Healths

FEBRILE NEUTROPENIA

FEBRILE NEUTROPENIA DESCRIPTION Febrile neutropenia is defined as an absolute neutrophil count of < 0.5 x109/L with a temperature of greater than 38°C for > 1 hour. This is a medical emergency as these patients can rapidly develop features of severe sepsis (multi-organ failure and/or hypotension). GENERAL MEASURES Treat the underlying cause of neutropenia, if […]

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ANAEMIA, SICKLE CELL

ANAEMIA, SICKLE CELL DESCRIPTION Homozygous sickle cell anaemia (HbSS: HbS > 50–100%). Individuals with sickle cell trait have < 50% HbS and are generally asymptomatic. The disease is characterised by various crises: vaso-occlusive, aplastic, megaloblastic and sequestration crises, and infection. The pain crisis/vaso-occlusive crisis The most common type of crisis is characterised by acute episodes […]

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ANAEMIA, MEGALOBLASTIC

ANAEMIA, MEGALOBLASTIC DESCRIPTION Anaemia caused by a deficiency of folate and/or vitamin B12. Investigations Elevated MCV (mean corpuscular volume) and MCH (mean corpuscular haemoglobin). Macro-ovalocytes on blood smear; polysegmentation of neutrophils, thrombocytopenia with giant platelets. Decreased serum vitamin B12 or red blood cell folate. Pancytopenia in severe cases. Intrinsic factor antibodies in vitamin B12 deficiency, […]

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ANAEMIA, IRON DEFICIENCY

DESCRIPTION Anaemia due to iron deficiency. Common causes of iron deficiency are chronic blood loss or poor nutritional intake.  Hypochromic microcytic anaemia Investigations Assess for a haematological response to iron therapy. GENERAL MEASURES Identify and treat the cause. Dietary adjustment. MEDICINE TREATMENT Oral iron supplementation Reticulocytosis begins on the 3rdor 4th day after therapy, peaks […]

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ANAEMIA, HAEMOLYTIC

DESCRIPTION Anaemia due to destruction of red blood cells. Destruction may be due to: » Extracellular factors such as auto-immunity or mechanical factors, e.g. disseminated intravascular coagulation (DIC), hypersplenism, medications. » Abnormalities of the cell membrane, e.g. hereditary spherocytosis. » Enzymes, e.g. G6PD deficiency. » Haemoglobin, e.g. sickle cell anaemia, thalassaemia. Investigations Evidence of haemolysis: […]

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ANAEMIA, CHRONIC DISORDER

DESCRIPTION Anaemia due to chronic inflammation. This is characteristically a normochromic normocytic anaemia. Common causes of anaemia of chronic disorder include: » malignancy, e.g. haematological or solid tumours, » autoimmune disorders, e.g. rheumatoid arthritis, » acute or chronic infections, e.g. HIV and TB, » chronic kidney disease, and » chronic rejection of solid-organ transplantation, etc. […]

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ANAEMIA, APLASTIC

DESCRIPTION Pancytopenia due to a hypoplastic bone marrow. Clinical features: » pallor, » petechiae, » purpura, and » bleeding with frequent or severe infections. MEDICINE TREATMENT If neutropenic and febrile, see section 2.7: Febrile Neutropenia. REFERRAL » Discuss all cases of suspected aplastic anaemia with a specialist. Stabilise patient, if necessary, with blood products before […]

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PERITONITIS

DESCRIPTION Infection of the peritoneum, usually secondary to a surgical cause such as perforated bowel. In this setting polymicrobial infection with anaerobes and Enterobacteriaceae are usually found. Primary or spontaneous bacterial peritonitis is much less common and usually complicates ascites in patients with portal hypertension. This is not usually polymicrobial but due generally to Enterobacteriaceae […]

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GIARDIASIS

DESCRIPTION Infection with the protozoan parasite, G. lamblia which colonises the proximal small intestine. GENERAL MEASURES Fluid and electrolyte replacement in severe diarrhoea. MEDICINE TREATMENT • Metronidazole, oral, 400 mg 8 hourly for 5 days. Reference and further reading Standard Treatment Guidelines and Essential Medicines List for South Africa 2012 Edition

Healths

AMOEBIC DYSENTERY

DESCRIPTION Diarrhoea with blood and/or mucus due to E. histolytica. GENERAL MEASURES Rehydration may be necessary. This should be done with oral rehydration solution (ORS) unless the patient is vomiting or profoundly dehydrated. Surgery for bowel perforation. MEDICINE TREATMENT Loperamide is contraindicated as it may result in toxic megacolon. • Metronidazole, oral, 800 mg 8 […]