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Saturday 14 December 2013

MRI Scan Part-4

MRI Scan At A Glance

  • MRI scanning uses magnetism, radio waves, and a computer to produce images of body structures.
  • MRI scanning is painless and does not involve x-ray radiation.
  • Patients with heart pacemakers, metal implants, or metal chips or clips in or around the eyes cannot be scanned with MRI because of the effect of the magnet.
  • Claustrophobic sensation can occur with MRI scanning.

Friday 13 December 2013

MRI scan Part-3

How does a patient prepare for an MRI scan and how is it performed?

All metallic objects on the body are removed prior to obtaining an MRI scan. Occasionally, patients will be given a sedative medication to decrease anxiety and relax the patient during the MRI scan. MRI scanning requires that the patient lie still for best accuracy. Patients lie within a closed environment inside the magnetic machine. Relaxation is important during the procedure and patients are asked to breathe normally. Interaction with the MRI technologist is maintained throughout the test. There are loud, repetitive clicking noises which occur during the test as the scanning proceeds. Occasionally, patients require injections of liquid intravenously to enhance the images which are obtained. The MRI scanning time depends on the exact area of the body studied, but ranges from half an hour to an hour and a half.

How does a patient obtain the results of the MRI scan?

After the MRI scanning is completed, the computer generates visual images of the area of the body that was scanned. These images can be transferred to film (hard copy). A radiologist is a physician who is specially trained to interpret images of the body. The interpretation is transmitted in the form of a report to the practitioner who requested the MRI scan. The practitioner can then discuss the results with the patient and/or family.
Future
Scientists are developing newer MRI scanners that are smaller, portable devices. These new scanners apparently can be most useful in detecting infections and tumors of the soft tissues of the hands, feet, elbows, and knees. The application of these scanners to medical practice is now being tested.

Pictures of an MRI of the spine

This patient had a herniated disc between vertebrae L4 and L5. The resulting surgery was a discectomy
Picture of herniated disc between L4 and L5
Picture of herniated disc between L4 and L5
Cross-section picture of herniated disc between L4 and L5
Cross-section picture of herniated disc between L4 and L5

Thursday 12 December 2013

MRI scan Part-2

What are the risks of an MRI scan?


What are the risks of an MRI scan?


An MRI scan is a painless radiology technique that has the advantage of avoiding x-ray radiation exposure. There are no known side effects of an MRI scan. The benefits of an MRI scan relate to its precise accuracy in detecting structural abnormalities of the body.
Patients who have any metallic materials within the body must notify their physician prior to the examination or inform the MRI staff. Metallic chips, materials, surgical clips, or foreign material (artificial joints, metallic bone plates, or prosthetic devices, etc.) can significantly distort the images obtained by the MRI scanner. Patients who have heart pacemakers, metal implants, or metal chips or clips in or around the eyeballs cannot be scanned with an MRI because of the risk that the magnet may move the metal in these areas. Similarly, patients with artificial heart valves, metallic ear implants, bullet fragments, and chemotherapy or insulin pumps should not have MRI scanning.
During the MRI scan, patient lies in a closed area inside the magnetic tube. Some patients can experience a claustrophobic sensation during the procedure. Therefore, patients with any history of claustrophobia should relate this to the practitioner who is requesting the test, as well as the radiology staff. A mild sedative can be given prior to the MRI scan to help alleviate this feeling. It is customary that the MRI staff will be nearby during MRI scan. Furthermore, there is usually a means of communication with the staff (such as a buzzer held by the patient) which can be used for contact if the patient cannot tolerate the scan.

Wednesday 11 December 2013

MRI scan Part-1



What is an MRI scan?

An MRI (or magnetic resonance imaging) scan is a radiology technique that uses magnetism, radio waves, and a computer to produce images of body structures. The MRI scanner is a tube surrounded by a giant circular magnet. The patient is placed on a moveable bed that is inserted into the magnet. The magnet creates a strong magnetic field that aligns the protons of hydrogen atoms, which are then exposed to a beam of radio waves. This spins the various protons of the body, and they produce a faint signal that is detected by the receiver portion of the MRI scanner. The receiver information is processed by a computer, and an image is produced.
The image and resolution produced by MRI is quite detailed and can detect tiny changes of structures within the body. For some procedures, contrast agents, such as gadolinium, are used to increase the accuracy of the images.

When are MRI scans used?

An MRI scan can be used as an extremely accurate method of disease detection throughout the body. In the head, trauma to the brain can be seen as bleeding or swelling. Other abnormalities often found include brain aneurysms, stroke, tumors of the brain, as well as tumors or inflammation of the spine.
Neurosurgeons use an MRI scan not only in defining brain anatomy but in evaluating the integrity of the spinal cord after trauma. It is also used when considering problems associated with the vertebrae or intervertebral discs of the spine. An MRI scan can evaluate the structure of the heart and aorta, where it can detect aneurysms or tears.
It provides valuable information on glands and organs within the abdomen, and accurate information about the structure of the joints, soft tissues, and bones of the body. Often, surgery can be deferred or more accurately directed after knowing the results of an MRI scan.

Tuesday 10 December 2013

Ascites Part-4



What is the outlook (prognosis) for ascites?

The outlook on ascites primarily depends on its underlying cause and severity.
In general, the prognosis of malignant ascites is poor. Most cases have a mean survival time between 20 to 58 weeks, depending on the type of malignancy as shown by a group of investigators.
Ascites due to cirrhosis usually is a sign of advanced liver disease and it usually has a fair prognosis with a 3-year survival rate of about 75%.
Ascites due to heart failure has a fair prognosis as the patient may live years with appropriate treatments.

Monday 9 December 2013

Ascites part-3

What are the complications for ascites?

Some complications of ascites can be related to its size. The accumulation of fluid may cause breathing difficulties by compressing the diaphragm and formation of pleural effusion.
Infections are another serious complication of ascites. In patients with ascites related to portal hypertension, bacteria from the gut may spontaneously invade the peritoneal fluid (ascites) and cause an infection. This is called spontaneous bacterial peritonitis or SBP. Antibodies are rare in ascites and, therefore, the immune response in the ascitic fluid is very limited. The diagnosis of SBP is made by performing a paracentesis and analyzing the fluid for the number of white blood cells or evidence of bacterial growth.
Hepatorenal syndrome is a rare, but serious and potentially deadly (average survival rates range from 2 weeks to about 3 months) complication of ascites related to cirrhosis of the liver leading to progressive kidney failure. The exact mechanism of this syndrome is not well known, but it may result from shifts in fluids, impaired blood flow to the kidneys, overuse of diuretics, and administration of contrasts or drugs that may be harmful to the kidney.

Can ascites be prevented?


The prevention of ascites largely involves preventing the risk factors of the underlying conditions leading to ascites.
In patients with known advanced liver disease and cirrhosis of any cause, avoidance of alcohol intake can markedly reduce the risk of forming ascites. Nonsteroidal antiinflammatory drugs (ibuprofen [Advil, Motrin, etc.]) should also be limited in patients with cirrhosis as they may diminish the blood flow to the kidneys, thus, limiting the salt and water excretion. Complying with dietary salt restrictions is also another simple preventive measure to reduce ascites.

Sunday 8 December 2013

Ascites Part-2

What is the treatment for ascites?

The treatment of ascites largely depends on the underlying cause. For example, peritoneal carcinomatosis or malignant ascites may be treated by surgical resection of the cancer and chemotherapy, while management of ascites related to heart failure is directed toward treating heart failure with medical management and dietary restrictions.
Because cirrhosis of the liver is the main cause of ascites, it will be the main focus of this section.

Diet

Managing ascites in patients with cirrhosis typically involves limiting dietary sodium intake and the use of diuretics (water pills). Restricting dietary sodium (salt) intake to less than 2 grams per day is very practical, successful, and widely recommended for patients with ascites. In majority of cases, this approach needs to be combined with the use of diuretics as salt restriction alone is generally not an effective way to treat ascites. Consultation with a nutrition expert in regards to daily salt restriction can be very helpful for patients with ascites.

Medication

Diuretics increase water and salt excretion from the kidneys. The recommended diuretic regimen in the setting of liver related ascites is a combination of spironolactone (Aldactone) and furosemide (Lasix). Single daily dose of 100 milligrams of spironolactone and 40 milligrams of furosemide is the usual recommended initial dosage. This can be gradually increased to obtain appropriate response to the maximum dosage of 400 milligrams of spironolactone and 160 milligrams of furosemide, as long as the patient can tolerate the dose increase without any side effects. Taking these medications together in the morning is typically advised to prevent frequent urination during the night.

Therapeutic paracentesis

For patients who do not respond well to or cannot tolerate the above regimen, frequent therapeutic paracentesis (a needle carefully is placed into the abdominal area, under sterile conditions) can be performed to remove large amounts of fluids. A few liters (up to 4 to 5 liters) of fluid can be removed safely by this procedure each time. For patients with malignant ascites, this procedure may also be more effective than diuretic use.

Surgery

For more refractory cases, surgical procedures may be necessary to control the ascites. Transjugular intrahepatic portosystemic shunts (TIPS) is procedure done through the internal jugular vein (the main vein in the neck) under local anesthesia by an interventional radiologist. A shunt is placed between the portal venous system and the systemic venous system (veins returning blood back to the heart), thereby reducing the portal pressure. This procedure is reserved for patients who have minimal response to aggressive medical treatment. It has been shown to reduce ascites and either limit or eliminate the use of diuretics in a majority of cases performed. However, it is associated with significant complications such as hepatic encephalopathy (confusion) and even death.
Mor

Saturday 7 December 2013

Ascites Part-1

Ascites Facts

  • Ascites refers to abnormal accumulation fluid in the abdominal (peritoneal) cavity.
  • The most common cause of ascites is cirrhosis of the liver.
  • Treatment of ascites depends on its underlying cause.

What is ascites?

Ascites is the accumulation of fluid (usually serous fluid which is a pale yellow and clear fluid) in the abdominal (peritoneal) cavity. The abdominal cavity is located below the chest cavity, separated from it by the diaphragm. Ascitic fluid can have many sources such as liver disease, cancers, congestive heart failure, or kidney failure.

What causes ascites?

The most common cause of ascites is advanced liver disease or cirrhosis. Approximately 85% of the ascites cases are thought to be due to cirrhosis. Although the exact mechanism of ascites development is not completely understood, most theories suggest portal hypertension (increased pressure in the liver blood flow) as the main contributor. The basic principle is similar to the formation of edema elsewhere in the body due to an imbalance of pressure between inside the circulation (high pressure system) and outside, in this case, the abdominal cavity (low pressure space). The increase in portal blood pressure and decrease in albumin (a protein that is carried in the blood) may be responsible in forming the pressure gradient and resulting in abdominal ascites.
Other factors that may contribute to ascites are salt and water retention. The circulating blood volume may be perceived low by the sensors in the kidneys as the formation of ascites may deplete some volume from the blood. This signals the kidneys to reabsorb more salt and water to compensate for the volume loss.
Some other causes of ascites related to increased pressure gradient are congestive heart failure and advanced kidney failure due to generalized retention of fluid in the body.
In rare cases, increased pressure in the portal system can be caused by internal or external obstruction of the portal vessel, resulting in portal hypertension without cirrhosis. Examples of this can be a mass (or tumor) pressing on the portal vessels from inside the abdominal cavity or blood clot formation in the portal vessel obstructing the normal flow and increasing the pressure in the vessel (for example, the Budd-Chiari syndrome).
Acites can also manifest as a result of cancers, called malignant ascites. These types of ascites are typically manifestations of advanced cancers of the organs in the abdominal cavity, such as, colon cancer, pancreatic cancer, stomach cancer, breast cancer, lymphoma, lung cancer, or ovarian cancer.
Pancreatic ascites can be seen in people with chronic (long standing) pancreatitis or inflammation of the pancreas. The most common cause of chronic pancreatitis is prolonged alcohol abuse. Pancreatic ascites can also be caused by acute pancreatitis as well as trauma to the pancreas.

Friday 6 December 2013

Ascites Cont.

When should I call my doctor about ascites?

People with ascites should be routinely followed by their primary physician and any specialists that may be involved in their care. Gastroenterologists (specialists in gastrointestinal diseases) and hepatologist (liver specialists) commonly see patients with ascites due to liver disease. Other specialists can also care for patients with ascites based on the possible cause and the underlying condition. The specialists usually ask the patient to first contact their primary physician if ascites increase. If ascites is causing symptoms of shortness of breath, abdominal discomfort ,or inability to do normal daily tasks such as walking, the patient's primary doctor should be notified.

How is ascites diagnosed?

The diagnosis of ascites is based on physical examination in conjunction with a detailed medical history to ascertain the possible underlying causes since ascites is often considered a nonspecific symptom for other diseases. If ascites fluid is greater than 500ml, it can be demonstrated on physical examination by bulging flanks and fluid waves performed by the doctor examining the abdomen. Smaller amounts of fluid may be detected by an ultrasound of the abdomen. Occasionally, ascites is found incidentally by an ultrasound or a CT scan done for evaluating other conditions.
Diagnosis of underlying condition causing ascites is the most important part of understanding the reason for a person to develop ascites. The medical history may provide clues to the underlying cause and typically includes questions about previous diagnosis of liver disease, viral hepatitis infection and its risk factors, alcohol abuse, family history of liver disease, heart failure, cancer history, and medication history.
Blood work can play an essential role in evaluating the cause of ascites. A complete metabolic panel can detect patterns of liver injury, functional status of the liver and kidney, and electrolyte levels. A complete blood count is also useful by providing clues to underlying conditions. Coagulation (clotting) panel abnormalities (prothrombin time) may be abnormal because of liver dysfunction and inadequate production of clotting proteins.
Sometimes the possible underlying causes of ascites may not be determined based on the history, examination, and review of laboratory data and imaging studies. Analysis of the fluid may be necessary in order to obtain further diagnostic data. This procedure is called paracentesis, and it is performed by trained physicians. It involves sterilizing an area on the abdomen and, with the guidance of ultrasound, inserting a needle into the abdominal cavity and withdrawing fluid for further analysis.
For di

Thursday 5 December 2013

Ascites

What are the types of ascites?

Traditionally, ascites is divided into 2 types; transudative or exudative. This classification is based on the amount of protein found in the fluid.
A more useful system has been developed based on the amount of albumin in the ascitic fluid compared to the serum albumin (albumin measured in the blood). This is called the Serum Ascites Albumin Gradient or SAAG.
  • Ascites related to portal hypertension (cirrhosis, congestive heart failure, Budd-Chiari) is generally greater than 1.1.
  • Ascites caused by other reasons (malignant, pancreatitis) is lower than 1.1.

What are the risk factors for ascites?

The most common cause of ascites is cirrhosis of the liver. Many of the risk factors for developing ascites and cirrhosis are similar. The most common risk factors include hepatitis B, hepatitis C, and long standing alcohol abuse. Other potential risk factors are related to the other underlying conditions, such as congestive heart failure, malignancy, and kidney disease.

What are the symptoms of ascites?


There may be no symptoms associated with ascites especially if it is mild (usually less than about 100 – 400 ml in adults). As more fluid accumulates, increased abdominal girth and size are commonly seen. Abdominal pain, discomfort, and bloating are also frequently seen as ascites becomes larger. Shortness of breath can also happen with large ascites due to increased pressure on the diaphragm and the migration of the fluid across the diaphragm causing pleural effusions (fluid around the lungs). A cosmetically disfiguring large belly, due to ascites, is also a common concern of some patients.

Wednesday 4 December 2013

Anemia Part-8


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What are the complications of anemia?

As mentioned earlier, hemoglobin has the important role of delivering oxygen to all parts of the body for consumption and carries back carbon dioxide back to the lung to exhale it out of the body. If the hemoglobin level is too low, this process may be impaired, resulting in low levels of oxygen in the body (hypoxia).

What is the outlook (prognosis) for anemia?

Anemia generally has a very good prognosis and it may be curable in many instances. The overall prognosis depends on the underlying cause of anemia, its severity, and the overall health of the patient.

Tuesday 3 December 2013

Anemia Part-7

Anemia Part-7

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How is blood collected for a CBC?

Blood is collected by venipuncture (using a needle to draw blood from a vein) in a lab, hospital, or physician's office. Typically, blood is collected in a special sterile tube from an arm vein. The tube has some preservatives to prevent clotting of the blood. Results may be available in an hour or longer depending on the setting.
In some instances, a quick in office test called hemoglobin rapid test may be performed using a few drops of blood from a finger prick. The advantage of this quick test is that results may be obtained in a few minutes and only a few drops of blood may be required.

What is the red blood cell (RBC) count?

The red blood cells (RBCs or erythrocytes) are the most common type of cells in the blood. We each have millions and millions of these little disc-shaped cells. The RBC count is done to determine if the number of red blood cells is low (anemia) or high (polycythemia).
In an RBC count, the number and size of the RBCs are determined. This is usually reported as number of RBCs per a specified volume, typically in millions of RBCs in microliters (one one-thousandth of an ml) of whole blood. The shape of the RBCs is also evaluated under a microscope. All of this information, the number, size and shape of the RBCs, is useful in the diagnosis of anemia. Further, the specific type of anemia may be determined by this information.

What is hemoglobin?

Hemoglobin is a red pigment that imparts the familiar red color to red blood cells and to blood. Functionally, hemoglobin is the key chemical compound that combines with oxygen from the lungs and carries the oxygen from the lungs to cells throughout the body. Oxygen is essential for all cells in the body to produce energy.
The blood also transports carbon dioxide, which is the waste product of this energy production process, back to the lungs from which it is exhaled into the air. The transport of the carbon dioxide back to the lung is also achieved by hemoglobin. The carbon dioxide bound to hemoglobin is unloaded in the lungs in exchange for oxygen to be transported to the tissues of the body.

Monday 2 December 2013

Anemia Part-6

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What does a low hemoglobin level mean?

Low hemoglobin is called anemia. When there is a low hemoglobin level, there is often a low red blood cell count and a low hematocrit, too. Reference ranges are slightly different from one source to another, but typically hemoglobin of less than 13.5 gram/100 ml is abnormal in men and less than 12.0 gram/100 ml in women.

What is the hematocrit?

The hematocrit is specifically a measure of how much of the blood is made of red cells. The hematocrit is a very convenient way to determine whether the red blood cell count is too high, too low, or normal. The hematocrit is a measure of the proportion of blood that is composed of the red blood cells.

How is hematocrit determined?

The red blood cells in the sample of blood are packed down by spinning the tube in a centrifuge under prescribed conditions. The proportion of the tube that consists of red blood cells is then measured. Let's say that it is 45%. The hematocrit is 45%.

How is anemia treated?

The treatment of the anemia varies greatly. First, the underlying cause of the anemia should be identified and corrected. For example, anemia as a result of blood loss from a stomach ulcer should begin with medications to heal the ulcer. Likewise, surgery is often necessary to remove a colon cancer that is causing chronic blood loss and anemia.
Sometimes iron supplements will also be needed to correct iron deficiency. In severe anemia, blood transfusions may be necessary. Vitamin B12 injections will be necessary for patients suffering from pernicious anemia or other causes of B12 deficiency.
In certain patients with bone marrow disease (or bone marrow damage from chemotherapy) or patients with kidney failure, epoetin alfa (Procrit, Epogen) may be used to stimulate bone marrow red blood cell production.
If a medication is thought to be the culprit, then it should be discontinued under the direction of the prescribing doctor.

Anemia Part-5

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How is anemia diagnosed?

Anemia is usually detected, or at least confirmed, by a complete blood cell (CBC) count. A CBC test may be ordered by a physician as a part of routine general checkup and screening or based on clinical signs and symptoms that may suggest anemia or other blood abnormalities.

What is a complete blood cell (CBC) count?

Traditionally, CBC analysis was performed by a physician or a laboratory technician by viewing a glass slide prepared from a blood sample under a microscope. Today, much of this work is often automated and done by machines. Six component measurements make up a CBC test:
  1. Red blood cell (RBC) count
  2. Hematocrit
  3. Hemoglobin
  4. White blood cell (WBC) count
  5. Differential blood count (the "diff")
  6. Platelet count
Only the first three of these tests -- the red blood cell (RBC) count, the hematocrit, and the hemoglobin -- are relevant to the diagnosis of anemia.
Additionally, mean corpuscular volume (MCV) is also often reported in a CBC, which basically measures the average volume of red blood cells in a blood sample. This is important in distinguishing the causes of anemia. Units of MCV are reported in femtoliters, a fraction of one millionth of a liter.
Other useful clues to causes of anemia that are reported in a CBC are the size, shape, and color of red blood cells.
Picture of Red Blood Cells

Sunday 1 December 2013

Anemia Part-4

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Yes, anemia may be genetic. Hereditary disorders can shorten the life span of the red blood cell and lead to anemia (for example, sickle cell anemia). Hereditary disorders can also cause anemia by impairing the production of hemoglobin (for example, alpha thalassemia and beta thalassemia).
Depending on the degree of the genetic abnormality, hereditary anemias may cause mild, moderate, or severe anemia. In fact, some may be too severe to be compatible with life and may result in death of the fetus (unborn infant). On the other hand, some of these anemias are so mild that they are not noticeable and are incidentally revealed during a routine blood work.

What are the symptoms of anemia?

Some patients with anemia have no symptoms. Others with anemia may feel:
  • Tired
  • Fatigue easily
  • Appear pale
  • Develop palpitations (feeling of heart racing)
  • Become short of breath
Additional symptoms may include:
  • Hair loss
  • Malaise (general sense of feeling unwell)
  • Worsening of heart problems
It is worth noting that if anemia is longstanding (chronic anemia), the body may adjust to low oxygen levels and the individual may not feel different unless the anemia becomes severe. On the other hand, if the anemia occurs rapidly (acute anemia), the patient may experience significant symptoms relatively quickly.

Saturday 30 November 2013

Anemia Part-3


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What are other causes of anemia?

Some of the most common causes include:
  • Vitamin B12 deficiency may cause pernicious anemia. This type of anemia could happen in people who are unable to absorb vitamin B12 from their intestines due to a number of reasons.
    • Strict vegetarians are at risk if they do not take adequate vitamin supplements.
    • Long-term alcoholics.
    • People who have abnormal structure or function of the stomach or intestines leading to impaired B12 absorption despite adequate intake.
This typically causes macrocytic (large blood cell volume) anemia. Vitamin B12, along with folate, is involved in making the heme molecule that is an integral part of hemoglobin. Folate deficiency can be the culprit of anemia as well. This may also be caused by inadequate absorption, under-consumption of green, leafy vegetables, and also long-term heavy alcohol use.
  • There can be rupture or destruction of red blood cells (hemolytic anemia) due to antibodies clinging to the surface of the red cells. Examples of hemolytic anemia include hemolytic disease of the newborn, medication induced hemolytic anemia, transfusion related hemolysis, and autoimmune hemolytic anemia.
  • A wide assortment of bone marrow diseases can cause anemia.
    • For example, cancers that spread (metastasize) to the bone marrow, or cancers of the bone marrow (such as leukemia or multiple myeloma) can cause the bone marrow to inadequately produce red blood cells, resulting in anemia.
    • Certain chemotherapy for cancers can also cause damage to the bone marrow and decrease red blood cell production, resulting in anemia.
    • Certain infections may involve the bone marrow and result in bone marrow impairment and anemia.
    • Finally, patients with kidney failure may lack the hormone necessary to stimulate normal red blood cell production by the bone marrow.
    • Chronic alcohol consumption may lead to anemia via different pathways and thus, anemia is commonly seen in alcoholics.
  • Another common cause of anemia is called anemia of chronic disease. This could typically occur in individuals with longstanding chronic diseases.

Friday 29 November 2013

Anemia Part-2


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Can inadequate iron cause anemia?

Absolutely! As a matter of fact, iron deficiency is a very common cause of anemia. This is because iron is major component of hemoglobin and essential for its proper function. Chronic blood loss due to any reason is the main cause of low iron level in the body as it depletes the body's iron stores to compensate for the ongoing loss of iron. Anemia that is due to low iron levels is called iron deficiency anemia.
Young women are likely to have low grade iron deficiency anemia because of the loss of blood each month through normal menstruation. This is generally without any major symptoms as the blood loss is relatively small and temporary.
Another common reason for iron deficiency anemia can be due to recurring or small ongoing bleeding, for instance from colon cancer or from stomach ulcers. Stomach ulcer bleeding may be induced by medications, even very common over-the-counter drugs such as aspirin and ibuprofen (Advil, Motrin). Slow and chronic oozing from these ulcers can lead to loss of iron. Gradually, this could result in anemia. In infants and young children, iron deficiency anemia is most often due to a diet lacking iron.
Interpretation of CBC may lead to clues to suggest this type of anemia. For instance, iron deficiency anemia usually presents with low mean corpuscular volume (microcytic anemia) in addition to low hemoglobin.

What about acute (sudden) blood loss as a cause of anemia?

Acute blood loss from internal bleeding (as from a bleeding ulcer) or external bleeding (as from trauma) can produce anemia in an amazingly short span of time. This type of anemia could result in severe symptoms and consequences if not addressed promptly. Dizziness, lightheadedness, fatigue, confusion, shortness of breath, and even loss of consciousness can occur with severe, sudden blood loss anemia.

Thursday 28 November 2013

Heart Disease Part-7

Heart Disease Part-7

Heart Disease Part-7

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Angioplasty and stenting

If the coronary angiogram (coronary=heart + angio=artery + gram=record) shows significant blockage in an artery, the cardiologist may attempt an angioplasty, in which a balloon is placed via a catheter (as with angiography) at the area of narrowing and when quickly inflated, compresses the offending plaque into the wall of the artery. Often a stent, or a metal cage, is placed at the site of angioplasty to keep the blood vessel from narrowing again. Should a stent be placed, patients are usually started on antiplatelet medication to prevent clot formation. Clopidogrel (Plavix) and prasugrel (Effient) are the two most common medications prescribed.

Surgery

For those patients with multiple coronary artery blockages, coronary artery bypass grafting may be a consideration.

Tuesday 26 November 2013

Heart Disease Part-5

Heart Disease Part-5

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Heart Disease Part-5

Heart catheterization or coronary angiography

This test is the gold standard for the diagnosis of coronary artery disease. A cardiologist inserts and then threads a small tube through the groin or arm into the coronary arteries, where dye is injected to directly visualize the arteries on an x-ray. This test defines the anatomy of the coronary arteries. At the time of the catheterization, if blockages are found, they may be potentially treated with angioplasty in which a balloon is inflated to squash the plaque into the blood vessel wall and the insertion of a stent (wire cage that prevents the blood vessel from narrowing again).
CT coronary angiogram may be used test to diagnose coronary artery disease. During this procedure, intravenous dye containing iodine is injected into the patient and CT scanning is performed to image the coronary arteries.
Prior to the angiogram, a calcium score may be obtained. The calcium CT scan can measure the amount of calcium within heart blood vessels. If the score is 0, meaning that there is no calcium present, the risk of having heart disease is zero. The higher the score, the increased risk of narrowed coronary arteries.

What is the treatment for heart disease?

Coronary artery disease is usually treated in a multi-step approach depending upon a patient's symptoms. The patient and healthcare provider need to work together to return the patient to a normal lifestyle.

Prevention of heart disease

Comment on this
The key to the treatment is prevention. A healthy lifestyle includes exercise, proper nutrition, and smoking cessation. Moreover, controlling diabetes and high blood pressure to minimize contribution risk for heart disease is a major aspect of prevention.
An aspirin a day is recommended to decrease the risk for heart disease and should be started with the recommendation of a health care practitioner.
A little alcohol (one drink per day for women or two drinks per day for men) decreases the risk of heart disease compared to nondrinkers. However, it is not recommended that nondrinkers begin drinking.

Monday 25 November 2013

Heart Disease Part-4

Heart Disease Part-4

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Heart Disease Part-4

Echocardiography

Used with or without exercise, echocardiography can assess how the heart works. Using sound waves to generate an image, a cardiologist can evaluate many aspects of the heart. Echocardiograms can examine the structure of the heart including the heart valves, the thickness of the heart muscle, the septum (the tissues that separate the four heart chambers from each other) and the pericardial sac (the outside lining of the heart).
The test can indirectly assess blood flow to parts of the heart muscle. If there is decreased blood flow, then segments of the heart wall may not beat as strongly as adjacent heart muscle. These wall motion abnormalities signal the potential for coronary artery disease.
The echocardiogram can also assess the efficiency of the heart by measuring ejection fraction. Normally when the heart beats, it pushes more than 60% of the blood in the ventricle out to the body. Many diseases of the heart, including coronary artery disease, can decrease this percentage (the ejection fraction).

Perfusion studies

Radioactive chemicals like thallium or technetium can be injected into a vein and their uptake measured in heart muscle cells. Abnormally decreased uptake can signify decreased blood flow to parts of the heart because of coronary artery narrowing. This test may be used when the patient's baseline EKG is not normal and is less reliable when used to monitor a stress test.

Computerized tomography

The latest generation of CT scanners can take detailed images of blood vessels and may be used as an adjunct to determine whether coronary artery disease is present. In some institutions, the heart CT is used as a negative predictor. That means that the test is done to prove that the coronary arteries are normal rather than to prove that the disease is present.

Saturday 23 November 2013

Cholesterol Drugs May Boost Your Gums' Health, Too

Cholesterol Drugs May Boost Your Gums' Health, Too

 

The statin medications you take for your heart may have an unexpected side benefit: They help reduce inflammation of the gums, according to new research.
Using advanced imaging techniques, researchers were able to see that when people with gum disease took higher doses of the commonly prescribed cholesterol-lowering drugs, their gum inflammation decreased.
During the 12-week study, the researchers also looked for evidence of inflammation or hardening of the blood vessels (atherosclerotic disease) in the study volunteers, and they found that reduced gum inflammation was correlated with improved blood vessel health.
"There is a building, growing body of literature that draws a line between gum disease and atherosclerotic disease. In our study, benefits in the gums correlated with benefits in the arteries," said the study's senior author, Dr. Ahmed Tawakol, co-director of the Cardiac Imaging Trials Program at Massachusetts General Hospital and Harvard Medical School in Boston. "People with [gum disease] and atherosclerotic disease should likely be that much more vigilant in treating their gum disease."
The study was published online Oct. 2 in the Journal of the American College of Cardiology. Funding was provided by drug manufacturer Merck and Co., which does not produce the statin used in this study.
Currently, statins are prescribed to lower high levels of "bad" cholesterol, also known as LDL cholesterol. When there's too much LDL cholesterol, it can start to build up on blood vessel walls, leading to hardening of the arteries.
News Picture: Cholesterol Drugs May Boost Your Gums' Health, TooIn the United States, more than 30 million people take statins, and as many as 200 million people worldwide take these cholesterol-lowering medications, according to a journal editorial accompanying the study. Periodontal disease (or gum disease) affects nearly half of U.S. adults.
According to editorial author Dr. Michael Blaha, director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease in Baltimore, a "consistent stream of data" shows that statins have benefits beyond their cholesterol-lowering properties.
"There are three big categories of how statins likely exert their effects: lowering LDL, reducing inflammation, and by modulating plaque," said Blaha.
The current study lends support to the idea that statins can reduce inflammation. It included 83 adults who had risk factors for, or already had, atherosclerosis. They were randomly assigned to take either 10 or 80 milligrams of a statin called atorvastatin (brand name Lipitor) for three months.
Everyone underwent imaging at the start of the study, again after four weeks and then at 12 weeks.
At the end of the study, the investigators had complete data on 59 people. They found a significant reduction in gum inflammation for the people taking 80 mg of atorvastatin compared to those on the 10-mg dose. Changes began as early as four weeks after people started taking the higher-dose drug.
There was a more significant reduction in gum inflammation for people who had more serious gum disease at the start of the study and took a higher dose of the statin. The researchers also found that a reduction in gum inflammation correlated with reduced blood vessel inflammation.
"It was really those on the higher-dose statins that had the benefit," noted Tawakol. But, "I would not recommend the use of statins outside the current guidelines," he added. "We see this trial more as a proof-of-principle trial. Our findings need to be confirmed in a larger clinical trial."
Still, he said, there's little harm in telling people to take care of gum disease. "Patients with known heart disease and known gum disease should have their gum disease evaluated and treated," Tawakol said.

Daily Walk May Cut Your Breast Cancer Risk

Daily Walk May Cut Your Breast Cancer Risk

FRIDAY, Oct. 4 (HealthDay News) -- Older women who walk every day may reduce their risk of developing breast cancer. And those who exercise vigorously may get even more protection, according to new research.
The study of more than 73,000 postmenopausal women found that walking at a moderate pace for an hour a day was associated with a 14 percent reduced breast cancer risk, compared to leading a sedentary lifestyle. An hour or more of daily strenuous physical activity was associated with a 25 percent reduced risk, the study found.
This is welcome news for women who aren't very athletic.
"The nice message here is, you don't have to go out and run a marathon to lower your breast cancer risk," said study researcher Alpa Patel, senior epidemiologist at the American Cancer Society, which funded the study.
"Go for a nice, leisurely walk an hour a day to lower risk," Patel advised.
Breast cancer is the leading cancer among women. In the United States, about one in eight women will develop the disease in her lifetime.

News Picture: Daily Walk May Cut Your Breast Cancer RiskWhen they enrolled in 1992, the average age was nearly 63. The women completed a questionnaire about medical, environmental and demographic factors at the start and repeated the reports every two years between 1997 and 2009. The study participants also reported on their physical activity and time spent sitting, including watching television and reading, and reported any diagnosis of breast cancer.
During the follow-up, which was roughly 14 years, 4,760 women developed breast cancer.
The researchers compared the exercise habits of women who developed breast cancer and those who did not. About 9 percent never participated in physical activity, while about half reported walking as their sole activity.
Those who walked seven hours or more a week, even without engaging in other recreational physical activity, reaped protective benefits compared to those who walked three hours or less a week.
The message is encouraging, Patel said.
However, the study only found an association between moderate exercise and reduced breast cancer risk, not a direct cause-and-effect relationship.
While other studies have found that exercise lowered risk of breast cancer more for women with a lower body mass index (BMI) -- a calculation of body fat based on height and weight -- this study found the effect held regardless of BMI, weight gain in adulthood or use of postmenopausal hormone therapy.
Other studies have found a link between time spent sitting and breast cancer risk, but Patel's group did not find this link.
This is "a good news study for women," said another cancer expert, Dr. Laura Kruper, who was not involved with the research.
The findings add to the accumulating evidence about exercise lowering breast cancer risk, and present a goal that is reachable for most women, said Kruper, co-director of the breast cancer program at the City of Hope Cancer Center in Duarte, Calif.
"This is something nearly every woman can do," Kruper said of exercising moderately for an hour daily.
"This is not running a marathon," she said.
Her advice to sedentary women who want to reduce their breast cancer risk: "If you get off the couch and walk around, it would help."

Wednesday 20 November 2013

Heart Disease Part-3

Heart Disease Part-3

View the Heart Disease Slideshow

 Heart Disease Part-3

How is heart disease diagnosed?

The diagnosis of heart disease begins with obtaining a history that the potential for coronary artery disease exists. Risk factors need to be assessed and risk stratification occurs. The type of testing that is recommended, if any, depends upon the potential that the patient's symptoms actually represent angina and are coming from the heart.
Heart disease tests
Not every patient with chest pain needs heart catheterization (the most invasive test). Instead, the healthcare provider will try to choose the testing modality that will best provide the diagnosis, and if coronary artery disease is present, decide what impairment, if any, is present.

Electrocardiogram (ECG or EKG)

The heart is an electrical pump, and the electrical impulses it generates can be detected on the surface of the skin. Normal muscle conducts electricity in a reproducible fashion. Muscle that has decreased blood supply conducts electricity poorly. Muscle that has lost its blood supply and has been replaced with scar tissue cannot conduct electricity. The electrocardiogram (EKG) is a noninvasive test used to reflect underlying heart conditions by measuring the electrical activity of the heart.
Some people have "abnormal" EKGs at baseline but this may be normal for them. It is important that an electrocardiogram be compared to previous tracings if one is available. If a patient has a baseline abnormal EKG, they should consider carrying a copy with them for reference should they ever need another EKG.

Stress testing

If the baseline EKG is relatively normal, then monitoring the EKG tracing while the patient exercises may uncover electrical changes that may indicate the presence of coronary artery disease. There are a variety of testing protocols used to determine whether the exercise intensity is high enough to prove that the heart is normal.
Some patients are unable to exercise on a treadmill, but they can still undergo cardiac stress testing by using intravenous medication that causes the heart to work harder.
Stress testing is done under the supervision of medical personnel because of the potential of provoking angina, shortness of breath, abnormal heart rhythms, and heart attack.

Wednesday 13 November 2013

Heart Disease- Part-2

Heart Disease- Part-2

View the Heart Disease Slideshow

Heart Disease- Part-2

What are the symptoms of heart disease?

The typical symptoms of coronary artery disease are chest pain associated with shortness of breath. Classically, the pain of angina is described as a pressure or heaviness behind the breast bone with radiation to the jaw and down the arm accompanied by shortness of breath and sweating. Unfortunately, angina has a variety of signs and symptoms, and there may not even be specific chest pain. Other locations of pain and other symptoms may include shoulder or back ache, upper abdominal pain, nausea, and indigestion.
Women, the elderly, and people with diabetes may have different perceptions of pain or have no discomfort at all. Instead, they may complain of malaise or fatigue and generalized weakness and the inability to complete routine physical tasks such as walking or climbing stairs.
Health care practitioners and patients may have difficulty understanding each other when symptoms of angina are described. Patients may experience pressure or tightness but may deny any complaints of pain. Health care practitioners may misinterpret these symptoms when patient answers "no" to the question whether "pain is present," even though the patient is experiencing other types of discomfort.
People with coronary artery disease usually have gradual progression of their symptoms. As an artery narrows over time, the symptoms of decreased blood flow to part of the heart muscle may increase in frequency and/or severity. Health care practitioners may inquire about changes in exercise tolerance (How far can you walk before getting symptoms? Is it to the mailbox? Up a flight of stairs?), and whether there has been an acute change in the symptoms.
Once again, patients may be asymptomatic until a heart attack occurs. Of course, some patients also may be in denial as to their symptoms and procrastinate in seeking care.
Picture of the Heart and Heart Attack

Thursday 31 October 2013

Heart Disease- Part-1

Heart Disease- Part-1

View the Heart Disease Slideshow

Heart Disease- Part-1

Heart disease facts

  • Heart disease refers to several conditions that affect the heart and blood vessels. Arrhythmias, heart valve disease, congenital heart defects, and inflammation of the heart or its lining (the pericardium) are all diseases that affect the heart. However, this article will focus on the most common type of heart disease, coronary artery disease (CAD), also known as atherosclerotic heart disease (ASHD).
  • Coronary artery disease is the most common cause of death in the United States. Over a million people each year will have a heart attack and 25% will die before they get to the hospital while or in the Emergency Department.
  • Prevention is the key to treatment of heart disease.
  • Diagnosis of heart disease is often made by careful history taken by a health care practitioner. Some individuals may have atypical symptoms, including almost none at all.
  • The testing strategy to confirm the diagnosis and plan appropriate treatment needs to be individualized for each patient diagnosed with heart disease.
  • Treatment of heart disease depends upon the severity of disease, and is often directed by the symptoms experienced by the affected individual.

Introduction to heart disease

The heart is like any other muscle, requiring oxygen and nutrient-rich blood for it to function. The coronary arteries that supply blood to the heart muscle spread across the surface of the heart, beginning at the base of the aorta and branching out to all areas of the heart muscle.
The coronary arteries are at risk for narrowing as cholesterol deposits, called plaques, build up inside the artery. If the arteries narrow enough, blood supply to the heart muscle may be compromised (slowed down), and this slowing of blood flow to the heart causes pain, or angina.

Can Eating Peanut Butter Cut Breast Cancer Risk in Later Life?

Can Eating Peanut Butter Cut Breast Cancer Risk in Later Life?


 

Eating peanut butter regularly as a preteen and teen girl appears to decrease the risk of developing benign breast disease as an adult, new research has found.
Benign breast disease -- noncancerous changes in the breast tissue -- is a risk factor for breast cancer, experts agree.
The researchers followed more than 9,000 females, beginning when they were aged 9 to 15 in 1996, until 2010, when they were young women. Eating peanut butter three days a week reduced the risk of developing benign breast disease by 39 percent, said Dr. Graham Colditz, senior study author.
"I think this gives us enormous hope there are strategies we could be following to help prevent breast cancer that we haven't capitalized on yet," said Colditz, the associate director for cancer prevention and control at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, in St. Louis.
The study, published online Sept. 17 in Breast Cancer Research and Treatment, was funded by the Breast Cancer Research Foundation and the U.S. National Institutes of Health.
Benign breast disease is fairly common, and a known risk factor for breast cancer, Colditz said. Before menopause, "about one in four women have a benign lesion, confirmed by biopsy," he said. "It's very clear there is a strong link between the benign lesion and the subsequent risk of invasive breast cancer."
Depending on the characteristics of the benign lesion, he said, benign breast disease could increase breast cancer risk by threefold.
News Picture: Can Eating Peanut Butter Cut Breast Cancer Risk in Later Life?The study participants were part of a long-term, ongoing study on the health effects of diet and exercise in young people. They filled out questionnaires about their diet annually from 1996 until 2001, then four more times until 2010. They also reported if they had been diagnosed with benign breast disease. In all, 112 women said they had.
The researchers looked at foods with vegetable protein and vegetable fats, then focused on individual foods, including peanut butter, peanuts or other nuts, beans and corn.
A daily serving of any of these foods was linked with a 68 percent reduced risk of benign breast disease. At age 14, a daily serving of any of those foods was linked with a 66 percent lower risk of benign breast disease, and girls who had about three servings a week of peanut butter had a 39 percent lower risk.
The researchers found a link between eating peanut butter and lower breast disease risk, not a cause-and-effect relationship, and Colditz said he can't explain yet why the peanut butter seems protective.
"It could well be the protein," he said. In previous studies, the researchers have looked at other factors of a healthy diet, such as milk consumption, and their role in breast health. The peanut butter finding, he said, is strong, even when taking into account an overall healthy diet. "It's not something we can make go away," he said.
For now, Colditz said, the take-home message is for teens and preteens to substitute peanuts and peanut butter for less-healthy snacks such as cookies.
Another expert who reviewed the findings said the study is well done.
Dr. Steven Chen, an associate clinical professor of breast and endocrine surgery at the City of Hope Comprehensive Cancer Center, in Duarte, Calif., said that while lowering benign breast disease does lower breast cancer risk, many other factors increase breast cancer risk besides benign breast disease.
"It's always good to lower any risk [of breast cancer] you can, but whether peanut butter intake will have a major impact on developing breast cancer down the line, only time will tell," Chen said.
As for how to explain the link? "It's hard to say at this point," Chen said, adding that in countries where less meat is eaten, less breast cancer risk is reported. Based on the study findings, he said, teen girls and preteens "shouldn't avoid peanut butter and nuts if they are not allergic." Getting some protein through vegetables, which was also looked at in the study, is a good idea, too, he added.

Wednesday 30 October 2013

apixaban, Eliquis

apixaban, Eliquis

View the Atrial Fibrillation Slideshow Pictures

GENERIC NAME: apixaban

BRAND NAME: Eliquis

DRUG CLASS AND MECHANISM: Eliquis is an oral drug used for preventing blood clots in patients with atrial fibrillation. It is an anticoagulant that works by blocking the action of factor Xa. Factor Xa is an important protein in the coagulation cascade that causes blood to clot. Reducing the action of factor Xa reduces the ability of blood to clot. In patients with atrial fibrillation there is increased risk of blood clots which can travel to the brain where it causes strokes as well as to other organs. Eliquis reduces this risk. The FDA approved Eliquis in December 2012.
PRESCRIPTION: Yes
GENERIC AVAILABLE: No
PREPARATIONS: Tablets: 2.5 and 5 mg
STORAGE: Apixaban should be stored at room temperature between 15 C to 30 C (59 F to 86 F).
PRESCRIBED FOR: Eliquis is used for reducing the risk of strokes and blood clots in patients with atrial fibrillation who have no problems with their heart valve (nonvalvular atrial fibrillation).
DOSING: The usually recommended dose is 5 mg by mouth twice daily. The dose for individuals 80 years or older, weighing less than or equal to 60 kg, or with reduced kidney function is 2.5 mg twice daily.
DRUG INTERACTIONS: Blood levels of apixaban are increased by drugs that reduce the activity of the liver enzymes that break down apixaban. The dose of apixaban should be reduced to 2.5 mg twice daily if combined with drugs that reduce the activity of these enzymes. Examples include ketoconazole (Nizoral, Extina, Xolegel, Kuric), itraconazole (Sporanox), ritonavir (Norvir), and clarithromycin (Biaxin, Biaxin XL).
Drugs that increase the breakdown of apixaban reduce its blood levels and its effectiveness. Examples include carbamazepine (Tegretol, Tegretol XR, Equetro, Carbatrol), rifampin, St. John's Wort, and phenytoin (Diantin, Dilantin-125. They should not be combined with apixaban.
Administration of other drugs that also can prevent clotting will increase the risk of bleeding during treatment with apixaban. Examples include aspirin, heparin, chronic use of NSAIDs, and drugs that breakdown blood clots (fibrinolytics).
PREGNANCY: There are no adequate studies in pregnant women. Use during pregnancy may increase the risk of bleeding during pregnancy and delivery.
NURSING MOTHERS: It is not known if apixaban is excreted in human milk. Nursing mothers should discontinue apixaban or discontinue nursing.
SIDE EFFECTS: The most common side effects of apixaban involve bleeding. These include bleeding in the stomach, intestines, brain, and eyes; the bleeding may be fatal. Major bleeding events were fewer in patients who received apixaban when compared to a similar group that received warfarin (Coumadin), another widely used drug for preventing blood clots. Rash and serious allergic reactions also may occur.

Tuesday 29 October 2013

WebMD Resources for Affordable Care Act Enrollment

WebMD Resources for Affordable Care Act Enrollment



 Today the online "doors" swing open on the new health insurance Marketplaces. In every state and in Washington, D.C., millions of uninsured Americans will be able to shop for and buy health insurance offered through the Affordable Care Act. Despite years of preparation, that's news to most Americans. More than 70% of people without insurance don't realize that today is opening day of a 6-month open enrollment period, according to a poll by the Kaiser Family Foundation.
Whether you know about the Marketplaces or are learning about them for the first time, WebMD has a number of resources ready to help. They include:
  • Live chat today, noon to 1 p.m.: Our experts answer questions live about Day 1 of enrollment.
  • WebMD Answers: Health care reform experts give timely answers to your questions.
  • Health Insurance Advisor: This tool will help you compare plans specific to your health needs.

Monday 28 October 2013

More Evidence That Exercise Can Help Prevent High Blood Pressure

More Evidence That Exercise Can Help Prevent High Blood Pressure


 

Exercising during your leisure time could help prevent high blood pressure, but being physically active at work doesn't seem to provide the same benefit, according to a new review.
Researchers analyzed the findings of 13 studies that examined the effects of physical activity on blood pressure. The studies included a total of nearly 137,000 people in the United States, Europe and East Asia who initially had healthy blood pressure. During follow-up periods ranging from two to 45 years, more than 15,600 of the participants developed high blood pressure.
Compared to people who exercised less than one hour a week during their leisure time, the risk of developing high blood pressure was 11 percent lower among those who exercised one to three hours per week, and 19 percent lower among those who did more than four hours of recreational exercise a week, according to the study published Sept. 30 in the journal Hypertension.
The results suggest that the more leisure-time exercise you do, the lower your risk of developing high blood pressure.
News Picture: More Evidence That Exercise Can Help Prevent High Blood PressureHowever, the researchers did not find a solid link between physical activity at work and high blood pressure risk. Physical activity on the job, such as farm or industrial work, can involve heavy lifting, prolonged standing and repetitive tasks.
Exercise guidelines don't distinguish between physical activity at work or during leisure time, but "given the new findings, perhaps they should," study co-author Dr. Bo Xi, a lecturer at the Shandong University School of Public Health in Jinan, China, said in a journal news release.
Recreational exercise may help reduce the risk of high blood pressure by preventing weight gain, improving poor insulin sensitivity or reducing the blood vessels' resistance to blood flow, the researchers suggested.
But they noted that their findings don't show that leisure-time exercise actually prevents high blood pressure. People who exercise for fun may just have healthier lifestyles, Xi explained.
About 78 million U.S. adults have high blood pressure, which is a risk factor for heart and kidney disease.

Anemia Part-1

Anemia facts*

*Anemia facts medical author: William C. Shiel Jr., MD, FACP, FACR
  • Anemia is a medical condition in which the red blood cell count or hemoglobin is less than normal.
  • For men, anemia is typically defined as hemoglobin level of less than 13.5 gram/100 ml and in women as hemoglobin of less than 12.0 gram/100 ml.
  • Anemia is caused by either a decrease in production of red blood cells or hemoglobin, or an increase in loss or destruction of red blood cells.
  • Some patients with anemia have no symptoms. Others may feel tired, easily fatigued, appear pale, a feeling of heart racing, short of breath, and/or worsening of heart problems.
  • Anemia can be detected by a simple blood test called a complete blood cell count (CBC).
  • The treatment of the anemia varies greatly and very much depends on the particular cause.

What is anemia?

Anemia is a medical condition in which the red blood cell count or hemoglobin is less than normal. The normal level of hemoglobin is generally different in males and females. For men, anemia is typically defined as hemoglobin level of less than 13.5 gram/100 ml and in women as hemoglobin of less than 12.0 gram/100 ml. These definitions may vary slightly depending on the source and the laboratory reference used.

What causes anemia?

Any process that can disrupt the normal life span of a red blood cell may cause anemia. Normal life span of a red blood cell is typically around 120 days. Red blood cells are made in the bone marrow.
Anemia is caused essentially through two basic pathways. Anemia is caused by either:
  1. a decrease in production of red blood cells or hemoglobin, or
  2. an increase in loss or destruction of red blood cells.
A more common classification of anemia (low hemoglobin) is based on the Mean Corposcular Volume (MCV) which signifies the average volume of individual red blood cells.
  1. If the MCV is low (less than 80), the anemia is categorized as microcytic anemia (low cell volume).
  2. If the MCV is in the normal range (80-100), it is called a normocytic anemia (normal cell volume).
  3. If the MCV is high, then it is called a macrocytic anemia (large cell volume).
Looking at each of the components of a complete blood count (CBC), especially the MCV, a physician can gather clues as to what could be the most common reason for anemia in each patient.
Picture of Red Blood Cells
Picture of Red Blood Cells