Anemia severe

A similar classification scheme is used to gauge the severity of active CD.2 Patients with mild to moderate CD are typically ambulatory and have no evidence of dehydration, systemic toxicity, loss of body weight, or abdominal tenderness, mass, or obstruction. Moderate to severe disease is considered in patients who fail to respond to treatment for mild to moderate disease, or those with fever, weight loss, abdominal pain or tenderness, vomiting, intestinal obstruction, or significant anemia. Severe to fulminant CD is classified as the presence of persistent symptoms or evidence of systemic toxicity despite outpatient corticosteroid treatment, or presence of cachexia, rebound tenderness, intestinal obstruction, or abscess. 

Other diseases Autoimmune diseases Amyloidosis Aplastic anemia Paroxysmal nocturnal hemoglobinuria Fanconi s anemia Thalassemia major Sickle cell anemia Severe combined immunodeficiency Inborn errors of metabolism... 

Hematoiogic effects Severe leukopenia or thrombocytopenia, macrocytic anemia, severe bone marrow depression, and selective erythrocyte aplasia may occur in patients on azathioprine. Hematologic toxicities are dose-related, may occur late in the... 

As techniques for structure determination by X-ray diffraction i evolved, molecules of even greater complexity could be studied. Two ilDolecules of special biological interest were penicillin, the important ntibiotic discovered by Alexander Fleming, and vitamin B12, used tin the treatment of pernicious anemia. Several possible structures had kbeen proposed for penicillin, but the / -lactam structure was considered wmlikely by Robert Robinson and John Cornforth from the point of view... 

Characteristic lesions of vitamin E deficiency in animals include necrotizing myopathy (inaccurately referred to as nutritional muscular dystrophy), exudative diathesis, nutritional encephalomalacia, irreversible degeneration of testicular tissue, fetal death and resorption, hepatic necrosis, and anemia. Several of these conditions are directly related to peroxidation of unsaturated lipids in the absence of vitamin E, and others can be prevented by synthetic antioxidants or vitamin E. 

Pyridoxal phosphate (PLP) is the coenzyme required by enzymes that catalyze certain transformations of amino acids. The coenzyme is derived from pyridoxine, the vitamin known as vitamin Bg. The name pyridoxa/ indicates that the coenzyme is a pyridine aldehyde. A deficiency in vitamin Bg causes anemia severe deficiencies can cause seizures and death. 

Chronic iodine deficiency favors subciinicai hypothyroidism where, in the presence of anemia, severity increases, more so if anemia is paraiieied by goiter. 

The marketed products are formulated as a sterile, colorless, preservative-free liquid for intravenous or subcutaneous administration. The vial should not be shaken, or the glycoprotein may become denatured, rendering it inactive. Epoetin alpha is indicated for the treatment of various anemias. Several of the conditions are listed in Table 6.4. Epoetin alpha represents a major scientific advance in the treatment of patients with chronic renal failure, serving as a replacement therapy for inadequate production of endogenous EPO by failing kidneys. Epoetin alpha may decrease the need for infusions in dialysis patients. By several mechanisms related to elevating the erythroid progenitor cell pool, epoetin alpha increases the production of red blood cells. 

Signs and symptoms noted by these ancient writers, when translated to current toxicological and epidemiological nomenclature, included central and peripheral nervous system (PNS) motor and sensory injury, manifest hemato-toxicity as frank anemia, severe gastrointestinal effects (earliest references to lead colic ), and in later centuries, saturnine gout attending lead nephrotoxicity. 

Not surprisingly, lead levels like these made many people sick and resulted in multiple adult deaths. Of the 404 cases of water-related lead poisoning documented by Bacup s health officer, 21 suffered from wristdrop 197 from headaches a few from spastic paralysis 206 from abdominal colic 148 from anemia several from insomnia and 339 exhibited the blue gum line. In 71 cases there was no patellar tendon reflex —that is, no knee-jerk in response to stimulation. Vision problems were not uncommon, including three cases of temporary blindness that lasted from a few minutes to a few days. Vertigo was also not uncommon while a sense of heat and burning in the soles of the feet was rare but not unheard of. In nearly every case the perspiration was lessened. In 148 cases, obstinate constipation was present and the faeces were hard and dry, and showed deficiency of bile. A forerunner of saturnine nephritis, albuminuria occurred in many individuals. Shooting pains in the hands, arms, back, and legs were very common, and usually mistaken for muscular rheumatism. ... 

Hemolytic anemia—Several types of anemias are characterized by an overly rapid breakdown of red blood cells, which may be caused by genetic, nutritional, and/or toxic factors. Administration of extra iron or blood transfusions to people with these disorders may be dangerous because the iron which is released during the destruction of red cells may accumulate in various tissues where it may cause damage. 

Other agents are also used for the treatment of manic-depressive disorders based on preliminary clinical results (177). The antiepileptic carbamazepine [298-46-4] has been reported in some clinical studies to be therapeutically beneficial in mild-to-moderate manic depression. Carbamazepine treatment is used especially in bipolar patients intolerant to lithium or nonresponders. A majority of Hthium-resistant, rapidly cycling manic-depressive patients were reported in one study to improve on carbamazepine (178). Carbamazepine blocks noradrenaline reuptake and inhibits noradrenaline exocytosis. The main adverse events are those found commonly with antiepileptics, ie, vigilance problems, nystagmus, ataxia, and anemia, in addition to nausea, diarrhea, or constipation. Carbamazepine can be used in combination with lithium. Several clinical studies report that the calcium channel blocker verapamil [52-53-9] registered for angina pectoris and supraventricular arrhythmias, may also be effective in the treatment of acute mania. Its use as a mood stabilizer may be unrelated to its calcium-blocking properties. Verapamil also decreases the activity of several neurotransmitters. Severe manic depression is often treated with antipsychotics or benzodiazepine anxiolytics. 

Fohc acid is a precursor of several important enzyme cofactors required for the synthesis of nucleic acids (qv) and the metaboHsm of certain amino acids. Fohc acid deficiency results in an inabiUty to produce deoxyribonucleic acid (DNA), ribonucleic acid (RNA), and certain proteins (qv). Megaloblastic anemia is a common symptom of folate deficiency owing to rapid red blood cell turnover and the high metaboHc requirement of hematopoietic tissue. One of the clinical signs of acute folate deficiency includes a red and painhil tongue. Vitamin B 2 folate share a common metaboHc pathway, the methionine synthase reaction. Therefore a differential diagnosis is required to measure foHc acid deficiency because both foHc acid and vitamin B 2 deficiency cause... 

Methyldopa is effective in mild, moderate, and severe hypertension but a thiazide-type diuretic is needed to overcome the fluid retaining side effect. Methyldopa has been shown to prevent and induce regression of ventricular hypertrophy in hypertensive patients. The principal side effects are sedation, drowsiness, nasal congestion, fluid retention, and in rare occasions, hemolytic anemia. 

Several nonoccupational health problems have been traced to cobalt compounds. Cobalt compounds were used as foam stabilizers in many breweries throughout the world in the mid to late 1960s, and over 100 cases of cardiomyopathy, several followed by death, occurred in heavy beer drinkers (38,39). Those affected consumed as much as 6 L/d of beer (qv) and chronic alcoholism and poor diet may well have contributed to this disease. Some patients treated with cobalt(II) chloride for anemia have developed goiters and polycythemia (40). The impact of cobalt on the thyroid gland and blood has been observed (41). 

As regards toxicity, pyrazole itself induced hyperplasia of the thyroid, hepatomegaly, atrophy of the testis, anemia and bone marrow depression in rats and mice (72E1198). The 4-methyl derivative is well tolerated and may be more useful than pyrazole for pharmacological and metabolic studies of inhibition of ethanol metabolism. It has been shown (79MI40404) that administration of pyrazole or ethanol to rats had only moderate effects on the liver, but combined treatment resulted in severe hepatotoxic effects with liver necrosis. The fact that pyrazole strongly intensified the toxic effects of ethanol is due to inhibition of the enzymes involved in alcohol oxidation (Section 4.04.4.1.1). 

Toxic Effects on the Blood-Forming Tissues Reduced formation of erythrocytes and other elements of blood is an indication of damage to the bone marrow. Chemical compounds toxic to the bone marrow may cause pancytopenia, in which the levels of all elements of blood are reduced. Ionizing radiation, benzene, lindane, chlordane, arsenic, chloramphenicol, trinitrotoluene, gold salts, and phenylbutazone all induce pancytopenia. If the damage to the bone marrow is so severe that the production of blood elements is totally inhibited, the disease state is termed aplastic anemia. In the occupational environment, high concentrations of benzene can cause aplastic anemia. 

Usual dose schedules of streptozotocin involve 500 mg/m2 i.v. during five consecutive days. The major toxicity is renal tubular damage. Treatment of metastatic insulinomas may result in the release of insulin from the tumor and subsequent hypoglycemic coma. Less severe toxicities include diarrhea, anemia, and mild alterations in glucose tolerance or liver function tests. 

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