Manual on meat inspection for developing countries
Aplastic Anaemia Causes Your Blood Cell Production To Go Down
It is a very sad time for my family. My husband was experiencing dizzy spells and tiredness. He went to a GP (general practitioner), who was concerned at his low red blood cell count and referred him to a specialist. At first, he was thought to be having leukaemia. But he was finally diagnosed as having aplastic anaemia. What is this disease?
Aplastic anaemia is a rare blood disease.
In the past, it used to be confused with leukaemia, but it is actually a separate disorder.
It occurs when your bone marrow cannot make enough blood cells and platelets.
It is rare, occurring in only one or two people out of a million, but it is very dangerous.
Where is my bone marrow?
Your bone marrow is the soft, gelatinous tissue that fills the central cavities inside your bones.
There are two types of bone marrow: red and yellow.
Red bone marrow contains myeloid tissue, which are made of blood-forming stem cells.
These cells produce your different blood cells and platelets.
Another term for them is haematopoietic (blood-producing) stem cells.
Yellow bone marrow contains mesenchymal stem cells, which produce your fat, cartilage and bone.
Both types of bone marrow are filled with fibrous tissue and blood vessels.
Stem cells are immature cells that can turn into many different types of cells.
Think of them as factory components that can be shaped into different things.
Yellow bone marrow is located in the most central part of your bone cavity, and is surrounded by a layer of your red bone marrow.
The whole thing looks like a sponge network.
How does my bone marrow function?
Your red bone marrow produces all your red blood cells and platelets, and around 60 to 70% of your white blood cells known as lymphocytes.
The bone marrow can also release immature lymphocytes to become fully matured in other organs, such as your spleen and lymph nodes.
Your red bone marrow also helps get rid of your old red blood cells, together with your liver and spleen.
Your yellow bone marrow acts as a store for fats.
The surprising thing about yellow bone marrow is that it can change into red bone marrow if your body really needs more blood cells, e.G. If you have severe blood loss in an accident, or if you have a fever and your body needs white blood cells to fight an infection.
The haematopoietic stem cells in your red bone marrow give rise to:
These cells transport oxygen throughout your body.
They last about only four months, which is why your bone marrow has to constantly produce more to replace the ones that can no longer function.
These cells fight infection.
There are various different types of white blood cells, such as lymphocytes and granulocytes, which include like neutrophils, monocytes, eosinophils and basophils.
They all form a team to fight different types of infection.
Think of them as a strike force with different skill sets.
These help with to clot your blood if you get an injury and bleed.
As mentioned earlier, the mesenchymal stem cells in your yellow bone marrow can differentiate into cells that form your bone, cartilage, fat tissue and fibres.
What happens when you get aplastic anaemia?
In this condition, your bone marrow simply cannot make enough blood cells.
It can happen suddenly, or it can be more insidious.
It usually occurs in fairly young people aged 15 to 25.
It can also happen to people aged 60 and above.
But why would my bone marrow suddenly stop producing blood cells?
There are many conditions that can suddenly affect your bone marrow and cause it to fail.
It usually happens when your own immune system attacks your bone marrow so that it cannot make stem cells.
Scarily amazing, isn't it?
The products of the factory (the white blood cells) can suddenly turn around and attack the factory!
Conditions that can cause an attack on your bone marrow include:
It doesn't mean that if you are pregnant or have any of these conditions that you will 100% get aplastic anaemia, but your risk will definitely be higher.
How will I know if I have aplastic anaemia?
The symptoms will be those produced by having a lack of red blood cells, white blood cells and platelets.
The symptoms develop slowly most of the time, but for some people, it can be very fast.
Lack of red blood cells can give rise to being fatigued all the time, as well as pallor, dizziness and headache.
Lack of white blood cells to fight infections can give rise to frequent viral infections that last longer than usual.
Lack of platelets can give rise to easy bruising as the blood doesn't clot quickly under the skin.
These are also the symptoms of leukaemia, which is why doctors usually run tests to rule out this condition as well.
Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, email starhealth@thestar.Com.My. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
Differences In Disease Activity By Onset-Age In People With Systemic Lupus Erythematosus
In a new study, people with systemic lupus erythematosus (SLE) who developed the disease later in life exhibited notable clinical differences and lower disease activity, however they also have the lowest survival rate.
A group of 845 people with SLE were studied for up to 45 years. The group was divided into four sub-groups according to age at diagnosis: juvenile SLE (≤18 years); adult SLE (18-49 years); late SLE (50-59 years); and very late SLE (≥60 years). The researchers also noted clinical differences according to age at diagnosis. For people diagnosed at a very late age with SLE they found:
While very uncommon, the researchers suggest SLE should not be excluded as a possible diagnosis in the elderly. Learn more about diagnosing lupus.
Read the study
What It's Like To Live With Neurologic Lyme Disease: A Patient Perspective
Lyme Disease Awareness Month runs throughout the month of May. It is a month that helps increase awareness and improve efforts on how to reduce the burden of the disease for patients. Approximately 15% of patients with Lyme disease will develop Lyme neuroborreliosis, or neurologic Lyme disease,1 which is an infectious disease that affects the central nervous system (CNS). It can be challenging for patients with neurologic Lyme disease to be diagnosed, especially if they do not present with typical symptoms.
For Maria Arini Lopez, it took her almost 2 years to be accurately diagnosed with neurologic Lyme disease. Looking back, Lopez considers herself one of the more fortunate patients, as she recalls learning that it can take more than 2 years to receive an official Lyme disease diagnosis. Lopez, who lives in central Maryland, shared that her COVID-19 pandemic hobby — gardening — was most likely the culprit of her infection in the spring of 2021.
She did not experience any of the tell-tale signs of Lyme disease, which includes the "erythema migrans" rash – often characterized by its "bull's eye" appearance. Lopez admits that her unusual symptoms made it challenging for clinicians to diagnose her with Lyme disease. This led to her extraordinarily complicated diagnostic journey.
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If patients present with inexplicable or atypical symptoms and happen to live in a Lyme-endemic region, testing for Lyme infection may be well worth the effort.
To better understand what it's like to live with neurologic Lyme disease and how clinicians can improve diagnosis and alleviate disease burden for patients, Lopez recounts her experience from her gradual onset of symptoms to receiving an official diagnosis and how the disease has impacted her daily life.
Take us through your experience of being diagnosed with neurologic Lyme disease. What did your clinicians do well? Did you have any poor experiences?Lopez: I had dramatically varied experiences with 8 different clinicians, including a primary care physician (PCP), optometrist, dentist, otolaryngologist, urogynecologist, rheumatologist, neurologist, and an integrative medicine physician.
I first saw my PCP in early July 2021 for an annual physical and full workup. I expressed feeling concerned that something was just not right. I was having trouble sleeping and felt depressed. I was also a lot more fatigued than usual.
The PCP dismissed my basic labs (complete blood count, metabolic panel, and urinalysis) as 'normal,' and told me that I was 'doing okay,' despite my communicating that I was struggling. My PCP confirmed that I had a urinary tract infection (UTI), another urgent care provider gave me antibiotics, and I was sent on my way.
My eyes and mouth became very dry, to such a degree that I began to think it might be Sjogren syndrome or some other autoimmune disease. Several years ago, I had been diagnosed with dry eye and had been faithfully following the dry eye regimen recommended by my optometrist, but it was no longer effective. I had the lowest grade for the dry eye testing thanks to the regimen I was prescribed. Now, I had confirmed grade 3 staining, despite following the same regimen. Based on all my symptoms, she agreed that something systemic was going on and that further testing was now necessary.
When I went to my dentist for my biannual cleaning, I told her about the abnormal sensations, or lack thereof in my lips and tongue, as well as the strange itching in my ears, and she acknowledged my suspicion that I might have Sjogren syndrome. She stated that compared with other patients she knew who had Sjogren syndrome, I had more saliva in my mouth, so she did not think it was the likely culprit, but that it might be worth ruling out. She highly recommended that I see an ear, nose, and throat (ENT) doctor.
The ENT doctor who I saw was extremely thorough. She ordered brain magnetic resonance imaging (MRI) to check for anything that may have been affecting the cranial nerves. Although the MRI was negative, it still ruled out certain outcomes. She also diagnosed me with ear eczema and prescribed a steroid cream and steroid ear drops for both ears. These medications helped immensely with the itching and flaking; however, they did not resolve the underlying discomfort, occasional sharp pain, and lack of flexibility in the cartilage of my right ear.
The ENT recommended I see a rheumatologist to completely rule out Sjogren syndrome and other potential autoimmune conditions, such as multiple sclerosis (MS). The rheumatologist was wonderful! She listened carefully to my medical history and immediately ran a series of more in-depth serological tests for a variety of autoimmune and rheumatic conditions that could possibly explain my symptoms. All of these tests, however, were negative.
What were some notable symptoms you were experiencing throughout your diagnostic journey?Lopez: Cognitive deficits became apparent, including short-term memory loss, severe brain fog and lack of clarity when thinking, slower processing speeds, and impaired executive function. What used to take me 30 minutes to complete now took hours. I no longer worked as a physical therapist, and symptoms were severely impacting my daily function and work as a freelance medical writer.
Other notable symptoms included daily headaches, neck stiffness, intermittent dizziness and vertigo, severe fatigue and flu-like symptoms, mood disturbances, and whole-body flushing similar to hot flashes that would last up to 30 minutes or longer. My right knee joint began to feel swollen and arthritic. As a manual physical therapist, I had worked for a decade in outpatient orthopedic settings with individuals with knee osteoarthritis and rheumatoid arthritis, so I knew what an arthritic knee felt like to the touch.
I finally turned to a neurologist. After listening to the timeline of my symptoms, he thought of 2 potential explanations. I either had a vitamin B12 deficiency that was contributing to what he called "subacute combined degeneration of the spinal cord," or there was something of a systemic and infectious nature, possibly viral, that was impacting my neurologic function. He prescribed sublingual B12 along with folic acid and B2 supplementation for 3 months to see if my neurologic symptoms improved. If not, he would investigate possibility that it was an infectious disease.
What happened at the 3-month mark?Lopez: After 3 months, the supplements had not improved my symptoms, and my health continued to deteriorate. I was preparing to undergo a lip biopsy in January 2022 to see if Sjogren syndrome was the answer. The ENT doctor mentioned that sometimes blood tests did not always effectively rule out Sjogren syndrome, but that a biopsy would be a definitive next step in the diagnostic process.
I read a story about a patient's experience with an integrative medicine doctor in Northern Virginia. I knew in my gut that I needed to schedule an evaluation with this doctor, or someone else at his practice. On the day I was scheduled for my lip biopsy, I cancelled my appointment and scheduled a virtual telemedicine visit with the integrative medicine specialist. By this time, I was fatigued to the point that traveling any distance took maximal effort.
After listening to my lengthy story, which I had now told upwards of 8 times, the integrative medicine doctor wrote a referral for me to undergo 52 blood tests, including a genetic test called GENIE, as well as the line blot serum tests for Lyme disease. On February 9, 2022, I finally found out that I had an active Lyme infection with Borrelia burgdorferi.
According to LabCorp, diagnosis of Lyme disease using Western blot testing requires positivity of 1 of the following 2 patterns:
My results indicated an IgM-positive pattern, reading:
Although it may have provided more detailed information to definitively confirm a Lyme neuroborreliosis diagnosis, I never underwent cerebrospinal fluid (CSF) analysis, which experts recommend in addition to serological testing.1,2
What did your clinician do well during your original diagnosis?Lopez: The integrative medicine specialist immediately started me on oral doxycycline. He provided me with extensive background information on the Herxheimer response, preparing me for the possibility that I may feel worse before I felt better. He also prescribed a substantial number of oral supplements to help my body better cope with the die-off and detoxification process. I received an email with a detailed explanation as to each supplement's purpose and how I was to take them.
After 4 months of treatment with antibiotics and supplements, the Lyme bloodwork was now negative, with only one band (Borrelia burgdorferi 41kD Ab.IgG) showing up as positive.
Fast forward to April 2024, although I completed a successful antibiotic, my sensory paresthesia throughout my body began to worsen again. I underwent additional neurologic testing, including nerve conduction velocity and electromyography testing for upper and lower extremities, a brain MRI without contrast, and complete spinal MRIs with and without contrast.
According to my neurologist, although my large nerve fiber axons seemed mostly intact, Lyme infection has the potential to trigger onset of small fiber neuropathy, contributing to my chronic, widespread skin sensory disturbances as well as several autonomic signs and symptoms, including:
These symptoms can flare up again during an acute viral or bacterial infection. A skin biopsy will be necessary to confirm the diagnosis of small fiber neuropathy. Regardless of the final diagnosis, I learned that Lyme disease can affect not only the CNS, but the peripheral nervous system too.
What do you want clinicians to take away from your experience with neurologic Lyme disease?Lopez: Active listening to the whole story in its entirety is critical and medical gaslighting happens, even to other health care providers, and it is unacceptable. Our symptoms and stories are valid, and they should not only be believed, but taken seriously to avoid potentially permanent neurologic deficits.
It is understandable that health care providers can be limited by their scope of practice or area of specialization, but they should never be limited in terms of referring their patients to a specialist or provider who they think might be able to find answers and provide solutions. These recommendations often lead the patient in the right direction and at the very least do not leave them hanging without answers or effective treatment. Continuity of care matters.
Also, not every patient will present with a history of a tick bite or an erythema migrans rash. These patients may experience progression of concerning symptoms that can mimic other conditions, complicating accurate diagnosis and enabling an acute, early-stage Lyme infection to transition into a chronic, late-stage infection that pervades multiple body systems, including the central nervous system, joints (especially the knees), and heart.
If patients present with inexplicable or atypical symptoms and happen to live in a Lyme-endemic region, testing for Lyme infection may be well worth the effort.
Thank you to all the health care providers that listen, believe, and actively seek answers without giving up. You give patients like me hope for a better future.
Editor's Note: This interview was edited for clarity and length.
This is the second article in a 2-part series on Lyme disease. The first article Lyme Neuroborreliosis: Expert Shares Key Insights on Diagnosis, Treatmentis available here.
This article originally appeared on Neurology Advisor
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