purpura

there is a cute little girl in 6S with purpura at both legs,with no history of fever,anemic and spontaneous bleeding(gum bleeding,epistaxis).diagnosis haven't make yet but i think it is idiopathic thrombocytopenia purpura(ITP).But we still waiting for the investigation's result.

so,here is an article about purpura in child:P
evaluating the child with purpura

pallor&lethargy

ahmad,5 years old boy come to the clinic due to PALLOR and LETHARGY.Below are the result of investigation:

colour of urine sample

urine FEME -->

pus cell & RBC –nil,
epithelial cell - <5/ul,>

question

i-Comment about the appearance of the urine (2m)

ii- What are the most likely substance responsible for (i) (4m)

iii- 2 relevant questions to be asked on patient’s arrival (4m)

iv- 2 clinical conditions that can give rise to these findings (4m)

v- 3 other relevant investigations & state the expected result (6m)

p/s:sorry!answers are not provided

DIC in AML

Dear Sharifah

Salam! As far as I know, only acute promyelocytic leukemia (AML3) can primarily cause DIC. Correct me if I’m wrong. Basically DIC in AML resulting from infiltration of myeloid cells in bone marrow which leads to thrombocytopenia.

Promyelocytic leukemia is an accumulation of immature granulocyte (could be lineage of myeloblast or megakaryoblast)

So when the immature granulocyte increase, it means that less functional platelet can be formed.

DIC is devided into two steps which are

1) Abnormal activation of coagulation (microthrombosis formation)

2) Exhaustion of coagulating factor (bleeding)

So (simple pathophysiology for us to remember is)

Disorder in hematopoiesis --> APL --> Infiltration of immature granulocyte in bone marrow --> decrease production of platelet --> thrombocytopenia --> abnormal activation coagulation pathway --> microthrombus production --> exhaustion of coagulating factor --> bleeding

Coomb's test

Assalamu'alaikum wbt

Just want to share about Coomb's test with u all guys...after have been lectured during hematology class yesterday...

Sharing is Loving~~

~Setiap Kesulitan Pasti Ada Kemudahan~

What is Coomb’s Test?

The test perform to detect incomplete antierythrocyte antibodies and cause premature RBC destruction (hemolysis).

Alternative names?

Direct antiglobulin test (DAT), and Indirect antiglobulin test (IAT)

What is normal result?

No clumping of cells (agglutination), indicating that there are no antibodies to red blood cells.

Direct Antiglobulin Test (DAT)	Indirect Antiglobulin Test (IAT)
To detect antibodies bound to RBC surface	To detect antierythrocyte antibodies free in serum
Patient’s blood	Patient’s serum
Procedure: Obtain washed RBCs (to eliminate all plasma IgG) Add antiglobulin antiserum Incubate 15 min 37oC Look for agglutination (visual, microscope)	Procedure: Washed normal RBCs, group 0 (or compatible) Incubate 15 min 37oC Wash incubated RBCs (to eliminate serum IgG) Add antiglobulin antiserum Incubate 15 min 37oC Look for agglutination (visual, microscope)
Usually performed to diagnosed the cause of anemia or jaundice	Rarely used to diagnose a medical condition. Often use to determine whether a person might have a reaction to a blood transfusion.

G6PD enzyme assay

a comfirmatory test for G6PD deficiency

G6PD deficiency is a sex linked disease and usually affect the male.Female act as a carrier.The picture above shows 3 sons are having G6PD deficiency.Also noted one son is spare form the disease because he recieves normal X from the mother.

souce:FLM

Fluorescent screening test for G6PD deficiency

principle-
G6PD will produce NADPH from NADP+.These NADPHs will fluoresces under UV light.In G6PD deficiency,less fluoresces occur due to less NADPH production

in what case,the result is false?

• False normal

Reticulocyte has large amount of G6PD.Therefore a small num of reticulocytes will produce large num of NADPH,

• False deficient

In anaemic condition,very little fluoresces is seen,eventhough the G6PD IS NORMAL

source:FLM