.Mr. S. has a platelet count of 50,000/mm3. What does this value indicate? 5. Br

Question

.Mr. S. has a platelet count of 50,000/mm3. What does this value indicate? 5. Brenda is diagnosed with pernicious anemia. She asks you to explain how she contracted this disease and why she has to get “shots” to improve the number of erythrocytes in her blood; she also wonders how long she will need to have these injections. 6. Howard, a 56-year-old smoker, has chronic obstructive pulmonary disease (COPD). He arrives at the clinic for a regular follow-up visit. His erythrocyte count, hemoglobin, and hematocrit are all elevated. What is the name of this type of disorder, and what is the likely cause? 7. Olivia is a 3-year-old recently diagnosed with acute lymphocytic leukemia (ALL) found during her annual physical examination. Her mother is very upset; she wants to know the signs and symptoms, so she may monitor her child for worsening disease

Explanation / Answer

Mr. S has low platelet count ( nromal range of platelet 1,50,000 - 4,50,000 / cubic mm ). So Mr. S has disease that can cuase low platelet count ( ie, viral infection like dengue, leukemia, cytotoxic drug, aplastic anemia, heavy alcoholism)

5. As it is told in the question that Brenda is receiving shots , it means that she is receiving Vitamin B12 injections ( cyanocobalamin or hydroxycobalamin)---> So Brenda developed pernicous anemia due to deficiency of vitamin B12.

causes of vitamin B12 deficiency :

Inadequate dietary intake of vitamin B12

Deficiency of intrinsic factors ( due to atrophy of gastric mucosa )

Zollinger-Ellison syndrome

Diphyllobothrium latum infection ( that can cause decrease absorption of vitamin B12 )

Deficiency of lasma transporter protein of cyanocobalamin

Disorders of ileal mucosa( like gastric resection, ileal inflammation , coeliac sprue, lymphoma, amyloidosis, absent IF-cobalamin receptor, Imerslünd-Grasbeck syndrome, ZES, TCII deficiency, use of certain drugs.

Vitamin B12 deficiency which is needed for DNA systhesis in erythrocyte---> as a result of vitasmin b12 deficiency in pernicious anemia erythrocyte cell division is hampered and as a result megalobastic eryhtrocyte are synthesized causing low hemoglobin conectration in the large sized RBC---> This is only cured by Vitamin B12 supplementation.--> That is why Brenda needs Vitamin B12 shots ( injection )---> Dose of the injection depends on the design of the therapy ( few regime require, initial weekly dose and then monthly (1000 microgram) injection of vitamin B12 ) ----> she can shift to oral vitamin B12 therapy when adequate response to parenteral( injection) Vitamin b12 therapy accurs ---> Adequate response is considered as increment of hemoglobin 1gm/dL/week---> then she can shift to oral therapy of vitamin b12 tablets containing 1000 micrgram vitamin b12 ---> if there is not adequate response or impaired response to oral therapy ---> lifelong injection of vitamin B12 is advised.

6. Howard's eryhtrocyte and hemobglobin increased in response to chronic hypoxia from COPD---> This type of disorder is called Secondary Polycythemia ( Polycythemia is secondary to the hypoxia)

Howard has COPD ---> which leads to chronic hypoxia to the tissue ( due to low ventialtion) ----> kidney tissue sense this hypoxia----> Erythropoietin systhesis by kidney increased ---> this leads to increased erythropoiesis ( increased production hemoglobin and eryhtrocytes) ---- So chronic hypoxia is the cause of this disease cally secondary polycythemia.

7. Childhood acute lymphocytic leukemia is blood siorder where bone marrow produces too many immature lymphocytes ( type of white blood cell) ---> as the lymphocytes are immature and very high in number this leads to ---> increased number of lymphocytes in the blood stream----> less room for other blood corpuscles like RBC, platelets, leukocytes ---> this results in the following:

1. Bleeding from gums.

2. Bone pain ( owing to incresed hematopoiesis)

3. Frequent infections ( as the lymphocytes are immature -->lymphocyte functions are impaired ---> immune system becomes impaired ---> frequent infection).

4. Fever ( result of infection and inflammatory mediators released by lymphocytes)

5. Nasal bleeding ( impaired function of platelet owinf to immature lymphocytes --- increased immature lymphocytes in blood occupy most of blood cmpartment-- thereby there is less room for RBC, platelets in the blood--> causing the effect).

6. Pale skin

7. Shortness of breath ( due to low rbc in blood)

So these are the sign and symptoms that should trigger olivia's mother to ask for a physician's guidance.

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