1/4. diagnosis of polycythemia vera in an anemic patient.Criteria proposed by the polycythemia vera Study Group (PVSG) as well as several derived algorithms are currently used for the diagnosis of polycythemia vera. Although these guidelines have significantly enhanced diagnostic accuracy, they uniformly consider erythrocytosis as the requisite premise for instigating the subsequent workup. We describe the unusual presentation of a patient with microcytic anemia in whom the diagnosis of polycythemia vera was reached using the PVSG criteria and confirmed by in vitro culture assay of erythroid progenitor cells. This case highlights the usefulness of the PVSG criteria, including the red cell mass determination, for the diagnosis of polycythemia vera even in anemic patients. The roles of spleen red cell pooling and plasma volume expansion as major determinants of this unusual presentation are discussed.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
2/4. iron deficiency anemia in children.Even when simple iron deficiency is strongly suspected, the child with severe anemia deserves a careful and thorough work-up before treatment is begun. Many other possible causes of anemia need to be excluded. No one test specifically identifies iron deficiency, but the combined use of several tests of iron status can establish iron deficiency with certainty. Hemoglobin level, mean corpuscular volume, serum iron, total iron binding capacity, free erythrocyte porphyrin and serum ferritin are the important studies.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
3/4. Overt iron deficiency in sickle cell disease.Overt iron deficiency was diagnosed in four patients with sickle cell disease. Three patients had homozygous SS and one had hemoglobin sc disease. The cause in each case was proved or suspected blood loss. iron repletion was accompanied by increases in the blood hemoglobin and hematocrit levels, erythrocyte mean corpuscular volume, and mean corpuscular hemoglobin concentration (MCHC) and by change in the RBC morphologic characteristics from hypochromic microcytic to normochromic normocytic. The diagnosis of iron deficiency was confirmed by the finding of a low serum ferritin level, a high serum total iron-binding capacity, or both. Two patients who had had no painful crises while they were iron deficient began having crises again, and another patient had painful crises for the first time after the blood values improved. Whether a lowered MCHC is beneficial to patients with sickle cell diseases is an important but unanswered question.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
4/4. Intravenous iron-dextran therapy in the treatment of anemia occurring in surgical, gynecologic and obstetric patients.An infusion of iron-dextran diluted in 1,000 milliliters of physiologic saline solution was given to 51 patients. The average hemoglobin response was 1.9 grams per deciliter per week. Mean corpuscular volume, mean corpuscular hemoglobin concentration and mean corpuscular hemoglobin deficits also were corrected. There were no allergic reactions. This is an extremely reliable and safe method of replenishing depleted iron in patients.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |