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Medical Clinics of North America

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https://www.readbyqxmd.com/read/28189182/anemia-things-have-changed
#1
EDITORIAL
Thomas G DeLoughery
No abstract text is available yet for this article.
March 2017: Medical Clinics of North America
https://www.readbyqxmd.com/read/28189181/this-is-not-an-anemic-issue
#2
EDITORIAL
Bimal H Ashar
No abstract text is available yet for this article.
March 2017: Medical Clinics of North America
https://www.readbyqxmd.com/read/28189180/blood-transfusion-therapy
#3
REVIEW
Lawrence Tim Goodnough, Anil K Panigrahi
Transfusion of red blood cells (RBCs) is a balance between providing benefit for patients while avoiding risks of transfusion. Randomized, controlled trials of restrictive RBC transfusion practices have shown equivalent patient outcomes compared with liberal transfusion practices, and meta-analyses have shown improved in-hospital mortality, reduced cardiac events, and reduced bacterial infections. This body of level 1 evidence has led to substantial, improved blood utilization and reduction of inappropriate blood transfusions with implementation of clinical decision support via electronic medical records, along with accompanying educational initiatives...
March 2017: Medical Clinics of North America
https://www.readbyqxmd.com/read/28189179/unusual-anemias
#4
REVIEW
Molly Maddock Daughety, Thomas G DeLoughery
Many processes lead to anemia. This review covers anemias that are less commonly encountered in the United States. These anemias include hemoglobin defects like thalassemia, bone marrow failure syndromes like aplastic anemia and pure red cell aplasia, and hemolytic processes such as paroxysmal nocturnal hemoglobinuria. The pathogenesis, diagnostic workup, and treatment of these rare anemias are reviewed.
March 2017: Medical Clinics of North America
https://www.readbyqxmd.com/read/28189178/syndromes-of-thrombotic-microangiopathy
#5
REVIEW
Joseph J Shatzel, Jason A Taylor
Thrombotic thrombocytopenia purpura (TTP) and the hemolytic uremic syndrome (HUS) are rare thrombotic microangiopathies that can be rapidly fatal. Although the acquired versions of TTP and HUS are generally highest on this broad differential, multiple rarer entities can produce a clinical picture similar to TTP/HUS, including microangiopathic hemolysis, renal failure, and neurologic compromise. More recent analysis has discovered a host of genetic factors that can produce microangiopathic hemolytic syndromes...
March 2017: Medical Clinics of North America
https://www.readbyqxmd.com/read/28189177/sickle-cell-disease-a-brief-update
#6
REVIEW
Sharl Azar, Trisha E Wong
Sickle cell disease (SCD) is an inherited monogenic disease characterized by misshapen red blood cells that causes vaso-occlusive disease, vasculopathy, and systemic inflammation. Approximately 300,000 infants are born per year with SCD globally. Acute, chronic, and acute-on-chronic complications contribute to end-organ damage and adversely affect quantity and quality of life. Hematopoietic stem cell transplantation is the only cure available today, but is not feasible for the vast majority of people suffering from SCD...
March 2017: Medical Clinics of North America
https://www.readbyqxmd.com/read/28189176/congenital-hemolytic-anemia
#7
REVIEW
Kristina Haley
Red blood cell (RBC) destruction can be secondary to intrinsic disorders of the RBC or to extrinsic causes. In the congenital hemolytic anemias, intrinsic RBC enzyme, RBC membrane, and hemoglobin disorders result in hemolysis. The typical clinical presentation is a patient with pallor, anemia, jaundice, and often splenomegaly. The laboratory features include anemia, hyperbilirubinemia, and reticulocytosis. For some congenital hemolytic anemias, splenectomy is curative. However, in other diseases, avoidance of drugs and toxins is the best therapy...
March 2017: Medical Clinics of North America
https://www.readbyqxmd.com/read/28189175/autoimmune-hemolytic-anemia
#8
REVIEW
Howard A Liebman, Ilene C Weitz
Autoimmune hemolytic anemia is an acquired autoimmune disorder resulting in the production of antibodies directed against red blood cell antigens causing shortened erythrocyte survival. The disorders can present as a primary disorder (idiopathic) or secondary to other autoimmune disorders, malignancies, or infections. Treatment involves immune modulation with corticosteroids and other agents.
March 2017: Medical Clinics of North America
https://www.readbyqxmd.com/read/28189174/myelodysplastic-syndromes-updates-and-nuances
#9
REVIEW
Kim-Hien T Dao
Myelodysplastic syndrome (MDS) is a heterogeneous, clonal stem cell disorder of the blood and marrow typically diagnosed based on the presence of persistent cytopenia(s), dysplastic cells, and genetic markers. Common issues that arise in the clinical management include difficulty confirming MDS diagnosis, lack of a standard approach with novel agents in MDS, and few prospective long-term, randomized controlled MDS clinical studies to guide allogeneic blood and marrow transplant. With the recent genetic characterization of MDS, certain aspects of these issues will be better addressed by integrating genetic data into clinical study design and clinical practice...
March 2017: Medical Clinics of North America
https://www.readbyqxmd.com/read/28189173/iron-deficiency-anemia
#10
REVIEW
Thomas G DeLoughery
Iron deficiency is one of the most common causes of anemia. The 2 main etiologies of iron deficiency are blood loss due to menstrual periods and blood loss due to gastrointestinal bleeding. Beyond anemia, lack of iron has protean manifestations, including fatigue, hair loss, and restless legs. The most efficient test for the diagnosis of iron deficiency is the serum ferritin. Iron replacement can be done orally, or in patients in whom oral iron is not effective or contraindicated, with intravenous iron.
March 2017: Medical Clinics of North America
https://www.readbyqxmd.com/read/28189172/megaloblastic-anemias-nutritional-and-other-causes
#11
REVIEW
Ralph Green, Ananya Datta Mitra
Vitamin B12 and folate deficiencies are major causes of megaloblastic anemia. Causes of B12 deficiency include pernicious anemia, gastric surgery, intestinal disorders, dietary deficiency, and inherited disorders of B12 transport or absorption. The prevalence of folate deficiency has decreased because of folate fortification, but deficiency still occurs from malabsorption and increased demand. Other causes include drugs and inborn metabolic errors. Clinical features of megaloblastic anemia include anemia, cytopenias, jaundice, and megaloblastic marrow morphology...
March 2017: Medical Clinics of North America
https://www.readbyqxmd.com/read/28189171/anemia-of-inflammation-a-review
#12
REVIEW
Paula G Fraenkel
Impaired iron homeostasis and the suppressive effects of proinflammatory cytokines on erythropoiesis, together with alterations of the erythrocyte membrane that impair its survival, cause anemia of inflammation. Recent epidemiologic studies have connected inflammatory anemia with critical illness, obesity, aging, kidney failure, cancer, chronic infection, and autoimmune disease. The proinflammatory cytokine, interleukin-6, the iron regulatory hormone, hepcidin, and the iron exporter, ferroportin, interact to cause iron sequestration in the setting of inflammation...
March 2017: Medical Clinics of North America
https://www.readbyqxmd.com/read/28189170/anemia-evaluation-and-diagnostic-tests
#13
REVIEW
Michael J Cascio, Thomas G DeLoughery
Anemia is among the most common medical problems and clinical and laboratory evaluation need to be approached logically. The complete blood count with red cell indices offers clues to diagnosis. Many anemias have characteristic red cell morphology. The reticulocyte count serves as a useful screen for hemolysis or blood loss. Testing for specific causes of the anemia is performed. Occasionally, examination of the bone marrow is required for diagnosis. Molecular testing is increasingly being use to aid the diagnostic process...
March 2017: Medical Clinics of North America
https://www.readbyqxmd.com/read/27884240/the-sounds-of-progress
#14
EDITORIAL
Bimal H Ashar
No abstract text is available yet for this article.
January 2017: Medical Clinics of North America
https://www.readbyqxmd.com/read/27884239/continuing-challenges-and-unresolved-problems-in-hypertensive-diseases
#15
EDITORIAL
Edward D Frohlich
No abstract text is available yet for this article.
January 2017: Medical Clinics of North America
https://www.readbyqxmd.com/read/27884238/the-pressure-of-aging
#16
REVIEW
Majd AlGhatrif, Mingyi Wang, Olga V Fedorova, Alexei Y Bagrov, Edward G Lakatta
Significant hemodynamic changes ensue with aging, leading to an ever-growing epidemic of hypertension. Alterations in central arterial properties play a major role in these hemodynamic changes. These alterations are characterized by an initial decline in aortic distensibility and an increase of diastolic blood pressure, followed by a sharp increase in pulse wave velocity (PWV), and an increase in pulse pressure (PP) beyond the sixth decade. However, the trajectories of PWV and PP diverge with advancing age...
January 2017: Medical Clinics of North America
https://www.readbyqxmd.com/read/27884237/diastolic-dysfunction-and-hypertension
#17
REVIEW
Wilson Nadruz, Amil M Shah, Scott D Solomon
Left ventricular (LV) diastolic dysfunction (LVDD) is characterized by alterations in LV diastolic filling, and is a strong predictor of cardiovascular events and heart failure. Hypertension is the most important risk factor for LVDD in the community and promotes LVDD through several mechanisms, including hemodynamic overload and myocardial ischemia. Associated factors such as age, ethnicity, dietary sodium, obesity, diabetes mellitus, and chronic kidney disease also contribute to LVDD in hypertensive individuals...
January 2017: Medical Clinics of North America
https://www.readbyqxmd.com/read/27884236/renal-arterial-disease-and-hypertension
#18
REVIEW
Stephen C Textor
Renal artery disease produces a spectrum of progressive clinical manifestations ranging from minor degrees of hypertension to circulatory congestion and kidney failure. Moderate reductions in renal blood flow do not induce tissue hypoxia or damage, making medical therapy for renovascular hypertension feasible. Several prospective trials indicate that optimized medical therapy using agents that block the renin-angiotensin system should be the initial management. Evidence of progressive disease and/or treatment failure should allow recognition of high-risk subsets that benefit from renal revascularization...
January 2017: Medical Clinics of North America
https://www.readbyqxmd.com/read/27884235/hypertension-in-patients-with-cardiac-transplantation
#19
REVIEW
Amanda L Bennett, Hector O Ventura
Hypertension is a common complication among post cardiac transplant recipients affecting more than 95% of patients. Increased blood pressure poses a significant cardiovascular morbidity and mortality in these patients; it should be identified quickly and needs to be managed appropriately. Understanding the pathophysiology and contributing factors to this disease in these complex and unique patients is the key to appropriate treatment selection.
January 2017: Medical Clinics of North America
https://www.readbyqxmd.com/read/27884234/the-hypertensive-myocardium-from-microscopic-lesions-to-clinical-complications-and-outcomes
#20
REVIEW
María U Moreno, Rocío Eiros, Juan J Gavira, Catalina Gallego, Arantxa González, Susana Ravassa, Begoña López, Javier Beaumont, Gorka San José, Javier Díez
The chronic hemodynamic load imposed by hypertension on the left ventricle leads to lesions in the myocardium that result in structural remodeling, which provides support for alterations in cardiac function, perfusion, and electrical activity that adversely influence the clinical evolution of hypertensive heart disease. Management must include detecting, reducing, and reversing left ventricular hypertrophy, as well as the detection and repair of microscopic lesions responsible for myocardial remodeling. Reducing the burden associated with hypertensive heart disease can be targeted using personalized treatment...
January 2017: Medical Clinics of North America
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