Complete blood count with Differential (CBC with DIFF): Red Cell Distribution Width (RDW)

Tags

alcohol, anemia, band neutrophils, bands, basophil, cancer, CBC, CBC with diff, CBC with differential, Chronic disease, Elevated RDW, eosinophil, Folate deficiency, Hydroxyurea, Imuran, infection, inflammation, iron deficiency, leukemia, liver disease, lymphocytes, lymphoma, malignancy, mcv, methotrexate, monocytes, Multiple myeloma, Myelodysplastic syndrome, neutrophil, Renal failure, Sickle cell Anemia, Thalassemia, Toxins, vitamin b12

Red Cell Distribution Width (RDW) measures the variability in the size of red blood cells. This parameter can help distinguish the various causes of anemia along with Mean corpuscular volume (MCV). With the addition of RDW, Mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) are no longer clinically used because of their limitations.

MCV is elevated (greater than 96) in:
– Vitamin B12 deficiency (Elevated RDW)
– Folate deficiency (Elevated RDW)
– Medications: Methotrexate, Imuran, Hydroxyurea (Normal RDW)
– Alcohol (Normal RDW)
– Liver disease (Elevated RDW)
– Multiple myeloma (Elevated RDW)
– Myelodysplastic syndrome (Elevated RDW)

MCV is normal (Between 80-96):
– Chronic disease (Elevated RDW)
– Renal failure (Elevated RDW)
– Sickle cell Anemia (Elevated RDW)
– Early Vitamin B12 and iron deficiency or mixed deficiencies (Elevated RDW)

MCV is low (less than 80) in:
– Iron deficiency (Elevated RDW)
– Toxins and drugs (Normal RDW)
– Thalassemia (Normal RDW)
– Myelodysplastic Syndrome (Elevated RDW)

Complete blood count with Differential (CBC with DIFF): Mean Corpuscular Hemoglobin (MCH)

Tags

alcohol, anemia, band neutrophils, bands, basophil, cancer, CBC, CBC with diff, CBC with differential, Chronic disease, Elevated RDW, eosinophil, Folate deficiency, Hydroxyurea, Imuran, infection, inflammation, iron deficiency, leukemia, liver disease, lymphocytes, lymphoma, malignancy, mcv, methotrexate, monocytes, Multiple myeloma, Myelodysplastic syndrome, neutrophil, Renal failure, Sickle cell Anemia, Thalassemia, Toxins, vitamin b12

Mean Corpuscular Hemoglobin (MCH) measures the average amount of Hemoglobin per single red blood cell. It was used in the past to determine the cause of anemia. But because of its limitations, Mean Corpuscular Volume or MCV along with Red Cell Distribution Width (RDW) have replaced MCH as means of determining the cause of anemia. These are outlined below:

MCV is elevated (greater than 96) in:
– Vitamin B12 deficiency (Elevated RDW)
– Folate deficiency (Elevated RDW)
– Medications: Methotrexate, Imuran, Hydroxyurea (Normal RDW)
– Alcohol (Normal RDW)
– Liver disease (Elevated RDW)
– Multiple myeloma (Elevated RDW)
– Myelodysplastic syndrome (Elevated RDW)

MCV is normal (Between 80-96):
– Chronic disease (Elevated RDW)
– Renal failure (Elevated RDW)
– Sickle cell Anemia (Elevated RDW)
– Early Vitamin B12 and iron deficiency or mixed deficiencies (Elevated RDW)

MCV is low (less than 80) in:
– Iron deficiency (Elevated RDW)
– Toxins and drugs (Normal RDW)
– Thalassemia (Normal RDW)
– Myelodysplastic Syndrome (Elevated RDW)

Complete blood count with Differential (CBC with DIFF): Mean Corpuscular Hemoglobin Concentration (MCHC)

Tags

alcohol, anemia, band neutrophils, bands, basophil, cancer, CBC, CBC with diff, CBC with differential, Chronic disease, Elevated RDW, eosinophil, Folate deficiency, Hydroxyurea, Imuran, infection, inflammation, iron deficiency, leukemia, liver disease, lymphocytes, lymphoma, malignancy, mcv, methotrexate, monocytes, Multiple myeloma, Myelodysplastic syndrome, neutrophil, Renal failure, Sickle cell Anemia, Thalassemia, Toxins, vitamin b12

Mean Corpuscular Hemoglobin Concentration (MCHC) measures the average concentration of hemoglobin per red blood cell. It was used in the past to determine the cause of anemia. But because of its limitations, Mean Corpuscular Volume or MCV along with Red Cell Distribution Width (RDW) have replaced MCHC as means of determining the cause of anemia. These are outlined below:

MCV is elevated (greater than 96) in:
– Vitamin B12 deficiency (Elevated RDW)
– Folate deficiency (Elevated RDW)
– Medications: Methotrexate, Imuran, Hydroxyurea (Normal RDW)
– Alcohol (Normal RDW)
– Liver disease (Elevated RDW)
– Multiple myeloma (Elevated RDW)
– Myelodysplastic syndrome (Elevated RDW)

MCV is normal (Between 80-96):
– Chronic disease (Elevated RDW)
– Renal failure (Elevated RDW)
– Sickle cell Anemia (Elevated RDW)
– Early Vitamin B12 and iron deficiency or mixed deficiencies (Elevated RDW)

MCV is low (less than 80) in:
– Iron deficiency (Elevated RDW)
– Toxins and drugs (Normal RDW)
– Thalassemia (Normal RDW)
– Myelodysplastic Syndrome (Elevated RDW)

Complete blood count with Differential (CBC with DIFF): Mean Corpuscular Volume (MCV)

Tags

alcohol, anemia, band neutrophils, bands, basophil, cancer, CBC, CBC with diff, CBC with differential, Chronic disease, Elevated RDW, eosinophil, Folate deficiency, Hydroxyurea, Imuran, infection, inflammation, iron deficiency, leukemia, liver disease, lymphocytes, lymphoma, malignancy, mcv, methotrexate, monocytes, Multiple myeloma, Myelodysplastic syndrome, neutrophil, Renal failure, Sickle cell Anemia, Thalassemia, Toxins, vitamin b12

Mean Corpuscular Volume (MCV) measures the volume of red blood cells using hematocrit and red blood cell count. It is indication of the size of the red blood cells. Normal range is between 80 and 96 depending on the individual laboratory.

MCV is used along with Red Cell Distribution Width (RDW) in order to determine the cause of anemia. With the addition of RDW, Mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) are no longer clinically used because of their limitations.

MCV is elevated (greater than 96) in:
– Vitamin B12 deficiency (Elevated RDW)
– Folate deficiency (Elevated RDW)
– Medications: Methotrexate, Imuran, Hydroxyurea (Normal RDW)
– Alcohol (Normal RDW)
– Liver disease (Elevated RDW)
– Multiple myeloma (Elevated RDW)
– Myelodysplastic syndrome (Elevated RDW)

MCV is normal (Between 80-96):
– Chronic disease (Elevated RDW)
– Renal failure (Elevated RDW)
– Sickle cell Anemia (Elevated RDW)
– Early Vitamin B12 and iron deficiency or mixed deficiencies (Elevated RDW)

MCV is low (less than 80) in:
– Iron deficiency (Elevated RDW)
– Toxins and drugs (Normal RDW)
– Thalassemia (Normal RDW)
– Myelodysplastic Syndrome (Elevated RDW)

Sulfasalazine

Tags

anti-ccp, arava, cimzia, enbrel, humira, methotrexate, remicade, rheumatoid arthritis, rheumatoid factor, sulfasalazine, synovitis, Xeljanz

Points to remember about Sulfasalazine are:

– This is seventy year old medication.
– It was developed as a combination of an anti-inflammatory and a sulfa antibiotic to treat Rheumatoid Arthritis.
– It is the first disease modifying drug (DMARD) that was actually developed to treat Rheumatoid Arthritis.
– Enteric coated form of Sulfasalazine would minimize stomach side-effects.
– It can be used by itself or along with other DMARDs such as Methotrexate, Plaquinel.
– Periodic blood testing is needed to look for possible toxicity specifically affecting liver and Neutrophils.
– Although never approved by FDA, it is used to treat variety of inflammatory conditions including:
– Rheumatoid Arthritis
– Psoriatic Arthritis
– Spondyloarthropathy
– Ankylosing Spondylitis
– Juvenile Rheumatoid Arthritis
– Ulcerative Colitis
– It can help both bowel and joint symptoms in patients with inflammatory bowel disease who also have associated arthritis.
– It may take up to three months to see an effect.
– At times the improvement is so slow that Sulfasalazine has to be stopped to see if the patient actually becomes worse off of it. Becoming worse off of this treatment would be indication of a response and treatment with Sulfasalazine can thus be resumed.

Rheumatoid Arthritis

Tags

arava, Arthritis, biological, methotrexate

There are seven things that one should keep in mind about Rheumatoid Arthritis.

1. Early diagnosis and treatment is crucial.
2. Seeing a rheumatologist who specializes in diagnosis of rheumatoid arthritis is a must.
3. Start biological treatment between three to four months and no later than six months.
4. You can get medications free if you have no insurance and drug companies will pay your copay up to 1000 dollars per month if you have insurance.
5. Close monitoring for side-effects with blood testing is needed to avoid serious complications.
6. Start biological therapies early if you have a severe case of arthritis or have deformity.
7. Remember the morbidity and mortality of rheumatoid arthritis is similar to cancer. This means without treatment your life expectancy will be reduced by 18 years.

M Rezaian,MD

Steroids use and higher infection rates in children with juvenile arthritis

Tags

biologics, enbrel, humira, methotrexate, TNF inhibitors, uvenile idiopathic arthritis

Children with juvenile idiopathic arthritis (JIA) were shown to have higher rate of infection than those without arthritis. The higher rate of infection was associated with the use of steroids and not with the use of methotrexate or TNF inhibitors. Arthritis and Rheumatism

Tofacitinib in Rheumatoid Arthritis

Tags

arava, biologics, cimzia, enbrel, humira, methotrexate, orencia, rheumatoid arthritis, rituxan, simponi

Tofacitinib, the new rheumatoid arthritis drug, appears to be just as effective as Humira for treatment of Rheumatoid Arthritis. However, the side-effects of this treatment may limit its usefulness and these include lowering of white blood cell count, elevated cholesterol, as well as infections. This drug could still be useful in patients who have failed other biologic therapies. NEJM.