New Findings About Breast Cancer and Obesity

In the news and talk shows there are many discussions about obesity concerning the heart, joints, and other parts of the body. A new article is reporting that obesity affects breast cancer recurrence rate. I am encouraging you to change what you eat if you are overweight.  Look for products that are low in carbs and low in fat.  Please read the follow article by Private MD Lab. It is a wake-up call for change.

For women who receive lab test results indicating they have breast cancer, the prognosis may be more favorable if they are not overweight. New research indicates that women who are overweight or obese at the time of their diagnosis may be more likely to experience a recurrence of cancer after their initial treatment.

The findings have important implications for the prevention of breast cancer deaths. The researchers said that breast cancer rates have been climbing along with obesity rates. The fact that the two phenomena may be linked suggests that encouraging healthier lifestyles may be an effective method for reducing the number of women affected by breast cancer.

For the study, researchers from the Dana-Farber Cancer Institute in Boston examined the medical records of 1,909 women treated for breast cancer between 1997 and 1998. The results showed that those who were overweight or obese were significantly more likely to experience a recurrence.

"When you consider that data from 2007 to 2008 show that 68 percent of U.S. adults aged 20 years and over were overweight or obese, as compared to only 56 percent of the same group in 1994-1998, you can see the way the problem is growing," said lead researcher Jennifer Ligibel.

http://www.privatemdlabs.com/blood-testing-news/Breast/Obesity-may-affect-breast-cancer-recurrence-rates--$800736771.php

Myeloproliferative Dimyeloproliferative disorders

Myeloproliferative disease or MPD deals with  a group of diseases of the bone marrow in which excess cells are produced.

Myeloproliferative disorders is the name for a group of conditions that cause blood cells -- platelets, white blood cells, and red blood cells -- to grow abnormally in the bone marrow. Though myeloproliferative disorders are serious, and may pose certain health risks, people with these conditions often live for many years after diagnosis. The prognosis largely depends on the type of disorder.

Myeloproliferative disorders include:

• Polycythemia vera -- occurs when the bone marrow produces too many blood cells, especially red blood cells. More than 95% of people with polycythemia vera carry the blood mutation JAK2V617F.
• Essential thrombocytosis -- occurs when the body produces too many platelet cells, which help blood to clot. Clots can block blood vessels leading to heart attack or stroke.
• Primary or idiopathic myelofibrosis, also known as myelosclerosis -- occurs when the bone marrow produces too much collagen or fibrous tissue in the bone marrow. This reduces bone marrow's ability to produce blood cells.
• Chronic myelogenous leukemia (CML) -- cancer of the bone marrow that produces abnormal granulocytes, a type of white blood cell, in the bone marrow.

Signs and Symptoms:

Many people with myeloproliferative disorders have no symptoms when their doctors first make the diagnosis. One symptom shared by all myeloproliferative disorders, with the exception of essential thrombocytosis, is an enlarged spleen. An enlarged spleen can cause abdominal pain and a feeling of fullness.

Many times, especially in the early stages, myeloproliferative disease does not have symptoms. When it does have signs, they vary from person to person. If you have symptoms, they may include:

• Headache
• Fatigue
• Shortness of breath
• Easy bruising or bleeding
• Petechiae (tiny red spots under the skin)
• Unexplained weight loss
• Night sweats
• Fever

Specific disorders in which the bone marrow produces too many cells have similar and yet different symptoms.

Some signs and symptoms of the different types of myeloproliferative disorders include:

Polycythemia vera

• Fatigue, general malaise
• Trouble breathing
• Intense itching after bathing in warm water
• Stomachaches
• Purple spots or patches on the skin
• Nosebleeds, gum or stomach bleeding, or blood in the urine
• Throbbing and burning pain in the skin, often with darkened, blotchy areas
• Headache and problems with vision
• High blood pressure
• Blockage of blood vessels. This may cause heart disease, stroke, or gangrene (tissue death) of the arms and legs.

Essential thrombocytosis

• Heart attack or stoke
• Headache
• Burning or throbbing pain, redness, and swelling of the hands and feet
• Bruising
• Gastrointestinal bleeding or blood in the urine

Primary myelofibrosis

• Fatigue, general malaise
• Trouble breathing
• Anemia
• Weight loss
• Fever and night sweats
• Abnormal bleeding

Chronic myelogenous leukemia (CML)

• Fatigue, general malaise
• Weight loss or loss of appetite
• Fever and night sweats
• Bone or joint pain
• Heart attack or stroke
• Trouble breathing
• Gastrointestinal bleeding
• Infection

Laboratory Tests

Complete blood count (CBC) and differential CBCs and differentials are the most frequently ordered tests used to help diagnose and monitor MPDs. Often ordered as part of a yearly physical exam, they are routine tests that count the number and relative proportion of each of the different types of cells in your blood stream. They give your doctor information about the size, shape, and relative maturity of the blood cells present in your blood at that moment.
CBCs and differentials can be used to detect WBC, RBC, and platelet increases, decreases, and abnormalities. They can help determine their severity, diagnose their cause, monitor the course of a disease, and monitor the response to treatment.
With polycythemia vera, increased RBCs, platelets, and sometimes WBCs, may be seen. With myelofibrosis, immature granulocytes and misshapen immature teardrop-shaped red blood cells are often seen, and WBC and RBC numbers are often decreased. With thrombocythemia, greatly increased numbers of platelets are seen along with abnormally large platelets, platelet clumps, and fragments of megakaryocytes.
Irregularities in cell counts may be due to MPDs, but they may also be due to a variety of other temporary or chronic conditions. Other testing is usually done to confirm or rule out the diagnosis of an MPD.
Bone marrow aspiration/biopsyIf a doctor suspects a bone marrow disorder, he may order a bone marrow aspiration or biopsy to collect a small sample of marrow. When a specialist (a pathologist, oncologist, or hematologist) examines the bone and fluid from the bone marrow sample under the microscope, he can see the number, size, and shape of precursor cells (blasts), red and white blood cells, and megakaryocytes (platelet precursors). He can determine the proportions of mature and immature cells, see any overgrowth of fibrous tissue, and detect any cancer cells from cancers that may have spread to the marrow. Most bone marrow disorders can be diagnosed during this examination.

ABGs (Arterial blood gases) - This test measures the amount of gases in your arterial blood and may be done when polycythemia vera is suspected. Low levels of oxygen are associated with secondary polycythemia.
Erythropoietin is a hormone that stimulates the bone marrow to produce RBCs. With primary polycythemia, erythropoietin levels will be very low or absent, but with secondary polycythemia they will be normal or high.
Genetic testing is sometimes used in suspected chronic myelogenous leukemia to check for the presence or absence of a Philadelphia (Ph') chromosome or a bcr-abl translocation (see BCR ABL) and in suspected polycythemia vera, myelofibrosis, and essential thrombocythemia for the presence or absence of JAK2 mutations, a gene associated with marrow cell production.

                                        Video of Bone Marrow Biopsy

              This video is a lecture about a very common MPD  which is polycythemia vera.  It is seen frequently in persons who live in high altitudes.

For more information then check the following websites:

http://www.umm.edu/altmed/articles/myeloproliferative-disorders-000114.htm or

http://labtestsonline.org/understanding/conditions/myelopro-disorders?start=2
                                      

Circumcision and Prostate Cancer

According to a new article published Bradenton Herald recently , support the Jews are right in promoting circumcision on male infants.

 

 NEW YORK, March 13, 2012 — /PRNewswire/ -- It's never too early to fight prostate cancer, according to new research linking male circumcision at birth and a reduced risk of prostate cancer. A recent study published in the Cancer journal shows circumcised men could be 15 percent less likely to develop prostate cancer as an adult. As New York's leading robotic prostate cancer surgeon, Dr. David Samadi, welcomes this close-to-home news in the battle against prostate cancer.

These new findings in favor of an age-old tradition seem to support what our Jewish ancestors have espoused for years – circumcision is the secret to a blessed and healthy life. The covenant of circumcision takes place when a Jewish male infant is eight days old and is intended as a visible sign of a his covenant with God.
In the U.S. today, the procedure for removing a man's foreskin is widespread  for Jews and non-Jews, alike. Often pediatricians and urologists recommend circumcision for both cosmetic and health reasons. Many men prefer the physical characteristics of a circumcised penis and it has proven to offer significant hygiene benefits, particularly in reducing risk of sexually transmitted diseases (STDs).
The medical benefit of circumcision may now extend to the prostate. In the absence of the germ-trapping foreskin, the cleaner environment of a circumcised penis may reduce the risk of infection that can cause prostate inflammation that could ultimately lead to prostate cancer. So far, the findings are observational and do not show definitive cause and effect. The 15 percent reduced risk of prostate cancer was found in men who were circumcised prior to their first sexual intercourse.
Dr. Samadi, Vice Chairman, Department of Urology, and Chief of Robotics and Minimally Invasive Surgery at The Mount Sinai Medical Center, explains these findings. "This is not to say that prostate cancer is a sexually transmitted disease; however, there is substantial evidence linking infection and certain cancers. The human papillomavirus (HPV) is a prime example of one such cancer. Other cancers of the throat, cervix, and stomach have similar origins."
Dr. Samadi reminds men of other lifelong wellness factors for decreasing risk of prostate cancer, while raising awareness about risk factors and the importance of early detection.
Exercise and weight – Obesity can increase a man's risk of prostate cancer death by 33 percent. Maintaining a healthy weight through moderate exercise helps prevent prostate cancer and better positions you to fight the disease should you ever be diagnosed.
Healthy diet – In addition to supporting a healthy weight, certain diet factors are believed to aid in prostate cancer prevention. Among them are foods rich in antioxidants like tomatoes, cruciferous vegetables such as broccoli, and green tea.
Annual PSA test – A recent European study found a 38 percent reduction in prostate cancer death through routine PSA blood screening. Dr. Samadi encourages all men to discuss risk factors with their doctor and determine the right age to begin annual PSA level monitoring, no later than age 50. A qualified physician should monitor a man's PSA velocity each year, watching for any spikes indicating the need for further testing.

Read more here: http://www.bradenton.com/2012/03/13/3936425/the-rabbi-was-right-prostate-cancer.html#storylink=cpy

 http://www.bradenton.com/2012/03/13/3936425/the-rabbi-was-right-prostate-cancer.html

Read more here: http://www.bradenton.com/2012/03/13/3936425/the-rabbi-was-right-prostate-cancer.html#storylink=cpy

Bile Duct Cancer

Bile duct cancer is also know as Cholangiocarcinoma. Your bile duct is like a slender tube that moves a fluid called bile from your liver to your small intestine. Bile duct cancer (sometimes called cholangiocarcinoma) is a cancerous (malignant) growth in the duct. Cancer of the bile duct is rare and is most prevalent in people ages 50 to 70.

Cholangiocarcinoma or bile duct cancer is a cancerous (malignant) growth in one of the ducts that carries bile from the liver to the small intestine.

isks for this condition include:

• Bile duct (choledochal) cysts
• Chronic biliary irritation
• History of infection with the parasitic worm, liver flukes
• Primary sclerosing cholangitis
• Ulcerative colitis

Cholangiocarcinoma is rare. It occurs in approximately 2 out of 100,000 people.

Symptoms

• Chills
• Clay-colored stools
• Fever
• Itching
• Loss of appetite
• Pain in the upper right abdomen that may radiate to the back
• Weight loss
• Yellowing of the skin (jaundice)

Signs and tests

Your health care provider will perform a physical exam. Tests will be done to check for a tumor or blockage in the bile duct. These may include:

• Abdominal CT scan
• Abdominal ultrasound
• CT scan-directed biopsy
• Cytology -biopsy by surgeon and tissue evaluated prepared by tech and evaluated by pathologist
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Magnetic resonance cholangiopancreatography (MRCP)
• Percutaneous transhepatic cholangiogram (PTCA)

Blood tests that may be done include:

• Liver function tests (especially alkaline phosphatase or bilirubin levels) the elevation values of these tests will alert physicians to liver disfunction.
  

Treatment

The goal is to treat the cancer and the blockage it causes. When possible, surgery to remove the tumor is the treatment of choice and may result in a cure. If the tumor is large, the entire liver may need to be removed and a liver transplant will be needed. However, often the cancer has already spread by the time it is diagnosed.
Chemotherapy or radiation may be given after surgery to decrease the risk of the cancer returning. However, the benefit of this treatment is not certain.
Endoscopic therapy with stent placement can temporarily relieve blockages in the biliary ducts and relieve jaundice in patients when the tumor cannot be removed. Laser therapy combined with light-activated chemotherapy medications is another treatment option for those with blockages of the bile duct.

                                         New Treatment for Bile Duct Cancer

                                         Overall Discussion of Bile Cancer

For more information:  http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001336/

or http://www.cancer.gov/cancertopics/types/bileduct

Upratentorial Primitive Neuroectodermal Tumors, Childhood

Supratentorial primitive neuroectodermal tumors are fast-growing tumors that form in brain cells in the cerebrum. The cerebrum is at the top of the head and is the largest part of the brain. The cerebrum controls thinking, learning, problem-solving, emotions, speech, reading, writing, and voluntary movement.
Childhood supratentorial primitive neuroectodermal tumors are also called cerebral neuroblastomas or cerebral medulloblastomas.

                                            Supratentorial primitive neuroectodermal tumors

Although cancer is rare in children, brain tumors are the most common type of childhood cancer other than leukemia and lymphoma.
This summary refers to the treatment of primary brain tumors (tumors that begin in the brain). Treatment of metastatic brain tumors, which are tumors formed by cancer cells that begin in other parts of the body and spread to the brain, is not discussed in this summary.
Brain tumors can occur in both children and adults; however, treatment for children may be different than treatment for adults. (Refer to the PDQ treatment summary on Adult Brain Tumors for more information.)
The cause of most childhood brain tumors is unknown.
The symptoms of childhood supratentorial primitive neuroectodermal tumors and pineoblastoma vary and often depend on the child’s age, where the tumor is located, and the size of the tumor.
These symptoms may be caused by a supratentorial primitive neuroectodermal tumor, a pineoblastoma, or by other conditions. A doctor should be consulted if any of the following problems occur:

• Weakness or change in sensation on one side of the body.
• Morning headache or headache that goes away after vomiting.
• Nausea and vomiting.
• Seizures.
• Unusual sleepiness or change in energy level.
• Change in personality or behavior.
• Unexplained weight loss or weight gain.
•  

Besides the normal scans that will be performed such as X-ray, CT scans and MRI's there will also be laboratory testing.

If doctors think your child may have a CNS embryonal tumor, a biopsy may be done to remove a sample of tissue. For brain tumors, the biopsy is done by removing part of the skull and using a needle to remove a sample of tissue. Sometimes, a computer-guided needle is used to remove a sample of tissue. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, the doctor may remove as much tumor as safely possible during the same surgery.
The following tests may be done on the sample of tissue that is removed:

• Immunohistochemistry study: A laboratory test in which a substance such as an antibody, dye, or radioisotope is added to a sample of cancer tissue to test for certain antigens. This type of study is used to tell the difference between different types of cancer.
• Light and electron microscopy: A laboratory test in which cells in a sample of tissue are viewed under regular and high-powered microscopes to look for certain changes in the cells.
• Cytogenetic analysis: A laboratory test in which cells in a sample of tissue are viewed under a microscope to look for certain changes in the chromosomes. 
• Lumbar puncture: A procedure used to collect cerebrospinal fluid from the spinal column. This is done by placing a needle into the spinal column. This procedure is also called an LP or spinal tap.  

 TREATMENT
The standard treatment is surgery, radiation, chemotherapy and stem cell transplant.


Below is a video of mother dealing with the trauma of her daughter who has this brain tumor.  Cancer is traumatic for anyone and their family.  Support of such individuals is very important.

For more information: http://my.clevelandclinic.org/disorders/ewings_sarcoma/hic_childhood_supratentorial_primitive_neuroectodermal_tumors_and_pineoblastoma.aspx


or http://cancer.osu.edu/patientsandvisitors/cancerinfo/cancertypes/brain/about/supratentorial/pages/index.aspx#SummarySection_1

Waldenstrom Macroglobulinemia, A Rare and Complicated Disease

WM is a rare disorder with an incidence of approximately three per million people per year with 1400 new cases diagnosed in the United States each year . The median age at diagnosis is 64 years; less than 1 percent of patients are under 40 years of age, and approximately 60 percent are males. WM is much more common in Caucasians than in other ethnic groups . Specifically, it is uncommon in Blacks and those of Mexican descent who make up approximately 5 percent of cases.
The majority of patients with the histopathologic finding of lymphoplasmacytic lymphoma (LPL) have a circulating monoclonal IgM consistent with the diagnosis of WM. In the past, LPL and WM have been arbitrarily differentiated from each other based on the level of the monoclonal IgM protein. Currently, the preferred terminology in cases of LPL with circulating monoclonal IgM is WM, rather than lymphoplasmacytic lymphoma, regardless of the size of the monoclonal IgM protein.

Waldenström macroglobulinemia, one of the malignant monoclonal gammopathies, is a chronic, indolent, lymphoproliferative disorder.It is characterized by the presence of a high level of a macroglobulin (immunoglobulin M [IgM]), elevated serum viscosity, and the presence of a lymphoplasmacytic infiltrate in the bone marrow. (See Pathophysiology, Etiology, and Workup.)
A clonal disease of B lymphocytes, Waldenström macroglobulinemia is considered to be a lymphoplasmacytic lymphoma, as defined by the Revised European American Lymphoma Classification (REAL) and World Health Organization (WHO) classification.
The clinical manifestations of Waldenström macroglobulinemia result from the presence of the IgM paraprotein and malignant lymphoplasmacytic cell infiltration of the bone marrow and other tissue sites. The clinical presentation is similar to that of multiple myeloma except that organomegaly is common in Waldenström macroglobulinemia and is uncommon in multiple myeloma and  lytic bony disease and renal disease are uncommon in Waldenström macroglobulinemia but are common in multiple myeloma. (See Pathophysiology, Presentation, and Workup.)

Complications

Complications of Waldenström macroglobulinemia include the following:

• Hyperviscosity syndrome
• Visual disturbances secondary to hyperviscosity syndrome
• Diarrhea and malabsorption secondary to gastrointestinal (GI) involvement
• Renal disease (less common)
• Amyloidosis of the heart, kidney, liver, lungs, and joints
• Bleeding manifestations secondary to platelet dysfunction and coagulation factor and fibrinogen abnormalities due to interaction with  plasma IgM
• Raynaud phenomenon secondary to cryoglobulinemia
• Increased predisposition to infection due to B-cell dysfunction (disease related) or T-cell dysfunction (therapy related, particularly after nucleoside analogues)
• Cardiac failure
• Increased incidence of lymphomas, myelodysplasia, and leukemias
•  
   
  Initially this disease may look like Multiple Myeloma, but one can see that extensive testing is required for diagnosis. Of course, a bone marrow biopsy is important so the pathologist can look for abnormalities in the bone marrow tissue.
   

  Blood counts

  The complete blood count (CBC) is a test that measures the levels of red cells, white cells, and platelets in the blood. If the lymphoma cells occupy too much of the bone marrow, these levels will be low.
  

  Quantitative immunoglobulins

  This test measures the blood levels of the different antibodies. There are several different types of antibodies in the blood: IgA, IgE, IgG, and IgM. The levels of these immunoglobulins are measured to see if any are abnormally high or low. In WM the level of IgM is high but the IgG level is often low.
  

  Electrophoresis

  The immunoglobulin produced in WM (IgM) is abnormal because it is monoclonal -- meaning that it is just many copies of the exact same antibody. Serum protein electrophoresis (SPEP) is a test that measures the total amount of immunoglobulins in the blood and finds any abnormal (monoclonal) immunoglobulin. Then, another test, such as immunofixation or immunoelectrophoresis, is used to determine the type of antibody that is abnormal (IgM or some other type). Finding a monoclonal IgM immunoglobulin in the blood is necessary to make a diagnosis of WM. The abnormal protein in WM is known by several different names, including monoclonal immunoglobulin M, IgM protein, IgM spike, IgM paraprotein, and M-spike. Other types of monoclonal immunoglobulins, like IgA or IgG, are seen in different disorders (like multiple myeloma and some lymphomas).
  Sometimes pieces of the IgM protein are excreted by the kidneys into the urine. The procedure used for finding a monoclonal immunoglobulin in the urine is called urine protein electrophoresis (UPEP).
  

  Viscosity

  Viscosity measures how thick the blood is. If the IgM level is too high, it will cause the blood to become thick (viscous) so that it can't flow freely. Think about pouring honey compared to pouring water. If the blood becomes too thick, the brain doesn't get enough blood and oxygen. This can be treated with plasmapheresis (see below).
  

  Cryocrit

  This tests the blood for a cryoglobulin (a protein that causes the blood to clump together in cool temperatures).
  

  Beta-2-microglobulin

  This is another protein produced by the malignant lymphoplasmacytoid cells. This protein itself doesn't cause any problems, but it is a useful indicator of a patient’s prognosis (outlook). High levels mean a poor outlook.
  
  WM is a rare disorder with an incidence of approximately three per million people per year with 1400 new cases diagnosed in the United States each year. The median age at diagnosis is 64 years; less than 1 percent of patients are under 40 years of age, and approximately 60 percent are males . WM is much more common in Caucasians than in other ethnic groups . Specifically, it is uncommon in Blacks and those of Mexican descent who make up approximately 5 percent of cases .
  The majority of patients with the histopathologic finding of lymphoplasmacytic lymphoma (LPL) have a circulating monoclonal IgM consistent with the diagnosis of WM. In the past, LPL and WM have been arbitrarily differentiated from each other based on the level of the monoclonal IgM protein. Currently, the preferred terminology in cases of LPL with circulating monoclonal IgM is WM, rather than lymphoplasmacytic lymphoma, regardless of the size of the monoclonal IgM protein.
  
  
  
• For more information:  www.medscape.com, www.uptodate.com, www.cancer.org
  
  
  
  
  
  
  
  
  
   
   

New Diagnostic Technology Helps Oncologists Diagnosis In Colon Cancer

Rapid molecular testing in the laboratories has greatly helped oncologists to diagnose cancers of the breast, lymphoma and leukemia.
One type of cancer that is a high-profile target for improved diagnostic testing is colon cancer. It is one of the most common malignancies in men and women. The National Cancer Institute estimates that 141,210 new cases of colon and rectal cancers will be reported and an estimated 49,380 Americans will die of these diseases this year.  Anytime time a lab presents new testing it requires financial,clinical and operational resources. Since there is a high rate of colon cancer it is important to have more accurate testing.  Past testing such occult blood and sigmoidoscopy are variable and can have false positives.  The new testing is using monoclonal and polyclonal antibodies to detect only human blood in stool, this technology has improved specificity, sensitivity, accuracy, the White Paper reported.

In conclusion, the ability of new technologies to contribute to improved performance of assays used in screening individuals for colorectal cancer demonstrate how swiftly the standard of care in laboratory medicine can be changed for the better. New generation FOB lab tests are one example of the types of changes now occurring across the entire range of testing services offered by clinical laboratories and pathology groups.

Read more: New Diagnostic Technology Creates Opportunities for Clinical Laboratories to Help Physicians with Faster, More Accurate Diagnoses | Dark Daily http://www.darkdaily.com/new-diagnostic-technology-creates-opportunities-for-clinical-laboratories-to-help-physicians-with-faster-more-accurate-diagnoses-10311#ixzz1hw54QQj0

Blood Disorder: Pernicious Anemia (Vitamin B12 Deficiency)

Pernicious Anemia is not a cancer but blood disorder.  This disorder is treated by a hematologist oncologist or a family physician.

Above an image of a patient's blood smear that has been stained showing classic pernicious anemia


Pernicious anemia is a disease that begins slowly and make take several years to realize what is happening in your body. This disease is classified as autoimmune.  The definition of autoimmune arise from an overactive immune response of the body against substances and tissues normally present in the body. In other words, the immune system mistakes some part of the body as a pathogen and attacks its own cells. This may be restricted to certain organs (e.g. in autoimmune thyroiditis) or involve a particular tissue in different places (e.g. Goodpasture's disease which may affect the basement membrane in both the lung and the kidney). The treatment of autoimmune diseases is typically with immunosuppression—medication which decreases the immune response.

Pernicious anemia is a decrease in red blood cells that occurs when the body cannot properly absorb vitamin B12 from the gastrointestinal tract. Vitamin B12 is necessary for the proper development of red blood cells.
Pernicious anemia is a type of megaloblastic anemia. Megaloblastic anemia is a blood disorder in which there is anemia with larger-than-normal red blood cells.

The body needs vitamin B12 to make red blood cells. To provide vitamin B12 to your blood cells, you need to eat enough foods containing vitamin B12, such as meat, poultry, shellfish, eggs, and dairy products.To absorb vitamin B12, your body uses a special protein called intrinsic factor, which is released by cells in the stomach. The combination of vitamin B12 bound to intrinsic factor is absorbed in the last part of the small intestine.
When the stomach does not make enough intrinsic factor, the intestine cannot properly absorb vitamin B12.
Very rarely, infants and children are born without the ability to produce enough intrinsic factor, or the ability to absorb the combination of intrinsic factor and vitamin B12 in the small intestine. Pernicious anemia that occurs at birth (congenital) is inherited. You need the defective gene from each parent to get it.
Common causes of pernicious anemia include:

• Weakened stomach lining (atrophic gastritis)
• The body's immune system attacking the cells that make intrinsic factor (autoimmunity against gastric parietal cells) or intrinsic factor itself

 RISK FACTORS

 

• Family history of the disease
• History of autoimmune endocrine disorders, including:
  
  • Addison's disease
  • Chronic thyroiditis
  • Graves disease
  • Hypoparathyroidism
  • Hypopituitarism
  • Myasthenia gravis
  • Secondary amenorrhea
  • Type 1 diabetes
  • Testicular dysfunction
  • Vitiligo
• Scandinavian or Northern European descent
  
  SYMPTOMS
  
  People with mild anemia may have no symptoms or very mild symptoms. More typical symptoms of vitamin B12 deficiency anemia include:
• Diarrhea or constipation
• Fatigue, lack of energy, or light-headedness when standing up or with exertion
• Loss of appetite
• Pale skin
• Problems concentrating
• Shortness of breath, mostly during exercise
• Swollen, red tongue or bleeding gums
• Nerve damage caused by vitamin B12 deficiency that has been present for a longer time may cause:
  
  • Confusion or change in mental status (dementia) in severe or advanced cases
  • Depression
  • Loss of balance
  • Numbness and tingling of hands and feet
    
    LAB TESTING
     1. Complete blood count which is where blood is drawn and the lab tech will process the specimen through an analyzer that will measure the blood counts which include white counts,red counts,hemoglobin,hematocrit,platelets and indices .
    2. Serum holotranscobalamin II 
            Circulating homocysteine is a risk factor of cardiovascular and cerebrovascular events.    Hyperhomocysteinemia may be an early indicator for vitamin B12 disorders because cobalamin is a cofactor in the remethylation process of homocysteine. Serum holotranscobalamin (holoTC II) becomes decreased before the development of metabolic dysfunction. In this study, we assessed circulating holoTC II to estimate the diagnosis of vitamin B12 deficiency in the first ischemic cerebrovascular attack.       

                  3. Reticulocyte Count measures the amount of red cells that are being produced from the bone 
                       marrow. 


                 4.  Schilling test is a medical investigation used for patients with vitamin B₁₂ deficiency. The                        patient is given radiolabeled B12 to drink. An intramuscular B12 injection an hour later.
                     24 hours later a urine sample is collected and is measured for B12 absorption.
                 
                5.  Methylmalonic Acid level is a blood test that is performed by gas chromotographic Mass
                     spectrometry. An elevated level may indicate a Vitamin B12 deficiency.


Treatment
 The treatment for pernicious anemia requires a monthly injection of vitamin B12 . This treatment brings great relief for the patient.  Fatigue and other symptoms are relieved.

For more information:  
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001595/

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.

stemcellresources.org

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.
Trials
Clinical trials currently are under way for Sickle Cell Anemia. For more information about these studies, visit www.clinicaltrials.gov

For more information go to the following web sites: 
http://www.nhlbi.nih.gov/health/health-topics/topics/sca/
http:// www.labstestsonline.org
http://www.healthfixdaily.com

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 :  http://www.labtestsonline.org ; http://www.medicineworld.org/cancer

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.http://youtube.com/watch?v=dTKAU34
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 .

http://www.mayoclinic.com/health/aplastic-anemia/; http://www.medline.com ; http://labsonline.com

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Hairy Cell Leukemia

Hairy Cell leukemia is a rare blood cancer.  This cancer is seen more in men that women and most often middle age to senior age adults. HCL is a slow growing leukemia and it affects the B-cells,lymphocytes, in the bone marrow.
Below is image of what HCL looks like under the microscope.

What are the symptoms of HCL?
You will notice that the white cells, lymphocytes, are larger than normal lymphocytes.  Also, notice the hair-like projections on the edge of the cytoplasm.

In hairy cell leukemia, the "hairy cells" (malignant B lymphocytes) accumulate in the bone marrow, interfering with the production of normal white blood cells, red blood cells, and platelets. Consequently, patients may develop infections related to low white blood cell count, anemia and fatigue due to a lack of red blood cells, or easy bleeding due to a low platelet count.^[12] Leukemic cells may gather in the spleen and cause it to swell; this can have the side effect of making the person feel full even when he or she has not eaten much.
Hairy cell leukemia is commonly diagnosed after a routine blood count shows unexpectedly low numbers of one or more kinds of normal blood cells, or after unexplained bruises or recurrent infections in an otherwise apparently healthy patient.
Platelet function may be somewhat impaired in HCL patients, although this does not appear to have any significant practical effect.^[13] It may result in somewhat more mild bruises than would otherwise be expected for a given platelet count or a mildly increased bleeding time for a minor cut. It is likely the result of producing slightly abnormal platelets in the overstressed bone marrow tissue.
Patients with a high tumor burden may also have somewhat reduced levels of cholesterol,^[14] especially in patients with an enlarged spleen.^[15] Cholesterol levels return to more normal values with successful treatment of HCL.

The causes of HCL has determined that persons who farm and garden may have increases risk in getting this cancers. 
The U.S. Institute of Medicine (IOM) announced "sufficient evidence" of an association between exposure to herbicides and later development of chronic B-cell leukemias and lymphomas in general.


Diagnosis for HCL involves the following lab tests.
  Acomplete blood count (CBC), but additional testing is necessary to confirm the diagnosis. A CBC normally shows low counts for white blood cells, red blood cells, and platelets in HCL patients. However, if large numbers of hairy cells in the blood streams ,then normal or high lymphocytes can be found.  Another test is viewing a slide in which a drop of blood has been smeared across the glass and then stained with a Wrights which differentiates the different types of white cells.  HCL appear as the image above.  A bone marrow aspirate is a great tool in the final diagnosis.  The bone marrow is where blood cells are made.  The bone marrow will be stained and viewed under a microscope. The diagnosis can be confirmed by using the stain known as TRAP(tartrate resistant acid phospatase).


Hairy cell leukemia is not curable, but can be easily put into remission for several years.

For more info:  mayoclinic.com/hairycellleukemia, wilkipedia.com/hairycellleukemia

Mesothelioma

Mesothelioma is a cancer that is very uncommon. Abestos is the cause for this cancer. It is a type of cancer that affects the mesothelium ,tissue lining, around different organs.  If it is found in the lungs then it is called pleural mesothelioma.  Peritoneal mesothelioma refers to the abdomen or stomach.  Finally, pericardium mesothelioma refers to the lining around the heart.

A physician needs to determine what is causing the abnormal symptoms one is experiencing in order to give a correct diagnosis. They must obtain a tissue sample for a pathologist to view.  To obtain a tissue sample a physician may do a needle aspiration or surgically remove tissue from the organs.

After visual inspection, the biopsy is processed and inserted into a mold with hot paraffin wax. When this wax cools, the specimen is locked in place and protected from contamination. Thin slices of this wax are then cut and placed under a microscope for inspection. To improve visibility of the cell tissue, various types of dye may be applied.
After this preparation process is completed, the histologist views the specimen with the help of a microscope. The histologist will be looking for unique characteristics of cancer cells in order to verify a cancer diagnosis. Different types of cancer exhibit unique cellular characteristics that usually allow for diagnosis of an exact cancer type.
So how does the histologist and pathologist determine the difference between sarcomatoid  and epithileal mesothelioma cell?  They use a immunochemical stain that take advantage of the antibody/antigen binding properties to alter the color of the cell in which binding occurs.

If you have any of the following symptoms and know that you have been exposed to abestos then you need to be seen as soon as possible.  They symptoms are difficulty breathing, chest pain, cough, weight loss and fever.