How can we differentiate between thalassemia and iron def?

When no electrophoresis findings are present in stem ...😕

And just on the basis of hb mcv and mch.

Iron def.. Mcv will be below 70 but not less than 65..
Mch will be below 31 but not 25..
Thalasemia..
Mcv will be below 60
Mch will be below 20

Also by
#Mentzer index
The index is calculated from the results of a complete blood count. If the quotient
of the mean corpuscular volume (MCV, in fL) divided by the red blood cell count
(RBC, in Millions per microLiter) is less than 13, thalassemia is said to be more
likely. If the result is greater than 13, then iron-deficiency anemia is said to be
more likely.

>>>HEART apex is 8cm from MEDIAN plan

>>>PAH has HIGH clearance value because it is FREELY FILTERED and also SECRETED
completely and so it can be used for Renal Plasma Flow estimation
>>>Centrioles are cylindrical structures that are composed of groupings of
microtubules. Centrioles are found in animal cells and play a role in cell
division.
>>>Ankle Jerk S1 root
>>>Open wound healing...CONTRACTION OF MYOFIBROBLASTS
>>>IRON DEFICIENCY ANEMIA : weakness, dysphagia, target cells
>>>NONFLUENT APHASIA - BROCAS
>>>Mother has rubella, fetal cardiac defects in 5th through 10th week
>>>Chiasma lesion: B/T hemianopia
>>>LINOLEIC : Essential Fatty ACID
>>>Pregnant woman, Bile Duct Obstruction... DX with GGT
>>>Cell Shrinkage is specific feature of APOPTOSIS
>>>Oculomotor nerve : Ciliary Ganglion
>>>Quadrate lobe drains into LEFT hepatic duct
>>>When tissue collagen comes into contact, INTRINSIC PATHWAY activated
>>>HEP A and E = OROFECAL ROUTE
>>>Alcohol INHIBITS ADH
>>>BRODER TUMOR CLASSIFICATION = Mitosis and differentiation
>>>Basal ganglia - Internal capsule lies medial to globus pallidus
>>>Size of head of embryo is about ½ of the CRL at the intraembryonic age of 3
months
>>>KALLMANN SYNDROME...Lesion to Arcuate Nucleus
>>>RT SIDED HEMIPLAGIA - LEFT INTERNAL CAPSULE
>>>RT LOSS OF VIBRATION, LEFT LOSS OF PAIN AND TEMP - RT HEMISECTION
>>>CLONORCHIS SINENSIS : cholangiocarcinoma
>>>N.Menin... DOC Penicillin G
>>>HIV POS PT EARLY CHANGE IN LN HYPERPLASTIC CHANGE.
>>>GH secretion INCREASE IN REM SLEEP. (please confirm this - not sure)

BEST DIAGNOSTIC TESTS FOR ANEMIAS

*Iron deficiency anemia =====> Dec ferritin (not "increased TIBC")

*Thalesemia =====> Hb Electrophoresis
* Lead Poisoning =====> Lead level Blood+Urine
* B12 Def =====> Inc methylmalonic acid
* Folate def =====> RBCs Folate levels (not "blood folate levels")
* Pernicious Anemia =====> Antibodies against intrinsic factor
* PNH =====> ctyometry
* Sickle Cell =====> Hb electrophoresis
* G6PD def =====> RBC enzyme essay
* pyruvate kinase disease =====> Rbc enzyme assay
* Aplastic anemia =====> Bone marrow examination
* Hemolytic anemia =====> Decreased haptoglobin (not "increased reticulocytosis")

ANEMIA RELATED

■■GASTRECTOMY.
●●Immediately IDA occurs(due to low iron storage )
●●PARTIAL==Fe deficiency anemia occur
●●TOTAL== B12 deficiency anemia occurs.
Refer Nelson.
●●After 3 months==B12 deficiency anemia occurs (cpsp key).
●●Actually there is 1--3 years in some books and in GOLJAN 6--9 years storage in
liver present.

●●Reality is Post totally gastrectomy both

Fe+B12 deficiency occurs.

■■FERRUM or IRON.
main site of absorption Site is
☆☆Duodenum >>>jejunum.
●●Absorbable form is==Fe++Ferrous form.
●●In diet it is present in plants in trivalent form or Fe+++ which is converted by
HCL in Ferrous Fe++ form which is readily absorbed in duodenum.
●●In meat it is in Hb form which is easily absorbed bcz in Hb it's in Ferrous form.
●●Main regulator of Iron absorption
☆☆Hepcidin ==A protein formed by liver
●Mostly involved in Anemia of chronic disease
●●ACD Main Treatment is
☆☆RX the cause like Inflammatory disease etc.
☆☆Hepcidine Inhibition.
●●Iron stores in Female==2.4 gram
In males==4 gram.

■■B12:

main absorption site

☆☆ILEUM especially distal or terminal.
●●MCC== PERNICIOUS ANEMIA ==Also called AUTOIMMUNE ATROPHIC GASTRITIS due to ANTI-
PARIETAL antibodies and IF Antibodies.
●●MALABSOPTION also causes it's deficiency
●●ILEAL diseases like
● ILIOCECAL TB& Crohns Disease etc also cause B12 deficiency.

Ix:
●●Best diagnostic ==MMA++ HOMOCYSTINEMIA.
●●ANTI-PARIETAL cell antibodies
●●IF ANTIBODIES

FOR CAUSE FINDING

●●Schilling Test.

COMMONLY TESTED FACTS

I) ONLY TWO Cranial Nerves Decussate:

Optic & Trochlear.
2 & 4 Decussate.
2 & 4 Decussate.
2 & 4 Decussate.
II) Almost all the questions of leukemias can be correctly answered just by knowing
the age
range of these cancers:
0-14: ALL
14-39: AML
40-59: CML
60+: CLL
III) Rhabdomyolysis causes HYPERkalemia.
HYPOkalemia causes Rhabdomyolysis
IV) ALL causes of hypopituitarism result in deficiency of MORE than ONE hormone
EXCEPT
Kallmann Syndrome
V) Clostridium:
Tetani - causes SPASTIC paralysis.
Botulinum - causes FLACCID paralysis.
Perfringes - causes NO paralysis
VI) IN Nephron:
Maximum reabsorption of H2O take place in Proximal Convoluted Tubules, REGARDLESS
to
ADH status (present or absent).
VII) Offspring of Older Women: Inc incidence of Trisomy 21 (DOWN Syndrome).
Offspring of Older Men: Inc incidence of Achondroplasia & Marfan Syndrome.
VIII) Know the difference:
Cisplatin is NEPHrotoxic.
Cyclophosphamide is CYStotoxic (Hemorrahagic CYSitis)
IX) Try to Understand that:
History of Smoking = Bronchogenic Cancer.
Exposure to Asbestos = Mesothelioma.
Smoking Hx + Asbestos exposure = Bronchogenic Cancer.
X) Until proven Otherwise:
Post-coital vaginal bleeding is Cervical cancer.
Post-menopausal vaginal bleeding is Endometrial cancer.
Most important component of shock
Q: Most important component of shock is??
a) Hypotension
b) Tachycardia
c) Tissue hypoxia
d) Temperature
Answer: C
Explanation: By definition shock is inadequate tissue perfusion, which is just
ANOTHER way
of saying "Tissue Hypoxia".
Q: Young female with low MCV and MCH but normal Fe and TIBC, most likely test to
make
Diagnosis?
A. bone marrow aspiration
B. Hb A2
C. Retic count
Answer: B
Explanation: Microcytic Anemia With NORMAL Iron studies (Serum Iron, TIBC, Ferritin
etc)
= Thalassemia.
Hb electropheresis is the Next best Investigation.
Question: One of the following is not an oncogenic virus?
a.EBV
b. Hep B
c.Hep D
d.herpes virus
e. HPV
Answer: C
Remember:
If Hep D and Herpes are in options SELECT Hep D.
If Hep D and HSV in options SELECT HSV.
Herpes --> family of 8 viruses (Including HHV8 and EBV - BOTH are carcinogenic)
1) Microcytic Anemia with Low Ferritin & High TIBC = Iron deficiency Anemia.
2) Microcytic Anemia with High Ferritin & Low TIBC = Anemia of Chronic Disease.
3) Microcytic Anemia with High Serum Iron = Sideroblastic Anemia.
4) Microcytic Anemia with NORMAL Iron studies = Thalassemia.
________
TIBC = Total Iron Binding Capacity
Ferritin = Stored Iron
A young female with pregnancy developed nausea vomiting and jaundice suddenly she
died
which is most unlikely in this patient?
A. HAV
B. Hep B
C. Hep C
D. Hep D
E. . Hep E
Answer: C (Hepatitis C)
Explanation: ALL Hepatitis viruses can cause Acute fulminant hepatitis EXCEPT
Hepatitis C.
The given presentations are HIGHLY suggestive of Fulminant hepatitis and the Least
likely or
most Unlikely cause will be Hepatitis C.
Coagulative Necrosis is seen in...
A.TB
B. Pyogenic infections
C.all infractions
D.gangrene
E.brain
Answer: A
Explanation: Yes! I know I know, T.B & Caseous Necrosis thing. Actually Caseous is
variant of
Coagulative Necrosis that's why here the correct answer is T.B (a)
Why NOT Gangrene?
We have TWO types of Gangrenes (a) Gas (b) Wet
Gas Gangrene is related to Coagulative while Wet Gangrene is related with
Liquifective
Necrosis.
Here in question we have generalized term "Gangrene" which can be BOTH - either Gas
or Wet.
1)
Oral Cavity:
Premalignant CONDITIONS = Submucous Fibrosis & Lichen planus.
Premalignant LESIONS = Erythroplakia & Leukoplakia.
2)
Isolated 6th cranial nerve palsy causes HORIZONTAL diplopia.
Isolated 4th cranial nerve palsy causes VERTICAL diplopia.
3)
Fluent aphasia: Cerebral lesion is POSTERIOR to the central sulcus.
Nonfluent aphasia: Cerebral lesion is ANTERIOR to the central sulcus.
Tamoxifen is an estrogen receptor AGONIST in the uterus.
Raloxifene is an estrogen receptor ANTAGONIST in the uterus.
Tamoxifen for PREmenopausal women with high risk for breast cancer.
Raloxifene for POSTmenopausal women with high risk for breast cancer.
ALL steroid hormones are protein bound EXCEPT DHEA.
ALL protein hormones are not bound to plasma proteins EXCEPT IGF-1.
ALL hormones are secreted in pulsatile fashion EXCEPT Thyroxin.
Regarding TB:
- T.B.
- T.B.
Calcification, Positive PPD, Caseating granuloma - in BOTH.
The MOST COMMON thyroid Carcinoma is Papillary (P-opular).
It also has P-sammoma bodies on histology.
It causes P-alpable lymph nodes (lymphatic spread)
n. MeninGitidis ferments Maltose & Glucose.
n. Gonorrhoeae ferments ONLY Glucose.
LYMPHATIC DRAINAGE OF MAJOR ORGANS
GIT: all lymph of GIT is drained into CYSTERNA CHYLI, THORACIC DUCT & then finally
drains into LEFT SUBCLAVIAN VEIN
CERVICAL ESOPHAGUS drains into Deep cervical nodes
THORACIC ESOPHAGUS drains into posterior mediastinal nodes
ABDOMINAL ESOPHAGUS drains into Preaortic & celiac nodes
STOMACH is drained to Aortic nodes
SMALL INTESTINE drains into Superior Mesentric nodes
LARGE INTESTINE drains into Central nodes through Epicolic, Paracolic &
Intermediate
nodes
RECTUM: Upper half drains into Inferior mesentric nodes
Lower half drains into internal iliaac nodes
ANAL CANAL: Upper half into internal iliac nodes
Lower half into Superficial inguinal nodes
MALE GENITAL TRACT
SCROTUM drains into Superficial inguinal nodes
TESTIS drains into Paraaortic nodes
PROSTATE drains into Internal & external Iliac nodes
PENIS.. Skin.. Superficial Inguinal nodes
Deep structure.. Internal Iliac nodes
FEMALE GENITAL TRACT
OVARY, FALLOPIAN TUBES, UPPER UTERINE CORPUS drains into Aortic & paraaortic
nodes.
UPPER VAGINA, CERVIX drains into External & Internal Iliac nodes.
LOWER VAGINA & VULVA drains into Inguinal nod