearing age. Women with essential thrombocytosis have an increased risk of adverse pregnancy outcome, including FGR, possibly related to placental thrombosis. Danazol, vincristine, rituximab, dapsone and thrombopoietin receptor agonists (e.g. eltrombopag) have been successfully used for severe resistant cases in pregnancy. The obstetric patient with massive bleeding should be managed according to pre-defined and agreed protocols in close collaboration with haematology and anaesthetic staff. Various complement abnormalities (including specific deficiencies and antibodies) are screened for at the National Renal Complement Therapeutics Centre in Newcastle, UK.
Answers: Cases 26–50
Nagi Barakat in Get Through MRCPCH Part 2: 125 Questions on Clinical Photographs, 2005
This boy was initially diagnosed as having orofacial granulomatosis, but as the gastrointestinal features became more obvious he was subsequently diagnosed with Crohn’s disease following a barium follow-through examination and colonoscopy.Although children often present with gastrointestinal features such as abdominal pain or altered bowel habit (diarrhoea or constipation), the range of symptoms is protean. General malaise and growth faltering may precede gastrointestinal symptoms. Recurrent oral ulceration and/or anal fissures may be the only problem. The disease may involve the joints (non-deforming arthritis), eyes (episcleritis), kidney and gallbladder (stones), and liver. Clues to the diagnosis of Crohn’s disease may be found with a normochromic anaemia and thrombocytosis. Inflammatory markers such as ESR and CRP may be elevated.The diagnosis may be confirmed at colonoscopy with tissue biopsy of affected bowel, which should demonstrate non-caseous granulomatous changes on microscopy. Management and treatment are usually coordinated through a paediatric gastroenterology service, and consist of oral aminosalicylates and (in more severe cases or during relapses) systemic corticosteroids. Other immusupressants may be used, such as azathioprine. New treatments for severe cases include infliximab, an anti-TNF- monoclonal antibody.
Spontaneous Resolution of Extreme Thrombocytosis in 2 Children
Published in Pediatric Hematology and Oncology, 2012
Shraga Aviner, Ehud Even-Or, Hannah Tamary
Essential thrombocytosis (ET) is rare in children, sometimes difficult to be distinguished from secondary thrombocytosis. This report concerns 2 children with extreme thrombocytosis of 4100 × 109/L and 1644 × 109/L with partial and complete remission at 3 months and 4 years from diagnosis, with a follow-up of 4 and 17 years, respectively, with no cytoreduction therapy. Diagnosis of ET was suggested according to accepted criteria. However, spontaneous remission of the thrombocytosis argues for the diagnosis of secondary thrombocytosis. These patients highlight the complexity of distinguishing childhood ET from secondary thrombocytosis and the need for cautious personalized decision on cytoreduction therapy.
Paraneoplastic thrombocytosis in gastrointestinal cancer
Published in Platelets, 2016
Zsolt Baranyai, Valéria Jósa, Ambrus Tóth, Zsuzsanna Szilasi, Balazs Tihanyi, Attila Zaránd, Laszlo Harsanyi, Zoltán Szállási
It has been demonstrated recently in several solid tumors that thrombocytosis at diagnosis may correlate with tumor invasion, metastatic progression and worse outcome. Several details of the pathomechanism of the relationship of thrombocytosis and cancer have been elucidated; however, the complete process is not clearly understood. Several hypotheses have been proposed. Recently, it was suggested that in ovarian cancer elevated IL-6 production by the tumor may induce increased megakaryopoiesis via hepatic thrombopoietin production leading to thrombocytosis. The importance of the prognostic power of elevated platelet count is still debated in gastrointestinal cancer. The aims of this review were to evaluate the prognostic significance of thrombocytosis in gastrointestinal tumors, to see whether clinical practice confirmed the hypotheses and to reveal the causes of the inconsistent findings.
Preliminary investigation about the expression of tubulin in platelets from patients with iron deficiency anemia and thrombocytosis
Published in Hematology, 2018
Kam Chau Yung, Ze Wen Zhang, Wen Jun Yu, Jin Feng Qiu, Cheng Wei Xu, Chun Ling He, Xian Ru Xu, Jun Yin
Objective: In order to inquire into the pathogenesis of increased platelet counts in peripheral blood of patients with iron deficiency anemia (IDA), the phenomenon of thrombocytosis was confirmed, and then the expression of tubulin within platelets from IDA patients was investigated. Methods: Peripheral blood samples were collected from 79 patients with IDA and were divided into 2 groups, group of IDA with normal platelet counts (34 cases), and group of IDA with increased platelet counts (thrombocytosis) (45 cases). Additionally, 45 peripheral blood samples from healthy volunteers were enrolled as a group of healthy controls. Count of platelets in peripheral blood was detected by means of LH-780 hematology analyzer and hemocytometer under a microscope respectively, and analyzed statistically. Results: There was no statistical difference between platelet counts detected by LH-780 hematology analyzer and hemocytometer under a microscope (P > .05). The mean fluorescence intensity (MFI) of both α-tubulin and β-tubulin within platelets from IDA patients with thrombocytosis was significantly less than that from healthy volunteers and IDA patients with normal platelet counts (P .05). Conclusion: Some patients with IDA are accompanied by thrombocytosis, from which the expression of α-tubulin and β-tubulin within platelets reduced obviously compared with those with normal platelet counts and healthy controls respectively. It is implied that downregulation of tubulin probably is a part of the pathogenesis leading to increased platelet counts in IDA.
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