https://wikem.org/w/api.php?action=feedcontributions&feedformat=atom&user=Gkatzb WikEM - User contributions [en] 2026-05-13T03:25:40Z User contributions MediaWiki 1.38.2 https://wikem.org/w/index.php?title=Uvulitis&diff=108674 Uvulitis 2016-11-01T08:26:48Z <p>Gkatzb: Angioedema Management</p> <hr /> <div>==General==<br /> *Uvulitis is characterized by inflammation and edema of uvula<br /> *Isolated uvular inflammation is rare<br /> *More commonly manifests with other inflammatory diseases of oropharynx:<br /> **Epiglottitis<br /> **Pharyngitis<br /> *Rarely causes life threatening respiratory distress<br /> ===Etiologies===<br /> *Major division: infectious vs. noninfectious etiology<br /> *'''Infections''': <br /> **Most commonly H. Influenzae Type B &amp; Group A Streptococcus<br /> ***H. Influenzae<br /> ****Frequently with Epiglottitis<br /> ***Group A Streptococcus<br /> ****Frequently with Pharyngitis<br /> **Less common<br /> ***S. Pneumoniae<br /> ****Adults<br /> ***Anaerobic bacteria<br /> ***Candida Albicans<br /> *'''Noninfectious'''<br /> **Trauma<br /> **[[Angioedema]]<br /> **Inhalant irritation<br /> ***Inhaled cannabinoids<br /> **Allergy<br /> ==Clinical Features==<br /> ===History===<br /> *Throat pain<br /> *Dysphagia<br /> *Sensation of something in their throat<br /> *Gagging sensation<br /> *Low-grade fever<br /> *Signs of Epiglottitis<br /> **Sudden onset<br /> ***High fever<br /> ***Dysphagia<br /> ***Dyspnea/SOB<br /> ***Drooling<br /> *Hx Sick Contacts<br /> *Exposure to Allergens<br /> *Recent surgical procedure with site of entry via mouth (EGD, Laryngoscopy, Orogastric Tube Placement, etc) <br /> *Recent inhalation of cannabis<br /> ===PMH===<br /> *Vaccination status<br /> ** H. Influenzae - epiglottitis <br /> **First H. Influenzae vaccine at 2 months, last booster 12-15 months<br /> *Hereditary Angioedema<br /> ===Physical Exam===<br /> *General<br /> **Range from well appearing to toxic<br /> *HEENT<br /> **Oropharynx<br /> ***Uvula<br /> ****Markedly erythematous and edematous<br /> ****Pinpoint hemorrhage is possible<br /> ****Vesicular lesions possible if viral etiology<br /> **** Nonerythematous, pale, swollen (uvular hydrops) may indicates angioedema<br /> ***Tonsils<br /> ****Edematous vs. nonedematous<br /> ****Exudative vs. nonexudative <br /> ***Erythematous posterior pharynx<br /> *Respiratory<br /> **Range non-labored breathing to respiratory distress<br /> **Stridor<br /> **”Hot Potato Voice”<br /> **Clear lungs bilaterally<br /> ==Differential Diagnosis==<br /> *Uvulitis<br /> **Infectious<br /> ***Group A Streptococcus<br /> ****[[Streptococcal Pharyngitis]]<br /> ***H. Influenza<br /> ****[[Epiglottitis]]<br /> ***Strep. Pneumoniae<br /> ***Candida Albicans<br /> **Noninfectious<br /> ***Trauma<br /> ***[[Angioedema]]<br /> ***Inhalant irritation<br /> ***Allergy<br /> *[[Epiglottitis]]<br /> *[[Streptococcal Pharyngitis]]<br /> *[[Peritonsillar Abscess]]<br /> *[[Retropharyngeal Abscess]]<br /> *[[Herpes Gingivostomatitis]]<br /> ==Evaluation==<br /> *'''Labs'''<br /> **Rapid strep throat swab<br /> **Heterophile antibody (monospot) test<br /> *'''If patient is ill appearing consider:'''<br /> **CBC<br /> **CMP<br /> **Blood culture<br /> *'''Imaging'''<br /> ** If concern for epiglottitis<br /> *** Lateral neck x-ray<br /> **If concern for retropharyngeal abscess<br /> ***CT neck with contrast<br /> ==Management ==<br /> *ABC’s and Resuscitation if necessary<br /> *Management guided by association with [[Epiglottitis]] or [[Streptococcal Pharyngitis]]<br /> ===Infectious===<br /> ====[[Epiglottitis]]====<br /> *General Treatment<br /> **Airway protection with fiberoptic intubation or tracheostomy<br /> **Dexamethasone 0.15mg/kg <br /> **Nebulized epinephrine<br /> *Antibiotic treatment<br /> **Pediatric:<br /> ***([[Cefotaxime]] 50mg/kg IV q8h and [[Ceftriaxone]] 50mg/kg IV q24hr) plus [[Vancomycin]] 15mg/kg IV q12h<br /> **Adult:<br /> ***([[Cefotaxime]] 2gm IV q4-8h or [[Ceftriaxone]] 2gm IV q24h) plus [[Vancomycin]]<br /> ====[[Streptococcal Pharyngitis]]====<br /> *Pediatrics<br /> ** Penicillin V 250mg PO BID x 10 days<br /> **Amoxicillin 50mg/kg PO once daily x 10 days<br /> *Adults<br /> **Penicillin V 500mg PO BID x 10 days<br /> **If compliance is unlikely<br /> ***Benzathine Penicillin 25,000Units/kg IM (to a maximum of 1.2 million units) x 1 dose<br /> **If allergic to PCN<br /> ***Clindamycin 300mg PO q8h x 10days<br /> ====C. Albicans====<br /> *Topical nystatin<br /> ===Noninfectious===<br /> ====Trauma====<br /> *Acetaminophen<br /> *Local anesthetic lozenges<br /> ====Allergy====<br /> *Treatment determined by severity of illness<br /> **Epinephrine 0.3mg 1:1,000 IM <br /> **Diphenhydramine 50mg IV<br /> **Ranitidine 150mg<br /> **Solumedrol 125mg IV<br /> ====[[Angioedema]]====<br /> *Cover for allergic reaction with medications above<br /> **If true angioedema, will not resolve symptoms<br /> *Stop ACE inhibitor<br /> *See {{Angioedema Management}}<br /> ====Inhalant irritation====<br /> *Antihistamines IV<br /> *Hydrocortisone or dexamethasone IV<br /> ==Disposition==<br /> *Determined by severity, complications, etc.<br /> ==Also See==<br /> *[[Epiglottitis]] <br /> *[[Retropharyngeal Abscess]]<br /> ==External Links==<br /> ==References==<br /> *Yellon R, Chi D. Atlas of pediatric physical diagnosis. 6th Ed. 2012; 23: Philadelphia, PA: Saunders/Elsevier; 2012: 913-960<br /> * Wald Ellen. Feigin and Cherry’s Textbook of Pediatric Infectious Disease, 7th ed. Philadelphia, PA : Elsevier/Saunders; 2014: 165-167<br /> *Guarisco J, Cheney M, Lejeune F, Reed H. Isolated uvulitis secondary to marijuana use. Laryngoscope. 1988; 98:1309-131<br /> *Boyce S, Quigley M. Uvulitis and partial upper airway obstruction following cannabis inhalation. Emergency medicine. 2002; 14:106-108<br /> *Westerman E, Hutton J. Acute uvulitis associated with epiglotitis. Arch Otolaryngol Head Neck Surg. 1986; 12:448-449<br /> *Peghlnl P, Salcedo J, Al-Kawas F. Traumatic uvulitis: a rare complication of upper GI endoscopy. Gastrointestinal Endoscopy. 2001; 53:818-820<br /> *Lee S, Schwatz R, Babadori R. Retropharyngeal abscess: epiglottitis of the new mellennium. The Journal of Pediatrics. 2001; 138:435-437</div> Gkatzb https://wikem.org/w/index.php?title=Uvulitis&diff=108673 Uvulitis 2016-11-01T08:05:39Z <p>Gkatzb: General, clinical features, Differential diagnosis, evaluation, management</p> <hr /> <div>==General==<br /> *Uvulitis is characterized by inflammation and edema of uvula<br /> *Isolated uvular inflammation is rare<br /> *More commonly manifests with other inflammatory diseases of oropharynx:<br /> **Epiglottitis<br /> **Pharyngitis<br /> *Rarely causes life threatening respiratory distress<br /> ===Etiologies===<br /> *Major division: infectious vs. noninfectious etiology<br /> *'''Infections''': <br /> **Most commonly H. Influenzae Type B &amp; Group A Streptococcus<br /> ***H. Influenzae<br /> ****Frequently with Epiglottitis<br /> ***Group A Streptococcus<br /> ****Frequently with Pharyngitis<br /> **Less common<br /> ***S. Pneumoniae<br /> ****Adults<br /> ***Anaerobic bacteria<br /> ***Candida Albicans<br /> *'''Noninfectious'''<br /> **Trauma<br /> **[[Angioedema]]<br /> **Inhalant irritation<br /> ***Inhaled cannabinoids<br /> **Allergy<br /> ==Clinical Features==<br /> ===History===<br /> *Throat pain<br /> *Dysphagia<br /> *Sensation of something in their throat<br /> *Gagging sensation<br /> *Low-grade fever<br /> *Signs of Epiglottitis<br /> **Sudden onset<br /> ***High fever<br /> ***Dysphagia<br /> ***Dyspnea/SOB<br /> ***Drooling<br /> *Hx Sick Contacts<br /> *Exposure to Allergens<br /> *Recent surgical procedure with site of entry via mouth (EGD, Laryngoscopy, Orogastric Tube Placement, etc) <br /> *Recent inhalation of cannabis<br /> ===PMH===<br /> *Vaccination status<br /> ** H. Influenzae - epiglottitis <br /> **First H. Influenzae vaccine at 2 months, last booster 12-15 months<br /> *Hereditary Angioedema<br /> ===Physical Exam===<br /> *General<br /> **Range from well appearing to toxic<br /> *HEENT<br /> **Oropharynx<br /> ***Uvula<br /> ****Markedly erythematous and edematous<br /> ****Pinpoint hemorrhage is possible<br /> ****Vesicular lesions possible if viral etiology<br /> **** Nonerythematous, pale, swollen (uvular hydrops) may indicates angioedema<br /> ***Tonsils<br /> ****Edematous vs. nonedematous<br /> ****Exudative vs. nonexudative <br /> ***Erythematous posterior pharynx<br /> *Respiratory<br /> **Range non-labored breathing to respiratory distress<br /> **Stridor<br /> **”Hot Potato Voice”<br /> **Clear lungs bilaterally<br /> ==Differential Diagnosis==<br /> *Uvulitis<br /> **Infectious<br /> ***Group A Streptococcus<br /> ****[[Streptococcal Pharyngitis]]<br /> ***H. Influenza<br /> ****[[Epiglottitis]]<br /> ***Strep. Pneumoniae<br /> ***Candida Albicans<br /> **Noninfectious<br /> ***Trauma<br /> ***[[Angioedema]]<br /> ***Inhalant irritation<br /> ***Allergy<br /> *[[Epiglottitis]]<br /> *[[Streptococcal Pharyngitis]]<br /> *[[Peritonsillar Abscess]]<br /> *[[Retropharyngeal Abscess]]<br /> *[[Herpes Gingivostomatitis]]<br /> ==Evaluation==<br /> *'''Labs'''<br /> **Rapid strep throat swab<br /> **Heterophile antibody (monospot) test<br /> *'''If patient is ill appearing consider:'''<br /> **CBC<br /> **CMP<br /> **Blood culture<br /> *'''Imaging'''<br /> ** If concern for epiglottitis<br /> *** Lateral neck x-ray<br /> **If concern for retropharyngeal abscess<br /> ***CT neck with contrast<br /> ==Management ==<br /> *ABC’s and Resuscitation if necessary<br /> *Management guided by association with [[Epiglottitis]] or [[Streptococcal Pharyngitis]]<br /> ===Infectious===<br /> ====[[Epiglottitis]]====<br /> *General Treatment<br /> **Airway protection with fiberoptic intubation or tracheostomy<br /> **Dexamethasone 0.15mg/kg <br /> **Nebulized epinephrine<br /> *Antibiotic treatment<br /> **Pediatric:<br /> ***([[Cefotaxime]] 50mg/kg IV q8h and [[Ceftriaxone]] 50mg/kg IV q24hr) plus [[Vancomycin]] 15mg/kg IV q12h<br /> **Adult:<br /> ***([[Cefotaxime]] 2gm IV q4-8h or [[Ceftriaxone]] 2gm IV q24h) plus [[Vancomycin]]<br /> ====[[Streptococcal Pharyngitis]]====<br /> *Pediatrics<br /> ** Penicillin V 250mg PO BID x 10 days<br /> **Amoxicillin 50mg/kg PO once daily x 10 days<br /> *Adults<br /> **Penicillin V 500mg PO BID x 10 days<br /> **If compliance is unlikely<br /> ***Benzathine Penicillin 25,000Units/kg IM (to a maximum of 1.2 million units) x 1 dose<br /> **If allergic to PCN<br /> ***Clindamycin 300mg PO q8h x 10days<br /> ====C. Albicans====<br /> *Topical nystatin<br /> ===Noninfectious===<br /> ====Trauma====<br /> *Acetaminophen<br /> *Local anesthetic lozenges<br /> ====Allergy====<br /> *Treatment determined by severity of illness<br /> **Epinephrine 0.3mg 1:1,000 IM <br /> **Diphenhydramine 50mg IV<br /> **Ranitidine 150mg<br /> **Solumedrol 125mg IV<br /> ====[[Angioedema]]====<br /> *Cover for allergic reaction with medications above<br /> **If true angioedema, will not resolve symptoms<br /> *Stop ACE inhibitor<br /> *See {{Template:Angioedema#Management}}<br /> ====Inhalant irritation====<br /> *Antihistamines IV<br /> *Hydrocortisone or dexamethasone IV<br /> ==Disposition==<br /> *Determined by severity, complications, etc.<br /> ==Also See==<br /> *[[Epiglottitis]] <br /> *[[Retropharyngeal Abscess]]<br /> ==External Links==<br /> ==References==<br /> *Yellon R, Chi D. Atlas of pediatric physical diagnosis. 6th Ed. 2012; 23: Philadelphia, PA: Saunders/Elsevier; 2012: 913-960<br /> * Wald Ellen. Feigin and Cherry’s Textbook of Pediatric Infectious Disease, 7th ed. Philadelphia, PA : Elsevier/Saunders; 2014: 165-167<br /> *Guarisco J, Cheney M, Lejeune F, Reed H. Isolated uvulitis secondary to marijuana use. Laryngoscope. 1988; 98:1309-131<br /> *Boyce S, Quigley M. Uvulitis and partial upper airway obstruction following cannabis inhalation. Emergency medicine. 2002; 14:106-108<br /> *Westerman E, Hutton J. Acute uvulitis associated with epiglotitis. Arch Otolaryngol Head Neck Surg. 1986; 12:448-449<br /> *Peghlnl P, Salcedo J, Al-Kawas F. Traumatic uvulitis: a rare complication of upper GI endoscopy. Gastrointestinal Endoscopy. 2001; 53:818-820<br /> *Lee S, Schwatz R, Babadori R. Retropharyngeal abscess: epiglottitis of the new mellennium. The Journal of Pediatrics. 2001; 138:435-437</div> Gkatzb https://wikem.org/w/index.php?title=Hemolytic_anemia&diff=106624 Hemolytic anemia 2016-10-17T21:43:26Z <p>Gkatzb: Added table for lab interpretation</p> <hr /> <div>==General==<br /> *Wide variety of clinical presentation given the large differential diagnosis of Hemolytic Anemia<br /> *Symptoms, Physical Exam, and Labs findings differ depending on intravascular vs. extravascular hemolysis, acute vs. chronic<br /> *Common theme: low hemoglobin and hematocrit, reticulocytosis, elevated indirect bilirubin<br /> *Most important lab to elucidate diagnosis is blood smear<br /> *Divided by etiology: Acquired and Hereditary<br /> **Acquired:<br /> ***Microangiopathic, Autoimmune, infection<br /> **Hereditary:<br /> *** Sickle Cell Disease, Thalassemia, G6PD, Hereditary Spherocytosis<br /> *Most common emergent presentations are due to acute intravascular hemolytic anemias<br /> <br /> ==Clinical Features==<br /> ===History===<br /> *Anemia symptoms<br /> **Dyspnea<br /> **Fatigue<br /> **DOE<br /> *Stigmata of intravascular hemolysis<br /> **Jaundice (new onset)<br /> **Dark urine<br /> **Changes in stool color<br /> ** Neuro (TTP)<br /> *** Headache<br /> *** AMS<br /> *** Seizure<br /> *** Focal deficit<br /> *** Coma<br /> ** Rectal Bleeding (HUS)<br /> *Stigmata of thrombocytopenia<br /> **Petechiae<br /> **Bleeding<br /> *Stigmata of extravascular RBC destruction<br /> **Abdominal pain<br /> **Back pain<br /> *Systemic Symptoms<br /> **Fevers<br /> **Night sweats<br /> **Weight loss<br /> **Confusion<br /> *Other <br /> **Trauma<br /> **Initiation of new medication<br /> **Recent travel<br /> **Recent bug bites<br /> <br /> ===PMH===<br /> *Hereditary Spherocytosis<br /> *Sickle Cell Disease<br /> *G6PD Deficiency recently started new medication:<br /> ** Dapsone<br /> **Phenazopyridine<br /> **Nitrofurantoin<br /> **Primaquine<br /> **Rasburicase<br /> **Methylene blue<br /> **Tolonium chloride (toluidine blue)<br /> *Malignancy<br /> *Renal Failure<br /> *Connective Tissue Disease<br /> * Family history of Anemia/Bleeding<br /> <br /> ===Physical Exam===<br /> *Cardiovascular<br /> **Tachycardia with flow murmur<br /> ** Heart murmur – prosthetic heart valve<br /> *Abdominal Exam<br /> ** Hepatomegaly<br /> ** Splenomegaly<br /> ** Ascites<br /> *Skin<br /> **Petechiae<br /> **Bruising<br /> **Lymphadenopathy <br /> **Brown recluse spider bites<br /> <br /> ==Differential Diagnosis==<br /> <br /> ===Acquired Hemolytic Anemia===<br /> ====Microangiopathic Hemolytic Anemia====<br /> *HUS<br /> *TTP<br /> *DIC<br /> *Malignant Hypertension<br /> ====Autoimmune====<br /> *Warm Antibody Autoimmune Hemolytic Anemia<br /> ====Infection====<br /> *Malaria<br /> *Babesia<br /> ====Other====<br /> *Brown recluse spider venom<br /> ===Hereditary/Congenital Hemolytic Anemia===<br /> *G6PD – medication induced hemolytic anemia<br /> *Sickle Cell Disease<br /> *Thalassemia<br /> *Hereditary Spherocytosis<br /> <br /> ==Evaluation==<br /> *Labs<br /> ** CBC<br /> ***Look for low h/h<br /> ***Low platelet count -&gt; microangiopathic hemolytic anemia<br /> ** Blood smear is one of the most important tests to obtain<br /> ** Reticulocyte Count<br /> ** CMP<br /> *** Most important: indirect bilirubin and creatinine<br /> ** UA, Urine Hemoglobin, Urine Hemosiderin, Upreg<br /> ** PT/INR<br /> ** Hemolysis Labs<br /> *** LDH<br /> ***Haptoglobin<br /> ***Fibrinogen <br /> ** Direct Anti-Globulin Test or Coombs test<br /> ** If concern for Malaria:<br /> ***Thick and Thin prep<br /> *** Parasitemia <br /> **HIV<br /> **Blood cultures<br /> **Urine Cultures<br /> **Consider LP if neuro symptoms<br /> <br /> ==Lab Interpretation==<br /> {| {{table}}<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Microangiopathic Hemolytic Anemia'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''H/H'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Platelets'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Indirect Bili'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Creatinine'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Blood Smear'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''PT/INR'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''LDH'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Haptoglobin'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Fibrinogen'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''DAT/Coombs Test'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Thick/Thin Prep'''<br /> |-<br /> | HUS||low||low||elevated||highly elevated||schistocytes||wnl||elevated||low||wnl||negative||negative<br /> |-<br /> | TTP||low||low||elevated||elevated||schistocytes||wnl||elevated||low||wnl||negative||negative<br /> |-<br /> | DIC||low||low||elevated||elevated||schistocytes||elevated/elevated||elevated||low||low||negative||negative<br /> |-<br /> | Malignant Hypertension||low||low||elevated||variable||schistocytes||||elevated||low||||negative||negative<br /> |-<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Autoimmune'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''H/H'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Platelets'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Indirect Bili'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Creatinine'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Blood Smear'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''PT/INR'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''LDH'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Haptoglobin'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Fibrinogen'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''DAT/Coombs Test'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Thick/Thin Prep'''<br /> |-<br /> | Warm Antibody AHA||low||wnl||elevated||||spherocytes||||elevated||low||wnl||positive||negative<br /> |-<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Infection'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''H/H'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Platelets'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Indirect Bili'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Creatinine'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Blood Smear'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''PT/INR'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''LDH'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Haptoglobin'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Fibrinogen'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''DAT/Coombs Test'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Thick/Thin Prep'''<br /> |-<br /> | Malaria||low||wnl||elevated||||see thick/thin prep||variable||elevated||low||wnl||negative||paracytes<br /> |-<br /> | Babesia||||||||||see thick/thin prep||||||||||negative||paracytes<br /> |-<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Other'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''H/H'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Platelets'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Indirect Bili'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Creatinine'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Blood Smear'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''PT/INR'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''LDH'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Haptoglobin'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Fibrinogen'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''DAT/Coombs Test'''<br /> | align=&quot;center&quot; style=&quot;background:#f0f0f0;&quot;|'''Thick/Thin Prep'''<br /> |-<br /> | Brown rec||low||wnl||elevated||||||||elevated||||||positive||negative<br /> |}<br /> ==Management ==<br /> *ABC’s and Resuscitation if necessary<br /> *2 Large bore IVs<br /> *Emergent hematology consultation if patient is very ill appearing<br /> ===Acquired Hemolytic Anemia===<br /> ====Microangiopathic Hemolytic Anemia====<br /> *HUS<br /> **Supportive Care<br /> ***Hydration<br /> ***Pain control<br /> **Hemodialysis if acute renal failure<br /> **Do NOT give Antibiotics: results in increased expression of Shiga Toxin from E. Coli O157:H7<br /> <br /> *TTP<br /> ** Avoid platelet transfusion, except in life-threatening bleeding or intracranial hemorrhage<br /> **Plasma Exchange<br /> ** If Plasma exchange cannot be performed immediately, give FFP and pheresis later.<br /> ** Infusion with factor VIII concentrate<br /> <br /> *DIC<br /> **Platelets if count is &lt;50,000 and/or significant bleeding<br /> **pRBC if active bleeding or hemodynamically unstable<br /> **FFP if active bleeding<br /> **Cryoprecipitate if fibrinogen &lt;150 and bleeding<br /> **TXA is only indicated for active or massive bleeding<br /> <br /> *Malignant hypertension<br /> **Decreased blood pressure as clinically indicated<br /> <br /> ====Autoimmune====<br /> *Warm Antibody Autoimmune Hemolytic Anemia<br /> **High-dose corticosteroids PO (1-2mg/kg per day for 3-4 weeks)<br /> ** Monoclonal antibodies and immunosuppressive agents<br /> ** Plasma exchange for severe hemolysis<br /> ** Allogeneic RBC transfusion for life-threatening anemia<br /> <br /> ====Infection====<br /> *Malaria<br /> ** Visit CDC website to determine resistance pattern: https://www.cdc.gov/malaria/diagnosis_treatment/treatment.html<br /> ** CDC Malaria Hotline: (770) 488-7788 or (855) 856-4713 toll-free Monday-Friday 9 am to 5 pm EST - (770) 488-7100 after hours, weekends and holidays<br /> <br /> *Babesia <br /> **Mild/moderate Disease<br /> *** Atovaquone 750mg PO q12hr plus Azithromycin 500mg PO on day 1, then 250mg/day PO<br /> **Severe Disease<br /> *** Adult: Clindamycin 300-600mg IV qid or 600mg PO TID Plus Quinine 650mg PO TID x 7-10 days<br /> ***Consider exchange transfusion if parasitemia &gt;10%<br /> **Supportive treatment<br /> <br /> ====Other====<br /> *Brown recluse spider venom<br /> **Supportive care<br /> ***Hemodynamic support with fluids and pressers if necessary<br /> ***Blood product transfusion if necessary<br /> <br /> ===Hereditary/Congenital Hemolytic Anemia===<br /> *G6PD<br /> **Stop new medications<br /> **Treat any infections aggressively<br /> **Ovoid oxidant drugs<br /> **Blood transfusion if severe illness<br /> <br /> *Sickle Cell Disease<br /> **Hemolytic anemia in SCD is typically chronic in nature not requiring treatment in the ED. <br /> *Thalassemia<br /> **Hemolytic anemia in Thalassemia is typically chronic in nature not requiring treatment in the ED.<br /> *Hereditary Spherocytosis<br /> **Hemolytic anemia in Hereditary Spherocytosis is typically chronic in nature not requiring treatment in the ED.<br /> <br /> ==Disposition==<br /> Admit<br /> <br /> ==Also See==<br /> <br /> ==External Links==<br /> <br /> ==References==<br /> *Dhaliwal G, Cornett P, Tierney LM Jr. Hemolytic Anemia. Am Fam Physician. 2004 Jun 1;69(11):2599-606.<br /> * Rother RP, Bell L, Hillmen P, Gladwin MT. The Clinical Sequelae of Intravascular Hemolysis and Extracellular Plasma HemoglobinA Novel Mechanism of Human Disease. JAMA. 2005;293(13):1653-1662. doi:10.1001/jama.293.13.1653<br /> *Barcellini W, Fattizzo B. Clinical applications of hemolytic markers in the differential diagnosis and management of hemolytic anemia. Disease markers. 2015 Dec 27;2015.<br /> *Bain BJ. Diagnosis from the blood smear. New England Journal of Medicine. 2005 Aug 4;353(5):498-507.<br /> * Tefferi A. Anemia in adults: a contemporary approach to diagnosis. In Mayo Clinic Proceedings 2003 Oct 31 (Vol. 78, No. 10, pp. 1274-1280). Elsevier.<br /> *Wada H, Matsumoto T, Yamashita Y. Diagnosis and treatment of disseminated intravascular coagulation (DIC) according to four DIC guidelines. Journal of Intensive Care. 2014;2(1):15. doi:10.1186/2052-0492-2-15.<br /> * McDade, Jenny et al. Brown Recluse Spider (Loxosceles reclusa) Envenomation Leading to Acute Hemolytic Anemia in Six Adolescents. The Journal of Pediatrics, Volume 156, Issue 1, 155 - 157<br /> * Albert E. Anderson, Paul B. Cassaday, George R. Healy. Babesiosis in Man: Sixth Documented Case American Journal of Clinical Pathology Nov 1974, 62 (5) 612 618; DOI:10.1093/ajcp/62.5.612</div> Gkatzb https://wikem.org/w/index.php?title=Hemolytic_anemia&diff=106621 Hemolytic anemia 2016-10-17T21:31:17Z <p>Gkatzb: grammatical error</p> <hr /> <div>==General==<br /> *Wide variety of clinical presentation given the large differential diagnosis of Hemolytic Anemia<br /> *Symptoms, Physical Exam, and Labs findings differ depending on intravascular vs. extravascular hemolysis, acute vs. chronic<br /> *Common theme: low hemoglobin and hematocrit, reticulocytosis, elevated indirect bilirubin<br /> *Most important lab to elucidate diagnosis is blood smear<br /> *Divided by etiology: Acquired and Hereditary<br /> **Acquired:<br /> ***Microangiopathic, Autoimmune, infection<br /> **Hereditary:<br /> *** Sickle Cell Disease, Thalassemia, G6PD, Hereditary Spherocytosis<br /> *Most common emergent presentations are due to acute intravascular hemolytic anemias<br /> <br /> ==Clinical Features==<br /> ===History===<br /> *Anemia symptoms<br /> **Dyspnea<br /> **Fatigue<br /> **DOE<br /> *Stigmata of intravascular hemolysis<br /> **Jaundice (new onset)<br /> **Dark urine<br /> **Changes in stool color<br /> ** Neuro (TTP)<br /> *** Headache<br /> *** AMS<br /> *** Seizure<br /> *** Focal deficit<br /> *** Coma<br /> ** Rectal Bleeding (HUS)<br /> *Stigmata of thrombocytopenia<br /> **Petechiae<br /> **Bleeding<br /> *Stigmata of extravascular RBC destruction<br /> **Abdominal pain<br /> **Back pain<br /> *Systemic Symptoms<br /> **Fevers<br /> **Night sweats<br /> **Weight loss<br /> **Confusion<br /> *Other <br /> **Trauma<br /> **Initiation of new medication<br /> **Recent travel<br /> **Recent bug bites<br /> <br /> ===PMH===<br /> *Hereditary Spherocytosis<br /> *Sickle Cell Disease<br /> *G6PD Deficiency recently started new medication:<br /> ** Dapsone<br /> **Phenazopyridine<br /> **Nitrofurantoin<br /> **Primaquine<br /> **Rasburicase<br /> **Methylene blue<br /> **Tolonium chloride (toluidine blue)<br /> *Malignancy<br /> *Renal Failure<br /> *Connective Tissue Disease<br /> * Family history of Anemia/Bleeding<br /> <br /> ===Physical Exam===<br /> *Cardiovascular<br /> **Tachycardia with flow murmur<br /> ** Heart murmur – prosthetic heart valve<br /> *Abdominal Exam<br /> ** Hepatomegaly<br /> ** Splenomegaly<br /> ** Ascites<br /> *Skin<br /> **Petechiae<br /> **Bruising<br /> **Lymphadenopathy <br /> **Brown recluse spider bites<br /> <br /> ==Differential Diagnosis==<br /> <br /> ===Acquired Hemolytic Anemia===<br /> ====Microangiopathic Hemolytic Anemia====<br /> *HUS<br /> *TTP<br /> *DIC<br /> *Malignant Hypertension<br /> ====Autoimmune====<br /> *Warm Antibody Autoimmune Hemolytic Anemia<br /> ====Infection====<br /> *Malaria<br /> *Babesia<br /> ====Other====<br /> *Brown recluse spider venom<br /> ===Hereditary/Congenital Hemolytic Anemia===<br /> *G6PD – medication induced hemolytic anemia<br /> *Sickle Cell Disease<br /> *Thalassemia<br /> *Hereditary Spherocytosis<br /> <br /> ==Evaluation==<br /> *Labs<br /> ** CBC<br /> ***Look for low h/h<br /> ***Low platelet count -&gt; microangiopathic hemolytic anemia<br /> ** Blood smear is one of the most important tests to obtain<br /> ** Reticulocyte Count<br /> ** CMP<br /> *** Most important: indirect bilirubin and creatinine<br /> ** UA, Urine Hemoglobin, Urine Hemosiderin, Upreg<br /> ** PT/INR<br /> ** Hemolysis Labs<br /> *** LDH<br /> ***Haptoglobin<br /> ***Fibrinogen <br /> ** Direct Anti-Globulin Test or Coombs test<br /> ** If concern for Malaria:<br /> ***Thick and Thin prep<br /> *** Parasitemia <br /> **HIV<br /> **Blood cultures<br /> **Urine Cultures<br /> **Consider LP if neuro symptoms<br /> <br /> ==Lab Interpretation==<br /> TABLE<br /> <br /> ==Management ==<br /> *ABC’s and Resuscitation if necessary<br /> *2 Large bore IVs<br /> *Emergent hematology consultation if patient is very ill appearing<br /> ===Acquired Hemolytic Anemia===<br /> ====Microangiopathic Hemolytic Anemia====<br /> *HUS<br /> **Supportive Care<br /> ***Hydration<br /> ***Pain control<br /> **Hemodialysis if acute renal failure<br /> **Do NOT give Antibiotics: results in increased expression of Shiga Toxin from E. Coli O157:H7<br /> <br /> *TTP<br /> ** Avoid platelet transfusion, except in life-threatening bleeding or intracranial hemorrhage<br /> **Plasma Exchange<br /> ** If Plasma exchange cannot be performed immediately, give FFP and pheresis later.<br /> ** Infusion with factor VIII concentrate<br /> <br /> *DIC<br /> **Platelets if count is &lt;50,000 and/or significant bleeding<br /> **pRBC if active bleeding or hemodynamically unstable<br /> **FFP if active bleeding<br /> **Cryoprecipitate if fibrinogen &lt;150 and bleeding<br /> **TXA is only indicated for active or massive bleeding<br /> <br /> *Malignant hypertension<br /> **Decreased blood pressure as clinically indicated<br /> <br /> ====Autoimmune====<br /> *Warm Antibody Autoimmune Hemolytic Anemia<br /> **High-dose corticosteroids PO (1-2mg/kg per day for 3-4 weeks)<br /> ** Monoclonal antibodies and immunosuppressive agents<br /> ** Plasma exchange for severe hemolysis<br /> ** Allogeneic RBC transfusion for life-threatening anemia<br /> <br /> ====Infection====<br /> *Malaria<br /> ** Visit CDC website to determine resistance pattern: https://www.cdc.gov/malaria/diagnosis_treatment/treatment.html<br /> ** CDC Malaria Hotline: (770) 488-7788 or (855) 856-4713 toll-free Monday-Friday 9 am to 5 pm EST - (770) 488-7100 after hours, weekends and holidays<br /> <br /> *Babesia <br /> **Mild/moderate Disease<br /> *** Atovaquone 750mg PO q12hr plus Azithromycin 500mg PO on day 1, then 250mg/day PO<br /> **Severe Disease<br /> *** Adult: Clindamycin 300-600mg IV qid or 600mg PO TID Plus Quinine 650mg PO TID x 7-10 days<br /> ***Consider exchange transfusion if parasitemia &gt;10%<br /> **Supportive treatment<br /> <br /> ====Other====<br /> *Brown recluse spider venom<br /> **Supportive care<br /> ***Hemodynamic support with fluids and pressers if necessary<br /> ***Blood product transfusion if necessary<br /> <br /> ===Hereditary/Congenital Hemolytic Anemia===<br /> *G6PD<br /> **Stop new medications<br /> **Treat any infections aggressively<br /> **Ovoid oxidant drugs<br /> **Blood transfusion if severe illness<br /> <br /> *Sickle Cell Disease<br /> **Hemolytic anemia in SCD is typically chronic in nature not requiring treatment in the ED. <br /> *Thalassemia<br /> **Hemolytic anemia in Thalassemia is typically chronic in nature not requiring treatment in the ED.<br /> *Hereditary Spherocytosis<br /> **Hemolytic anemia in Hereditary Spherocytosis is typically chronic in nature not requiring treatment in the ED.<br /> <br /> ==Disposition==<br /> Admit<br /> <br /> ==Also See==<br /> <br /> ==External Links==<br /> <br /> ==References==<br /> *Dhaliwal G, Cornett P, Tierney LM Jr. Hemolytic Anemia. Am Fam Physician. 2004 Jun 1;69(11):2599-606.<br /> * Rother RP, Bell L, Hillmen P, Gladwin MT. The Clinical Sequelae of Intravascular Hemolysis and Extracellular Plasma HemoglobinA Novel Mechanism of Human Disease. JAMA. 2005;293(13):1653-1662. doi:10.1001/jama.293.13.1653<br /> *Barcellini W, Fattizzo B. Clinical applications of hemolytic markers in the differential diagnosis and management of hemolytic anemia. Disease markers. 2015 Dec 27;2015.<br /> *Bain BJ. Diagnosis from the blood smear. New England Journal of Medicine. 2005 Aug 4;353(5):498-507.<br /> * Tefferi A. Anemia in adults: a contemporary approach to diagnosis. In Mayo Clinic Proceedings 2003 Oct 31 (Vol. 78, No. 10, pp. 1274-1280). Elsevier.<br /> *Wada H, Matsumoto T, Yamashita Y. Diagnosis and treatment of disseminated intravascular coagulation (DIC) according to four DIC guidelines. Journal of Intensive Care. 2014;2(1):15. doi:10.1186/2052-0492-2-15.<br /> * McDade, Jenny et al. Brown Recluse Spider (Loxosceles reclusa) Envenomation Leading to Acute Hemolytic Anemia in Six Adolescents. The Journal of Pediatrics, Volume 156, Issue 1, 155 - 157<br /> * Albert E. Anderson, Paul B. Cassaday, George R. Healy. Babesiosis in Man: Sixth Documented Case American Journal of Clinical Pathology Nov 1974, 62 (5) 612 618; DOI:10.1093/ajcp/62.5.612</div> Gkatzb https://wikem.org/w/index.php?title=Hemolytic_anemia&diff=106620 Hemolytic anemia 2016-10-17T21:30:25Z <p>Gkatzb: Blank page to current: General, clinical features, evaluation, etc</p> <hr /> <div>==General==<br /> *Wide variety of clinical presentation given the large differential diagnosis of Hemolytic Anemia<br /> *Symptoms, Physical Exam, and Labs findings differ depending on intravascular vs. extravascular hemolysis, acute vs. chronic<br /> *Common theme: low hemoglobin and hematocrit, reticulocytosis, elevated indirect bilirubin<br /> *Most important lab to elucidate diagnosis is blood smear<br /> *Divided by etiology: Acquired and Hereditary<br /> **Acquired:<br /> ***Autoimmunity, microangiopathic, infection<br /> **Hereditary:<br /> *** Sickle Cell Disease, Thalassemia, G6PD, Hereditary Spherocytosis<br /> *Most common emergent presentations are due to acute intravascular hemolytic anemias<br /> <br /> ==Clinical Features==<br /> ===History===<br /> *Anemia symptoms<br /> **Dyspnea<br /> **Fatigue<br /> **DOE<br /> *Stigmata of intravascular hemolysis<br /> **Jaundice (new onset)<br /> **Dark urine<br /> **Changes in stool color<br /> ** Neuro (TTP)<br /> *** Headache<br /> *** AMS<br /> *** Seizure<br /> *** Focal deficit<br /> *** Coma<br /> ** Rectal Bleeding (HUS)<br /> *Stigmata of thrombocytopenia<br /> **Petechiae<br /> **Bleeding<br /> *Stigmata of extravascular RBC destruction<br /> **Abdominal pain<br /> **Back pain<br /> *Systemic Symptoms<br /> **Fevers<br /> **Night sweats<br /> **Weight loss<br /> **Confusion<br /> *Other <br /> **Trauma<br /> **Initiation of new medication<br /> **Recent travel<br /> **Recent bug bites<br /> <br /> ===PMH===<br /> *Hereditary Spherocytosis<br /> *Sickle Cell Disease<br /> *G6PD Deficiency recently started new medication:<br /> ** Dapsone<br /> **Phenazopyridine<br /> **Nitrofurantoin<br /> **Primaquine<br /> **Rasburicase<br /> **Methylene blue<br /> **Tolonium chloride (toluidine blue)<br /> *Malignancy<br /> *Renal Failure<br /> *Connective Tissue Disease<br /> * Family history of Anemia/Bleeding<br /> <br /> ===Physical Exam===<br /> *Cardiovascular<br /> **Tachycardia with flow murmur<br /> ** Heart murmur – prosthetic heart valve<br /> *Abdominal Exam<br /> ** Hepatomegaly<br /> ** Splenomegaly<br /> ** Ascites<br /> *Skin<br /> **Petechiae<br /> **Bruising<br /> **Lymphadenopathy <br /> **Brown recluse spider bites<br /> <br /> ==Differential Diagnosis==<br /> <br /> ===Acquired Hemolytic Anemia===<br /> ====Microangiopathic Hemolytic Anemia====<br /> *HUS<br /> *TTP<br /> *DIC<br /> *Malignant Hypertension<br /> ====Autoimmune====<br /> *Warm Antibody Autoimmune Hemolytic Anemia<br /> ====Infection====<br /> *Malaria<br /> *Babesia<br /> ====Other====<br /> *Brown recluse spider venom<br /> ===Hereditary/Congenital Hemolytic Anemia===<br /> *G6PD – medication induced hemolytic anemia<br /> *Sickle Cell Disease<br /> *Thalassemia<br /> *Hereditary Spherocytosis<br /> <br /> ==Evaluation==<br /> *Labs<br /> ** CBC<br /> ***Look for low h/h<br /> ***Low platelet count -&gt; microangiopathic hemolytic anemia<br /> ** Blood smear is one of the most important tests to obtain<br /> ** Reticulocyte Count<br /> ** CMP<br /> *** Most important: indirect bilirubin and creatinine<br /> ** UA, Urine Hemoglobin, Urine Hemosiderin, Upreg<br /> ** PT/INR<br /> ** Hemolysis Labs<br /> *** LDH<br /> ***Haptoglobin<br /> ***Fibrinogen <br /> ** Direct Anti-Globulin Test or Coombs test<br /> ** If concern for Malaria:<br /> ***Thick and Thin prep<br /> *** Parasitemia <br /> **HIV<br /> **Blood cultures<br /> **Urine Cultures<br /> **Consider LP if neuro symptoms<br /> <br /> ==Lab Interpretation==<br /> TABLE<br /> <br /> ==Management ==<br /> *ABC’s and Resuscitation if necessary<br /> *2 Large bore IVs<br /> *Emergent hematology consultation if patient is very ill appearing<br /> ===Acquired Hemolytic Anemia===<br /> ====Microangiopathic Hemolytic Anemia====<br /> *HUS<br /> **Supportive Care<br /> ***Hydration<br /> ***Pain control<br /> **Hemodialysis if acute renal failure<br /> **Do NOT give Antibiotics: results in increased expression of Shiga Toxin from E. Coli O157:H7<br /> <br /> *TTP<br /> ** Avoid platelet transfusion, except in life-threatening bleeding or intracranial hemorrhage<br /> **Plasma Exchange<br /> ** If Plasma exchange cannot be performed immediately, give FFP and pheresis later.<br /> ** Infusion with factor VIII concentrate<br /> <br /> *DIC<br /> **Platelets if count is &lt;50,000 and/or significant bleeding<br /> **pRBC if active bleeding or hemodynamically unstable<br /> **FFP if active bleeding<br /> **Cryoprecipitate if fibrinogen &lt;150 and bleeding<br /> **TXA is only indicated for active or massive bleeding<br /> <br /> *Malignant hypertension<br /> **Decreased blood pressure as clinically indicated<br /> <br /> ====Autoimmune====<br /> *Warm Antibody Autoimmune Hemolytic Anemia<br /> **High-dose corticosteroids PO (1-2mg/kg per day for 3-4 weeks)<br /> ** Monoclonal antibodies and immunosuppressive agents<br /> ** Plasma exchange for severe hemolysis<br /> ** Allogeneic RBC transfusion for life-threatening anemia<br /> <br /> ====Infection====<br /> *Malaria<br /> ** Visit CDC website to determine resistance pattern: https://www.cdc.gov/malaria/diagnosis_treatment/treatment.html<br /> ** CDC Malaria Hotline: (770) 488-7788 or (855) 856-4713 toll-free Monday-Friday 9 am to 5 pm EST - (770) 488-7100 after hours, weekends and holidays<br /> <br /> *Babesia <br /> **Mild/moderate Disease<br /> *** Atovaquone 750mg PO q12hr plus Azithromycin 500mg PO on day 1, then 250mg/day PO<br /> **Severe Disease<br /> *** Adult: Clindamycin 300-600mg IV qid or 600mg PO TID Plus Quinine 650mg PO TID x 7-10 days<br /> ***Consider exchange transfusion if parasitemia &gt;10%<br /> **Supportive treatment<br /> <br /> ====Other====<br /> *Brown recluse spider venom<br /> **Supportive care<br /> ***Hemodynamic support with fluids and pressers if necessary<br /> ***Blood product transfusion if necessary<br /> <br /> ===Hereditary/Congenital Hemolytic Anemia===<br /> *G6PD<br /> **Stop new medications<br /> **Treat any infections aggressively<br /> **Ovoid oxidant drugs<br /> **Blood transfusion if severe illness<br /> <br /> *Sickle Cell Disease<br /> **Hemolytic anemia in SCD is typically chronic in nature not requiring treatment in the ED. <br /> *Thalassemia<br /> **Hemolytic anemia in Thalassemia is typically chronic in nature not requiring treatment in the ED.<br /> *Hereditary Spherocytosis<br /> **Hemolytic anemia in Hereditary Spherocytosis is typically chronic in nature not requiring treatment in the ED.<br /> <br /> ==Disposition==<br /> Admit<br /> <br /> ==Also See==<br /> <br /> ==External Links==<br /> <br /> ==References==<br /> *Dhaliwal G, Cornett P, Tierney LM Jr. Hemolytic Anemia. Am Fam Physician. 2004 Jun 1;69(11):2599-606.<br /> * Rother RP, Bell L, Hillmen P, Gladwin MT. The Clinical Sequelae of Intravascular Hemolysis and Extracellular Plasma HemoglobinA Novel Mechanism of Human Disease. JAMA. 2005;293(13):1653-1662. doi:10.1001/jama.293.13.1653<br /> *Barcellini W, Fattizzo B. Clinical applications of hemolytic markers in the differential diagnosis and management of hemolytic anemia. Disease markers. 2015 Dec 27;2015.<br /> *Bain BJ. Diagnosis from the blood smear. New England Journal of Medicine. 2005 Aug 4;353(5):498-507.<br /> * Tefferi A. Anemia in adults: a contemporary approach to diagnosis. In Mayo Clinic Proceedings 2003 Oct 31 (Vol. 78, No. 10, pp. 1274-1280). Elsevier.<br /> *Wada H, Matsumoto T, Yamashita Y. Diagnosis and treatment of disseminated intravascular coagulation (DIC) according to four DIC guidelines. Journal of Intensive Care. 2014;2(1):15. doi:10.1186/2052-0492-2-15.<br /> * McDade, Jenny et al. Brown Recluse Spider (Loxosceles reclusa) Envenomation Leading to Acute Hemolytic Anemia in Six Adolescents. The Journal of Pediatrics, Volume 156, Issue 1, 155 - 157<br /> * Albert E. Anderson, Paul B. Cassaday, George R. Healy. Babesiosis in Man: Sixth Documented Case American Journal of Clinical Pathology Nov 1974, 62 (5) 612 618; DOI:10.1093/ajcp/62.5.612</div> Gkatzb https://wikem.org/w/index.php?title=Incarcerated_uterus&diff=105000 Incarcerated uterus 2016-10-07T02:05:24Z <p>Gkatzb: Inserted image and caption</p> <hr /> <div>[[File:Incarcerateduterus.JPG|thumb|Incarcerated Uterus: Compression and anterior displacement of bladder into abdominal cavity with compression of rectum. Most common presenting symptoms is urinary retention.]]<br /> <br /> ==Background==<br /> *Retroverted uterus is a normal variant (up to 20% of the population).<br /> *During pregnancy, a retroverted uterus spontaneously flips to become anteverted at 14-16 weeks gestation age.<br /> *Incarcerated uterus = impregnated retroverted uterus that is unable to spontaneously revert because the fundus is wedged below the sacral promontory. <br /> *Growth of uterus during pregnancy in retroverted position leads to compression of pelvic organs leading to symptomatology.<br /> <br /> ==Clinical Features==<br /> ===History===<br /> *Occurs only during pregnancy<br /> *Symptomatology is the result of compression of pelvic structures from enlarging uterus<br /> *Urinary Symptoms<br /> **[[Urinary retention]] is the most common presenting symptom.<br /> **Overflow incontinence<br /> **Urgency, frequency<br /> **[[Dysuria]]<br /> *Rectal symptoms<br /> **[[Constipation]]<br /> **Rectal pressure, tenesmus<br /> *Uncontrollable lower [[abdominal pain]]<br /> *[[Pelvic pain]]<br /> *[[Back pain]]<br /> *[[Vaginal Bleeding]]<br /> <br /> ===PMH===<br /> *Posterior and/or fundal fibroids<br /> *Endometriosis, adhesive disease (prior surgery, peritonitis, PID)<br /> *Prior history of incarcerated uterus<br /> <br /> ===Bimanual Exam===<br /> *'''ACOG Recommendation: All women with second trimester urinary retention should have a pelvic exam performed at presentation to exclude an incarcerated retroverted uterus''' <br /> *Findings<br /> **Extremely anterior cervix<br /> **Cervix posterior to pubic symphysis<br /> **Acutely angled vaginal canal<br /> **Unable to palpate uterus through abdomen<br /> <br /> ===Transvaginal Ultrasound===<br /> *Difficulty to identify cervix in 2nd and 3rd trimester<br /> *Cervix extends upward, superior to the bladder and pubic symphysis<br /> *Bladder will appear elongated and distended due to compression of uterus<br /> <br /> ==Differential Diagnosis==<br /> {{Abdominal Pain Pregnancy DDX}}<br /> {{Urinary retention DDX}}<br /> <br /> ==Evaluation==<br /> *ABC’s and Resuscitation if necessary<br /> *2 large bore IVs<br /> <br /> ===Labs===<br /> *Urine pregnancy, beta-HCG<br /> *CBC with differential<br /> *BMP, Mg/Phos, LFTs<br /> *UA/Urine Culture<br /> *PTT/PT/INR<br /> *Type and cross 2 units PRBC if bleeding concern<br /> <br /> ===Imaging===<br /> *Transvaginal Ultrasound<br /> *Non-emergent MRI if unable to obtain transvaginal ultrasound<br /> *Consider post-void residual<br /> <br /> ==Management==<br /> *Consultation with OB/GYN upon diagnosis<br /> ===Reduction of Incarcerated Uterus (ACOG Recommendations, 2014)===<br /> *Bladder decompression<br /> **Insertion of indwelling Foley Catheter<br /> *Pelvic exam to confirm diagnosis<br /> **Acute anterior angulation of vagina<br /> **Cervix positioned behind the pubic symphysis<br /> **Fundus not palpable abdominally<br /> Next steps are performed to achieve reduction of uterus by external/internal manipulation and should be performed with OB/GYN consultation<br /> *Patient position<br /> **Knee-chest or all fours<br /> *Manual reduction<br /> **Ensure bladder fully void<br /> **Vaginal examination with or without anesthesia<br /> *Colonoscopic <br /> **Gas insufflation of colon under anesthesia<br /> *Other<br /> **Amnioreduction<br /> **Surgical exploration through laparotomy<br /> ===Delivery===<br /> *C-section <br /> *Risk of uterine rupture if allowed to labor<br /> ===Complications===<br /> *Maternal<br /> **[[Acute renal failure]]<br /> **Severe hypertension resistant to medications<br /> **Lower limb edema<br /> **Uterine ischemia<br /> **[[Sepsis]]<br /> **[[DVT]], Post-partum [[PE]]<br /> *Fetal<br /> **Premature labor<br /> **Fetal mortality rate 33% (Gibbons and Paley)<br /> <br /> ==Disposition==<br /> *Admit<br /> **From the limited number of case studies, it appears most patients were admitted for inability to void, pain control, reduction of incarcerated uterus.<br /> <br /> ==See Also==<br /> <br /> ==External Links==<br /> <br /> ==References==<br /> *Newell S, Crofts J, Grant S. The Incarcerated Gravid Uterus Complications and Lessons Learned. American College of Obstetricians and Gynecologist 2014, 123:423-427<br /> *Gardner C, Jaffe T, Hertzberg B, Javan R, Ho L. The Incarcerated Uterus: A review of MRI and Ultrasound Imaging Appearances. American Journal of Roentgenology. 2013;201: 223-229.<br /> *Gibbons JM Jr, Paley WB. The incarcerated gravid uterus. Obstet Gynecol 1969; 33:842–845<br /> &lt;references/&gt;<br /> <br /> [[Category:OBGYN]]</div> Gkatzb https://wikem.org/w/index.php?title=File:Incarcerateduterus.JPG&diff=104999 File:Incarcerateduterus.JPG 2016-10-07T01:56:12Z <p>Gkatzb: Wikipedia</p> <hr /> <div>Wikipedia</div> Gkatzb https://wikem.org/w/index.php?title=User:Gkatzb&diff=104422 User:Gkatzb 2016-10-04T02:52:59Z <p>Gkatzb: training program</p> <hr /> <div>Garrett Blumberg, MD.<br /> UT Southwestern/Parkland Memorial Hospital</div> Gkatzb https://wikem.org/w/index.php?title=Incarcerated_uterus&diff=104419 Incarcerated uterus 2016-10-04T02:24:08Z <p>Gkatzb: Wrote background, clinical features, ddx, evaluation, management, and disposition</p> <hr /> <div>==Background==<br /> *Retroverted uterus is a normal variant (up to 20% of the population).<br /> *During pregnancy, a retroverted uterus spontaneously flips to become anteverted at 14-16 weeks gestation age.<br /> *Incarcerated uterus = impregnated retroverted uterus that is unable to spontaneously revert because the fundus is wedged below the sacral promontory. <br /> *Growth of uterus during pregnancy in retroverted position leads to compression of pelvic organs leading to symptomatology.<br /> <br /> ==Clinical Features==<br /> ===History===<br /> *Occurs only during pregnancy<br /> *Symptomatology is the result of compression of pelvic structures from enlarging uterus<br /> *Urinary Symptoms<br /> **Urinary retention is the most common presenting symptom.<br /> **Overflow incontinence<br /> **Urgency<br /> **Frequency<br /> **Dysuria<br /> *Rectal symptoms<br /> **Constipation<br /> **Rectal pressure<br /> **Tenesmus<br /> *Uncontrollable lower abdominal pain<br /> *Pelvic pain<br /> *Back pain<br /> *Vaginal Bleeding<br /> <br /> ===PMH===<br /> *Posterior fibroids<br /> *Fundal fibroids<br /> *Endometriosis<br /> *Adhesive disease (prior surgery, peritonitis, PID)<br /> *Prior history of incarcerated uterus<br /> <br /> ===Bimanual Exam===<br /> *'''ACOG Recommendation: All women with second trimester urinary retention should have a pelvic exam performed at presentation to exclude an incarcerated retroverted uterus''' <br /> *Findings<br /> **Extremely anterior cervix<br /> **Cervix posterior to pubic symphysis<br /> **Acutely angled vaginal canal<br /> **Unable to palpate uterus through abdomen<br /> <br /> ===Transvaginal Ultrasound===<br /> *Difficulty to identify cervix in 2nd and 3rd trimester<br /> *Cervix extends upward, superior to the bladder and pubic symphysis<br /> *Bladder will appear elongated and distended due to compression of uterus<br /> <br /> ==Differential Diagnosis==<br /> {{Urinary retention DDX}}<br /> <br /> {{Abdominal Pain Pregnancy DDX}}<br /> <br /> ===Gastroentestinal===<br /> *Appendicitis<br /> *Small bowel obstruction<br /> *Volvulus<br /> *Hernia<br /> *IBD &amp; IBS<br /> *Perforated viscous<br /> <br /> ===Genitourinary===<br /> *Cystitis<br /> *Urinary tract infection<br /> *Pyelonephritis<br /> *Hydronephrosis<br /> *Bladder rupture<br /> <br /> ===Spine===<br /> *Cauda Equina Syndrome<br /> *Herniated Nucleus Pulposus<br /> *Lumbar strain<br /> <br /> ==Evaluation==<br /> *ABC’s and Resuscitation if necessary<br /> *2 large bore IVs<br /> *Labs<br /> **Urine pregnancy<br /> **Beta-HCG<br /> **Stat Hematocrit<br /> **CBC with differential<br /> **BMP, Mg/Phos<br /> **LFT<br /> **UA/Urine Culture<br /> **PTT/PT/INR<br /> **HIV<br /> **Type and cross 2 units PRBC if bleeding concern<br /> *Imaging<br /> **Transvaginal Ultrasound<br /> **Non-emergent MRI if unable to obtain transvaginal ultrasound<br /> **Consider Post-void residual<br /> <br /> <br /> ==Management==<br /> *Consultation with OB/GYN upon diagnosis<br /> ===Reduction of Incarcerated Uterus (ACOG Recommendations, 2014)===<br /> *Bladder decompression<br /> **Insertion of indwelling Foley Catheter<br /> *Pelvic exam to confirm diagnosis<br /> **Acute anterior angulation of vagina<br /> **Cervix positioned behind the pubic symphysis<br /> **Fundus not palpable abdominally<br /> Next steps are performed to achieve reduction of uterus by external/internal manipulation and should be performed with OB/GYN consultation<br /> *Patient position<br /> **Knee-chest or all fours<br /> *Manual reduction<br /> **Ensure bladder fully void<br /> **Vaginal examination with or without anesthesia<br /> *Colonoscopic <br /> **Gas insufflation of colon under anesthesia<br /> *Other<br /> **Amnioreduction<br /> **Surgical exploration through laparotomy<br /> ===Delivery===<br /> *C-section <br /> *Risk of uterine rupture if allowed to labor<br /> ===Complications===<br /> *Maternal<br /> **Acute renal failure<br /> **Severe hypertension resistant to medications<br /> **Lower limb edema<br /> **Uterine ischemia<br /> **Sepsis<br /> **DVT<br /> **Post-partum PE<br /> *Fetal<br /> **Premature labor<br /> **Fetal death<br /> **Fetal mortality rate 33% (Gibbons and Paley)<br /> <br /> ==Disposition==<br /> *Admit<br /> **From the limited number of case studies, it appears most patients were admitted for inability to void, pain control, reduction of incarcerated uterus.<br /> <br /> ==See Also==<br /> <br /> ==External Links==<br /> <br /> ==References==<br /> *Newell S, Crofts J, Grant S. The Incarcerated Gravid Uterus Complications and Lessons Learned. American College of Obstetricians and Gynecologist 2014, 123:423-427<br /> *Gardner C, Jaffe T, Hertzberg B, Javan R, Ho L. The Incarcerated Uterus: A review of MRI and Ultrasound Imaging Appearances. American Journal of Roentgenology. 2013;201: 223-229.<br /> *Gibbons JM Jr, Paley WB. The incarcerated gravid uterus. Obstet Gynecol 1969; 33:842–845<br /> &lt;references/&gt;</div> Gkatzb