Anemia

Definition- Male<13, Female<12

Reticulocyte production index= (Ret.count) x (Hct/45) x (1/maturation correction), <2% indicate bone marrow problem

MCV= (Hct x 10)/RBC count

RI<2%

1.WBC/PLT decreased→ infection, drug, renal disease, splenomegaly, leukemia, aplastic anemia

2.WBC/PLT normal→ infection, drug, renal disease, Diamond-Blackfan anemia, hypoplastic anemia


1.Microcytic(MCV<80) IDA,thalassemia, chronic inflammation, sideroblastic, lead intoxication, copper/zinc deficiency

2.Normocytic(MCV 80~100)- bone marrow suppression, CRF, hypopituitarism, hypothyroidism, acute blood loss, chronic inflammation, IDA(early), pure red cell aplasia

3.Macrocytic(MCV>100)- ethanol, AML, reticulocytosis, MDS, liver disease, hypothyroidism, AZT, Lesch-Nyhan syndrome


Mucormycosis and Fungus

Common cause- Rhizopus(in moldy bread), spores are deposited at nasal, lung, GI, skin

Presentation- Severe facial sinuses infection→  may extend to brain

Iron study- High ferritin, low TIBC

Treatment- Liposomal form of amphotericin B(nephrotoxicity), Isavuconazole( QTc shortening), Posaconazole


1.Rhinocerebral disease

Risk factor- DKA, neutropenia

Presentation- Retro-orbital headache, invasion of the CN V and VII , Loss of vision can occur with retinal artery thrombosis, Brain involvement(conscious change)

CT- Mucosal thickening, air-fluid levels, and/or bony erosions

2.Pulmonary

Risk factor- Hematologic malignancies and a history of neutropenia

Presentation- Concurrent sinus involvement, fever

CT- Reverse halo sign (ground-glass opacity surronded by consolidation) 

3.Cutaneous

Risk factor- Previous trauma, contaminated bandage, injection sites

Presentation- Like cellulitis, black eschar formation

4.GI

Risk factor- Malnutrition, transplant, iron overload(deferoxamine therapy), trauma, burns, intravenous drug 

5.Disseminated- Kidneys, bones, heart

6.CNS involvement

Risk factor- Open head trauma, intravenous drug use, or malignancy

CT- Cavernous and, less commonly, sagittal sinus thrombosis


Treatment