Friday, December 9, 2011

Blood Disorder: Sickle Cell Anemia

Sickle Cell anemia is not a cancer but is treated by an oncologists at a local cancer center.  The local oncologist may refer the patient to a larger facility that has physicians that are specialists in hematology disorders.

Sickle Cell anemia is not a contagious disease but is a disease of the blood caused by inherited abnormal hemoglobin. Hemoglobin is the protein found in red blood cells that help transport oxygen throughout ones body. Sickle Cell disease is when a person inherits two abnormal genes, one from each parent. A person with a single Sickle cell is a carrier and will go on to lead a very normal life. 
This abnormality causes diseased cells to change shape from round to a crescent like shape, the cells become fragile and are prone to rupture. The odd shaped Sickle cells can also clog blood vessels which may cause organ and tissue damage.
bones, lungs,

Sickle Cell Trait

People who inherit a sickle hemoglobin gene from one parent and a normal gene from the other parent have a condition called sickle cell trait. Their bodies make sickle hemoglobin and normal hemoglobin.
People who have sickle cell trait usually have few, if any, symptoms and lead normal lives. However, some people may have medical complications.
People who have sickle cell trait can pass the sickle hemoglobin gene to their children. The following image shows an example of an inheritance pattern for sickle cell trait.

Sickle Cell Symptoms

The initial symptom may be pain throughout the whole body.  This is an indication of a sickle cell crisis. This crisis may affect various organs and structures of the human body such as bones,lungs joints and abdomen.
Other symptoms include headaches,dizziness,shortness of breath,jaundice(yellow coloring of skin and whites of the eyes).  Also, the skin will appear whiter than normal.

How is Sickle Cell Diagnosed?

The initial test is a complete blood count.  The CBC includes testing of the white count,red count,hemoglobin, hematocrit, and platelet.  In Sickle Cell the hemoglobin and red count will be abnormally low.  The lab tech will be alarmed that a peripheral smear need to be made from the patient's blood specimen and viewed under the microscope. The lab tech will alert the doctor of the result and he will order more specific testing.
The test that is used for a confirming diagnosis is the hemoglobin S.

Sickle cell tests are used to detect, diagnose, and confirm sickle cell anemia (also called sickle cell disease) and to identify those who may have sickle cell trait. Sickle cell anemia is an inherited disorder that leads to the production of an abnormal hemoglobin called hemoglobin S (Hb S or Hgb S). Hemoglobin is a protein found in red blood cells (RBCs) that binds to oxygen in the lungs and carries it to tissues throughout the body.
Typically, hemoglobin A (Hb A) makes up most of the hemoglobin found in normal RBCs in adults, with small amounts of hemoglobin A2 and hemoglobin F. Before babies are born, they normally produce large amounts of hemoglobin F (Hb F), which is then slowly replaced by Hb A after birth. Mutations in the genes that code for the production of hemoglobin can lead to abnormal types of hemoglobin. Common mutations include beta thalassemia and those associated with hemoglobin variants such as Hb S, hemoglobin C (Hb C). With a normal hemoglobin gene copy from one parent and a Hb S gene copy from the other parent (heterozygous), a person is said to have sickle cell trait and be a sickle cell carrier. When a person has two Hb S gene copies (one from each parent; homozygous), then he has sickle cell anemia (disease). If he has one Hb S gene and one other abnormal gene, such as Hb C gene, then he will experience some of the same symptoms associated with sickle cell disease.
Hb S can form crystals that change the shape of the RBC from a round disc to a characteristic sickle shape. This altered shape limits the RBC's ability to flow smoothly throughout the blood vessels in the body, limits the hemoglobin's ability to transport oxygen to tissues, and decreases the RBCs' lifespan from 120 days to about 10-20 days. A person with sickle cell disease (homozygous for Hb S) can become severely anemic because the body cannot produce RBCs as fast as they are destroyed. The affected person can suffer painful episodes and a variety of complications when sickled cells become lodged in and obstruct small blood vessels.
Sickle cell tests are done to determine whether someone is producing hemoglobin S, thus carrying a sickle gene. They are ordered routinely as part of newborn screening programs and are mandated by every state in the US and the District of Columbia. If results of a newborn screen are abnormal, then one or more sickle cell tests may be ordered to confirm abnormal findings. Sickle cell tests may also be ordered along with or following an abnormal CBC and blood smear, with normal iron studies to help evaluate a patient who has an unexplained hemolytic anemia or demonstrate symptoms that suggest the presence of sickle cell anemia.

Sickle Cell Treatment

Sickle Cell patients have a low response of being cured through blood and bone marrow stem cell ,but  the  pain symptoms can be treated by medications, rest, heat pads, drinking lots of water and oxygen therapy.

Severe sickle cell anemia can be treated with a medicine called hydroxyurea. This medicine prompts your body to make fetal hemoglobin. Fetal hemoglobin, or hemoglobin F, is the type of hemoglobin that newborns have.
In people who have sickle cell anemia, fetal hemoglobin helps prevent red blood cells from sickling and improves anemia.
Given daily, hydroxyurea reduces how often painful sickle cell crises and acute chest syndrome occur. Many people taking hydroxyurea also need fewer blood transfusions and have fewer hospital visits.
Doctors are studying the long-term effects of hydroxyurea on people who have sickle cell anemia. Early studies in children suggest that the medicine may help improve growth and preserve organ function, but this has not been proven.
Hydroxyurea can reduce the number of white blood cells in your blood. (These cells help fight infections.) This can lead to an increased risk of infections.
People who take hydroxyurea must have careful medical followup, including blood tests. The dose of this medicine may need to be adjusted to reduce the risk of side effects.
A doctor who has knowledge about hydroxyurea can tell you about the risks and benefits of taking this medicine.
Clinical trials currently are under way for Sickle Cell Anemia. For more information about these studies, visit

For more information go to the following web sites:

Wednesday, December 7, 2011

Colon Cancer Stage 2 Testing News

About the Oncotype DX Colon Cancer Assay and Stage II Colon Cancer

The Oncotype DX colon cancer assay is a colon cancer test that provides an individual, numerical assessment of how likely colon cancer is to return in patients with stage II colon cancer following surgery to remove the tumor. The multigene expression assay examines the activity of specific genes within a patient´s tumor sample in order to provide individualized information to each person and their physician about the specific biological make-up of their colon cancer.
The Oncotype DX assay is appropriate for people who are newly diagnosed with stage II colon cancer and is performed on tumor tissue removed during the original surgery. Because of this, the Oncotype DX assay does not require any additional surgery or procedures in order for a patient to get the test.
For detailed information about the Oncotype DX, please call: (866) ONCOTYPE or visit

Breast Cancer and The New Test Oncotype dx Assay

Information That Can Help Define Treatment Options and Make Treatment Decisions for Breast and Colon Cancer Patients

About the Oncotype DX Breast Cancer Assay and Early Stage Breast Cancer

The Oncotype DX breast cancer assay, is a test that examines a breast cancer patient's tumor tissue at a molecular level, and gives information about a patient's individual disease. This information can help individualize breast cancer treatment planning and identify options. The Oncotype DX breast cancer test is the only multigene expression test commercially available that has clinical evidence validating its ability to predict the likelihood of chemotherapy benefit as well as recurrence in early-stage breast cancer. The Oncotype DX gene expression assay is intended to be used by women with early-stage (stage I or II), node-negative, estrogen receptor-positive (ER+) invasive breast cancer who will be treated with hormone therapy.

Oncotype DX Breast Cancer Assay Evaluation and Impacts on Breast Cancer Treatment Options

The Oncotype DX breast cancer multigene expression test has been extensively evaluated in 14 clinical studies involving more than 4,000 breast cancer patients worldwide, including a large validation study published in The New England Journal of Medicine and a chemotherapy benefit study published in the Journal of Clinical Oncology.
Oncotype DX is the only test incorporated in published ASCO® and NCCN® breast cancer treatment guidelines for patients with node-negative breast cancer that is estrogen-receptor positive and/or progesterone-receptor positive. For complete information on Oncotype DX for Patients & Caregivers, Healthcare Providers, and Managed Care Organizations, visit Oncotype
For additional information for Patients & Caregivers and detail about breast cancer treatment options, visit  You may also watch a great, informative video at the address below.

Tuesday, December 6, 2011

Chemotherapy and Lab Testing

During a patient's chemotherapy treatments routine blood draws for lab testing are important. Chemotherapy drugs can affect your blood cell counts and organs of your body .  This can be monitored through the results of the lab test that are ordered.  A Complete Blood Count is very important as to monitor low white cell counts, platelet counts, red cell counts and low hemoglobin. When a CBC is ordered before a next chemo treatment they are looking for changes in all blood counts. The nurse will look at the ANC which stand for the Absolute Neutrophil Count.

Since chemotherapy attacks the fast growing cells, the normal tissues with high growth rate suffer the major brunt of attack of the chemotherapy drugs. These include the fast growing cells of the bone marrow, oral mucus membrane and lining of the stomach and intestine. This may subsequently lead to low blood counts, mouth soars, diarrhea, and abdominal upset. White blood cells are the guardian defense system of your body, and when the white cell count decrease due to the chemotherapy; you may be at great risk of an infection. Also when your body defense system is low due to low white cell count, once you get an infection it could be overwhelming.

Physicians usually calculate the absolute neutrophil count (ANC) from your regular blood count to determine the risk of infection. ANC is calculated by multiplying the total white cell count by the percentage of neutrophils and then dividing by 100. For example if your total white cell count is 4,000 and neutrophil percentage is 50 then your ANC is 2000 x 50 divided by 100 and equals 1000. If your white cell count is 8000 but neutrophil percentage is 25 then the ANC is again 1000. If your ANC is 500 to 1000 you have slightly increased risk of getting infections. If ANC is 300 to 500 you are at moderate risk of getting infections. If the ANC is less than 300 then you are at high risk of getting infections. Infection can come from out side or from your own body (example gut).

Some other blood tests that the physician may order during cycles of chemotherapy are a Complete Metabolic Panel and a Magnesium level.
A typical CMP-16 will specifically measure the levels of Glucose, Waste Products ( Blood Urea Nitrogen, Creatinine, Uric Acid, & the Glom Filtration Rate), Electrolytes (Sodium & Potassium Chloride), Minerals (Calcium & Phosphorus), Blood Fats (Cholesterol & Triglycerides), Proteins (Albumin, Globulin, & Total Protein), Enzymes (Total Bilirubin, Alkaline Phosphatase, GGTP, LDH, & SGOT (AST)).
cThe glucose checks your pancreas function.  Blood Urea Nitrogen and creatinine levels relate to kidney function.  Protein levels are important in liver and kidney damage.  Finally bilirubin and the enzyme testing is very important in determining liver damage. Magnesium is another electrolyte.  The magnesium can be low during chemo and may cause kidney damage. 

It is vitally important that you have your pre-chemotherapy  lab testing done the day before your chemo appointment.  When you do not have the labs performed then they have to order the tests stat and then wait and hour or two to begin your infusion.  As a result, this makes your nurse behind in her infusion schedule and other patients have to wait.

If you are experience weakness, shortness of breath, bleeding or muscle pain before your next blood draw for your chemotherapy then you need to contact the oncologist.

For more information : ;

Sunday, December 4, 2011

Bone Marrow Biopsy

I wanted to educate about why a Bone Marrow is needed in diagnosing the reason of abnormal complete blood count results.  The Bone Marrow is the spongy tissue that is inside some of your larger bones such  as iliai crest which is the on the side of hip area.  Cells are produced in the bone marrow and should have normal amounts. If you have leukemia then there will be abnormal amount of cells.
In order to diagnose your medical condition the oncologist must do a Bone Marrow aspirate. Inside your bone is a fluid portion and a solid portion and this needs to be aspirated with a larger needle.

                                           Educational video of a Bone Marrow Aspirate

If your diagnosis is a blood cancer then you may have other bone marrow biopsies to see if your treatment is succeeding .  Your bone marrow will be put into several tubes and the core(bone part) will be put in formalin.
 The will perform genetic testing, flow cytometry , histology and stains.

  Complications to bone marrows are rare.  I would not take any aspirin and always make the doctor aware if you are taking any blood thinners.

Blood Disorders : Aplastic Anemia

Aplastic anemia is a condition where the bone marrow does not produce sufficient enough of new cells to replenish the blood cells in the body.

There are many circumstances why the bone marrow can shut down production of new cells.

  • Radiation and chemotherapy treatments. While these cancer-fighting therapies kill cancer cells, they can also damage healthy cells, including stem cells in bone marrow. Aplastic anemia can be a temporary side effect of these treatments.
  • Exposure to toxic chemicals. Exposure to toxic chemicals, such as some used in pesticides and insecticides, may cause aplastic anemia. Exposure to benzene — an ingredient in gasoline — also has been linked to aplastic anemia. This type of anemia sometimes gets better on its own if you avoid repeated exposure to the chemicals that caused your initial illness.
  • Use of certain drugs. Some medications, such as those used to treat rheumatoid arthritis and some antibiotics, can cause aplastic anemia.
  • Autoimmune disorders. An autoimmune disorder, in which your immune system begins attacking healthy cells, may involve stem cells in your bone marrow.
  • A viral infection. Viral infections that affect bone marrow may play a role in the development of aplastic anemia in some people. Viruses that have been linked to the development of aplastic anemia include hepatitis, Epstein-Barr, cytomegalovirus, parvovirus B19 and HIV.
  • Pregnancy. Aplastic anemia that occurs in pregnancy may be related to an autoimmune problem — your immune system may attack your bone marrow during pregnancy.
  • Unknown factors. In many cases, doctors aren't able to identify the cause of aplastic anemia. This is called idiopathic aplastic anemia.
Above is an image of Aplastic anemia bone marrow biopsy under a microscope.

How is Aplastic Anemia Diagnosed?
A complete blood count is performed and the cell counts, hemoglobin will be low.  Also a bone marrow biopsy will be performed and sent to pathology for the cytology technologists to stain and prepare to be read by the pathologist.  The report is then sent to your family doctor , specialist or oncologist.  Hematology oncologist is the doctor who should treat aplastic anemia. If you like to view a bone marrow biopsy then go tot the following website.
Reticulocyte count is another test that is ordered in the diagnosis of Aplastic anemia. It is a test that measures how fast the bone marrow is producing new red cells. The reticulocyte test will be higher in if the hemoglobin is low and the bone marrow is trying to produce more cells due to blood loss.
Erythropoietin is a blood test that measures the amount of erythropoietin, a hormone which tells the bone marrow to produce more red cells.  This hormone is made by the cells in the kidney. The kidney produces more of the EPO hormone when oxygen levels are lower.  When someone is anemic they have trouble breathing because they do not have enough red cells to carry the oxygen.

Treatment for Aplastic anemia includes blood transfusions, platelet transfusions, a stem cell transplant, immunosuppressants, bone marrow stimulants and antiviral medications.

Anytime you may feel abnormally fatigued and have shortness of breath you need to see care from a medical professional.  You need to make sure that a complete blood count is performed .; ;

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