ABSTRACT
BACKGROUND: Pica is common in pregnancy and is often felt to be benign. The following case of severe pica presenting without anemia is unusual in its presentation, laboratory findings, and treatment. CASE: A 31-year-old multiparous woman at 37 0/7 weeks of gestation presented with esophagitis and gastritis secondary to laundry detergent consumption. She had borderline anemia (hemoglobin of 11 g/dL and hematocrit of 37%, mean corpuscular volume 80%) but was severely iron-deficient (serum ferritin 7 micrograms/dL). Parenteral iron infusion was associated with dramatic resolution of her cravings within 36 hours of treatment. CONCLUSION: Pica may be related to deficient iron stores in the absence of anemia and can result in serious morbidity. Parenteral iron may be associated with rapid pica resolution in symptomatic pregnant patients.
Subject(s)
Anemia, Iron-Deficiency , Chemically-Induced Disorders , Iron , Pica , Pregnancy Complications , Adult , Anemia, Iron-Deficiency/diagnosis , Anemia, Iron-Deficiency/physiopathology , Anemia, Iron-Deficiency/therapy , Chemically-Induced Disorders/diagnosis , Chemically-Induced Disorders/etiology , Chemically-Induced Disorders/physiopathology , Chemically-Induced Disorders/therapy , Detergents/toxicity , Esophagitis/chemically induced , Esophagitis/diagnosis , Female , Gastritis/chemically induced , Gastritis/diagnosis , Humans , Iron/administration & dosage , Iron Deficiencies , Noxae/toxicity , Pica/diagnosis , Pica/etiology , Pica/physiopathology , Pica/therapy , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/physiopathology , Pregnancy Complications/therapy , Trace Elements/administration & dosage , Trace Elements/deficiency , Treatment OutcomeABSTRACT
Drug-induced immune hemolytic anemia is considered to be rare but is likely underrecognized. The consulting pathologist plays a critical role in integrating serologic findings with the clinical history, as drug-induced antibodies should be distinguished as either drug-dependent or drug-independent for appropriate clinical management. Drug-dependent antibodies (DDABs) are most commonly associated with cefotetan, ceftriaxone, and piperacillin, whereas fludarabine, methyldopa, ß-lactamase inhibitors, and platinum-based chemotherapeutics are frequent causes of drug-independent antibodies (DIABs). DDABs usually demonstrate a positive direct antiglobulin test and a negative elution, while DIABs are serologically indistinguishable from warm autoantibodies and are similarly steroid-responsive. Drug cessation is always recommended.
Subject(s)
Anemia, Hemolytic, Autoimmune/chemically induced , Anemia, Hemolytic, Autoimmune/immunology , Autoantibodies/immunology , Anti-Bacterial Agents/adverse effects , Cephalosporins/adverse effects , HumansABSTRACT
We recently found positive correlations between human general intelligence and three key indices of semen quality, and hypothesized that these correlations arise through a phenotype-wide 'general fitness factor' reflecting overall mutation load. In this addendum we consider some of the biochemical pathways that may act as targets for pleiotropic mutations that disrupt both neuron function and sperm function in parallel. We focus especially on the inter-related roles of polyunsaturated fatty acids, exocytosis and receptor signaling.
ABSTRACT
The following abstracts are compiled from Check Sample exercises published in 2008. These peer-reviewed case studies assist laboratory professionals with continuing medical education and are developed in the areas of clinical chemistry, cytopathology, forensic pathology, hematology, microbiology, surgical pathology, and transfusion medicine. Abstracts for all exercises published in the program will appear annually in AJCP.
