Complete blood count with Differential (CBC with DIFF): Platelets

Tags

acetaminophen, alcohol, Allergic reactions, anemia, antiphospholipid antibody syndrome, babesia, Bactrim, band neutrophils, bands, basophil, bleeding, burn, cancer, CBC, CBC with diff, CBC with differential, Cell Fragments, Chronic infections, Clumping, eosinophil, h.pylori, heart attack, hemolytic anemia, heparin, Hepatitis C, HIV, infection, inflammation, inflammatory arthritis, iron deficiency, leukemia, lithium, lupus, lymphocytes, lymphoma, malignancy, megakaryocytes, mono, monocytes, naprosyn, neutrophil, NSAIDs, Pregnancy, quinine, Sepsis, steroids, sulfa drugs, Systemic Lupus, tagamet, Trauma, TTP, vancomycin, vasculitis, Vitamin B12 deficiency

Platelets are fragments of large cells called megakaryocytes that are involved in blood clotting.

High Platelet count are seen in:
– inflammatory diseases such as vasculitis, inflammatory arthritis
– Bleeding, iron deficiency, hemolytic anemia
– Trauma, burn, heart attack
– Chronic infections
– Allergic reactions
– Lymphoma, cancer
– Medications

Low Platelet count are seen in:
– Clumping. This results in falsely low platelet count
– Medications such as quinine, heparin, sulfa drugs such as Bactrim, antibiotics such as vancomycin, acetaminophen, NSAIDs like naprosyn, tagamet, cancer drugs
– Infections such as hepatitis C, HIV, Sepsis, mono, h.pylori, babesia
– Toxic such as alcohol
– Immune related such as in Systemic Lupus, Antiphospholipid antibody syndrome, TTP,
– Vitamin Deficiency such as Vitamin B12 deficiency
– Pregnancy
– Cancer

Complete blood count with Differential (CBC with DIFF): White Blood Cells

Tags

anemia, band neutrophils, bands, basophil, cancer, CBC, CBC with diff, CBC with differential, eosinophil, infection, inflammation, leukemia, lithium, lupus, lymphocytes, lymphoma, malignancy, monocytes, neutrophil, steroids

White blood cell count is commonly ordered even though it has no value as a screening test.

White blood cells:
White blood Cells include
– Mostly Neutrophils (60-70%)
– Lymphocytes (30-40%)
– Monocytes (2-8%)
– Eosinophils (1-4%)
– Band or Immature Neutrophils (0-3%). These appear with severe infections when there is recruitment of neutrophils mature or immature in a massive scale. When there are more than 10% immature neutrophils in circulation it is called bandemia.

High White blood cells and in particular Neutrophils are seen in:
– Infections such as pneumonia
– Inflammation
– Smoking
– Medications such as steroids, lithium
– Exercise / Stress
– Leukemia/Cancer

Low White blood cells or Neutrophils are seen in:
– After infections with bacteria or viruses
– Medications such as Cancer drugs
– Immune related such as in Systemic Lupus
– Vitamin Deficiency such as Vitamin B12 deficiency
– Leukemia / Cancer

Metal-on-metal hip implants

Tags

chromium, cobalt, Diabetes, Hip replacement, immune suppression, metal ion, nickel, obesity, steroids

The seven points to remember about metal-on-metal implants:

1. There are now FDA guidelines regarding these implants.

2. MoM hip systems should not be implanted in those with kidney failure, metal sensitivity to cobalt, chromium, nickel, immune suppressed patients, those on high dose steroids, and women of childbearing age.

3. Potential risks with with metal-on-metal hip implants according to FDA include:
Infection
Loosening
Dislocation
Osteolysis
Bone or device fracture
Elevated metal ion levels in the joint and blood
Transplacental transport of metal ions
Development of local inflammatory reactions and lesions including soft tissue masses and tissue necrosis
Development of potential systemic events related to elevated metal ion levels
Revision surgery
Femoral neck fracture (for hip resurfacing)

4. Those patients at risk for problems with metal-on-metal hip implants according to FDA
include:
Patients with bilateral implants
Patients with resurfacing systems with small femoral heads (44mm or smaller)
Female patients
Patients receiving high doses of corticosteroids
Patients with evidence of renal insufficiency
Patients with suppressed immune systems
Patients with suboptimal alignment of device components
Patients with suspected metal sensitivity (e.g. cobalt, chromium, nickel)
Patients who are severely overweight
Patients with high levels of physical activity.

5. Local symptoms related to MoM implants is as a result of metal particles being released to tissue surrounding the hip implant causing pain, bone and soft tissue damage. As a result patients may develop pain or swelling at or near the hip, a change in walking ability, or a noise from the hip. Other local reaction include:
Hypersensitivity (allergic type reaction)
Loosening
Infection
Osteolysis (bone loss)
Aseptic lymphocytic vasculitis-associated lesions (ALVAL) (histologic reaction in surrounding tissue)
Soft tissue mass (fluid-filled or solid soft tissue mass around the replaced joint that is diagnosed radiologically)
Femoral neck fracture (for resurfacing systems)

6. Systemic reactions to MoM implants has to do with metal ions that were release are moving via blood stream to other organs causing systemic symptoms. These systemic symptoms include:

General hypersensitivity reaction (skin rash)
Cardiomyopathy
Neurological changes including sensory changes (auditory, or visual impairments)
Psychological status change (including depression or cognitive impairment)
Renal function impairment
Thyroid dysfunction (including neck discomfort, fatigue, weight gain or feeling cold).

7. Proper patient selection, correct placement, and implantation are most important in order to avoid problems with metal-on-metal implants.

M. Rezaian, MD