Special and differentiating investigations in Anemia

Here, we would try to summarize all the investigations useful to differentiate various types of anemias--

1. Microcytic hypochromic anemias
-S. Ferritin, Total Iron Binding capacity, Transferrin saturation help in distinguishing IDA, AOCD, Beta thal trait.
HbA2 levels between 3.5-8% are diagnostic of beta thal trait.

2. Macrocytic anemias
S. VitB12 and S.Folic acid assays to differentiate megaloblastic from non megaloblastic macrocytic anemias.
PBS f/s/o megaloblastic anemia - macovalocytes, hypersegmented neutrophils, pancytopenia +/-

3. Warm Antibody against P antigen and cold antibodies (I antigen) to detect AIHA and also to differentiate AIHA from HS.

4. G6PD Assays- suspected G6PD deficiency anemias

Redistribution of drug

I knew what is is Distribution of drug but I think somewhere along my medical school I might have missed reading about REdistribution of drug. Here's what it is:

Biochemistry – How to study?

We see many requests coming to our study groups, asking for few tips to study Biochemistry. Today I thought we should talk about it for the sake of our 1^st year Medicowesomites!! Yay!

Ok, Biochemistry, as the name itself implies is about Chemistry in Biological systems. So what do we most encounter in Biochemistry and how to tackle them?

Ulcerative Colitis, Crohn's disease and rectal involvement

Greetings everyone!

Here's a short post on how to remember that rectum is involved in Ulcerative Colitis (And spared in Crohn's disease.)

ICE syndrome mnemonic

Hello!
A short post of mnemonics on one of the coolest syndrome of the eyes.....

Thalassemia mnemonic

Hello!

I was reading thalassemia today and I thought of sharing few facts and this trick for learning the beta chain variants of hemoglobin (Hb) in Thalassemia.

Facts about thalassemia:

Zollinger Ellison syndrome mnemonic

Hello! Here's a short concept for the day!

Normally, secretin decreases gasrtin and gastric acid production,

In Zollinger Ellison syndrome, however, secretin increases gastrin production.

Non caseating granulomas mnemonic

Hello!

The mnemonic for non caseating granulomas is RBCS

Bernard Soulier syndrome mnemonic

This mnemonic would not help you to remember all the aspects of the syndrome but two quite important points would be on the tip of tongue for sure.

Remember the dog - St. Bernard's

Age of completion of ossification mnemonic

Hello!

For those who forget the age at which ossification centres close, this post is for you!

Bartters, Gitelmans and Liddles syndrome mnemonic

Hello!

Bartters, Gitelmans and Liddles syndrome present with chloride resistant (high urinary chloride) hypokalemic metabolic alkalosis.

What differentiates them:
Bartters: Hypercalciuric (Furosemide like! Loops lose calcium, remember?)
Gitelman: Hypocalciuric (Thiazides don't!) and Hypomagnesemia. Presents with cramping and spasms.
Liddles: Presents with hypertension, metabolic alkalosis and hypokalemia (Aldosterone excess like!)

Here's a mnemonic for it!

"FaceBook GoT ALL HYPER about a Little syndrome"

FB - Bartter's is like Furosemide
GoT - Gitelman Thiazide
All hyper little - Liddles is like HyperALdosteronemia

These syndromes are rare, so it’s important to rule out more common causes (Like diuretics)

That's all!

Here's an aphorism by Sir William Osler: “Care more for the individual patient than for the special features of his disease.” :)

-IkaN

Bile acid sequestrants mnemonic

Hello! The bile acid binding resins are:
Cholestyramine
Colestipol
Colesevelam

I'll talk about Cholestyramine in this post!

Iron deficiency anemia

   IRON DEFICIENCY ANEMIA

-The commonest nutritional anemia in India

-Causes:
Decreased Intake
Lack of absorption (eg. Celiac disease)
Increased loss ( in the form of blood loss through any system)

- More common in women d/t menstrual bleed, increased requirement in pregnancy and lactation.

 CLINICAL PRESENTATION
Increased fatiguability
Pica
May present as a triad with dysphagia and esophageal web in Plummer Vinson syndrome
Glossitis

INV:
Low Hb
Low Rbc count
Low MCV, MCH And MCHC
Low S. Ferritin
Raised TIBC
Reduced Transferrin saturation
Microcytic hypochromic picture on Peripheral blood smear; Pencil cells may be seen

Heyde's syndrome mnemonic

Greetings! Short post for the day about Heyde's syndrome!

The mnemonic is: Heydes' hidden bleeding heart.

Pathophysiology of achalasia mnemonic

Hello!

This post is about the pathophysiology of achalasia!

In achalasia, there is loss of NO and VIP releasing inhibitory neurons. Thus, the loss of the inhibitory innervation in achalasia results in the manometric consequence of failure of LES relaxation as well as loss of esophageal peristalsis.

Classification of enzymes mnemonic

Hello!

This mnemonic on classification of enzymes was submitted by Mohd. Ayub Ali.

The mnemonic is, "On The Himalayas, Lyf (life) Is Lightened."

Intermediates in Gluconeogenesis mnemonic

Hi guys!

So today I wanted to talk to you about Gluconeogenesis.

The first thing is that gluconeogenesis takes place in the mitochondria.

Now when anyone says, "mitochondria", I (and probably all of us) immediately jump to, "mitochondria is the powerhouse of the cell".

Why does Digoxin toxicity result in increased automaticity?

Hey everyone!

Digitalis and other cardiac glycosides are known to cause an AV nodal delay.

Then why does too much Digoxin result in some arrhythmias that are due to increased automaticity? Brady arrhythmias are explainable. But why tachy arrhythmias?

Atrial fibrillation in WPW syndrome

Random fact that I learnt today!

If a patient with WPW syndrome develops symptomatic atrial fibrillation, what is the drug of choice?

Answer is procainamide.

Stable patients suspected of having WPW with atrial fibrillation should not receive agents that predominantly block atrioventricular conduction, but they may be treated with procainamide or ibutilide.

Why?
Because if you block the AV node using beta blockers, calcium channel blockers or digoxin, you will favour conduction to the accessory pathway. This will worsen the arrhythmia.

That's why, in stable patients, chemical cardioversion is preferred.

If instability is present, electrical cardioversion is required.

That's all!
-IkaN

Related post: Supraventricular tachycardia mnemonic

Organisms covered by Ampicillin mnemonic

So here it is...

Ampicillin HELPS to clear Enterococci!

Haemophilus influenzae
E. Coli
Listeria monocytogenes
Proteus
Salmonella

Ps: Gram-negative organisms have 'porin' channels in their outer lipid membrane through which the Beta-lactam antibiotics enter the cell. Also the lipopolysaccharide layer that contains endotoxins! (Gram-positive organisms do not have such things in their cell wall)
The only exception is Listeria monocytogenes that has little amounts of such endotoxins, inspite of being Gram-positive bacteria!

That's all!

-JasKunwar Singh

Interesting facts about testing 9th, 10th and 11th Cranial nerves

Hey guys!
So here's my first blog! Hope you like it!

Did you know that when 11th cranial nerve is involved on one side, you check for turning of head to opposite side and shoulder shrugging on the same side?

But when involved bilaterally, the patient can't turn their head.

So to test bilateral sternocleidomastoids, you ask the patient to sit up from sleeping position. He'll have head lag!

Here's another interesting fact:
Gag reflex is involved in 9th or 10th cranial nerve nerve palsy... This specifically localises lesion at medulla because both nerves originate there.

That's all!
Thanks ☺

-Rippie