#bandemia

[irvingggggggggg]

House of Vans // Otoboke Beaver

Bandemia // Demencia Infantil | Grito Exclamación | Unperro Andaluz | Mengers

Foro Indie Rocks // Lorelle Meets The Obsolete

[archivoff]

La Nana Punk antes de tocar con Grito Exclamación en Reposición de Show que se CANCELÓ organizado por Bandemia. Colonia Obrera, CDMX. 03 de agosto 2024

[mcatmemoranda]

From Wikipedia:

Bandemia refers to an excess or increased levels of band cells (immature white blood cells) released by the bone marrow into the blood. It thus overlaps with the concept of left shift—bandemia is a principal type of left shift and many (perhaps most) clinical mentions of the latter refer to instances of this type. It is a signifier of infection (or sepsis) or inflammation.[2]Measurement of it can play a role in the approach to appendicitis.[3]

Left shift or blood shift is an increase in the number of immature cell types among the blood cells in a sample of blood. Many (perhaps most) clinical mentions of left shift refer to the white blood cell lineage, particularly neutrophil-precursor band cells,[1] thus signifying bandemia. Less commonly, left shift may also refer to a similar phenomenon in the red blood cell lineage in severe anemia, when increased reticulocytes and immature erythrocyte-precursor cells appear in the peripheral circulation.

The standard definition of a left shift is an absolute band form count greater than 7700/microL.[3] There are competing explanations for the origin of the phrase "left shift," including the left-most button arrangement of early cell sorting machines[4][5] and a 1920s publication by Josef Arneth, containing a graph in which immature neutrophils, with fewer segments, shifted the median left.[6] In the latter view, the name reflects a curve's preponderance shifting to the left on a graph of hematopoietic cellular differentiations.

It is usually noted on microscopic examination of a blood smear. This systemic effect of inflammation is most often seen in the course of an active infection and during other severe illnesses such as hypoxia and shock. Döhle bodies may also be present in the neutrophil's cytoplasm in the setting of sepsis or severe inflammatory responses.

It is believed that cytokines (including IL-1 and TNF) accelerate the release of cells from the postmitotic reserve pool in the bone marrow, leading to an increased number of immature cells.

[falcemartello]

•••

L'80% dei senatori legge come un analfabeta. "In gue gueshto momendo in gui la bandemia shta vlagellanto il nostro ba baese..."

@boni_castellane

[emcases]

Bounceback

A patient comes in with hypotension.  As you gather information, you realize he has urosepsis.  He was in the ED yesterday with urinary retention (due to prostate cancer), required a suprapubic tube by GU, and his creatinine rose from a baseline of 2.0 to 2.7.  The UA is consistent with infection and the culture has already grown gram negative rods.  He was sent home with antibiotics.  Today, his creatinine is 6.0 and he has 25% bandemia.  He appears well despite his hypotension and the BP came up after 3L of lactated ringers.  

Do you say anything to the team that discharged him the day before, and if so, what do you tell them?

[profsycamore]

Tonight’s nicknames:

Moon Jumper

Sycamore

ProfSycaMore

Arantxa

Samhain

A BOO 4 U

Bandemia

Magic

Ana Maria

[cosmicloveoftheages]

Question 1 An 18-year-old man presents with periumbilical pain, vomiting, and ab

Question 1 An 18-year-old man presents with periumbilical pain, vomiting, and ab

Question 1 An 18-year-old man presents with periumbilical pain, vomiting, and abdominal cramping over the past 48 hours. Physical examination reveals rebound tenderness and laboratory analysis shows the presence of bandemia and a total WBC of 28,000 mm3. To support the diagnosis of acute appendicitis with suspected appendiceal rupture, you consider obtaining the following abdominal imaging…

[d-e-l-i-g-h-t-e--d]

Question 1 An 18-year-old man presents with periumbilical pain, vomiting, and ab

Question 1 An 18-year-old man presents with periumbilical pain, vomiting, and ab

Question 1 An 18-year-old man presents with periumbilical pain, vomiting, and abdominal cramping over the past 48 hours. Physical examination reveals rebound tenderness and laboratory analysis shows the presence of bandemia and a total WBC of 28,000 mm3. To support the diagnosis of acute appendicitis with suspected appendiceal rupture, you consider obtaining the following abdominal imaging…

[paconline]

La Explosiva Banda de Maza FT La Original Banda El Limón De Salvador Lizárraga, Roberto Junior Y Su Bandeño, Banda Los Mazatlecos & La Banda Que Hacía Falta – Bandemia (Single 2020) http://dlvr.it/RZNdZY

[archivoff]

Sonic Emerson (Sebastian Neyra) con visuales de Paula Soto en Reposición de Show que se CANCELÓ organizado por Bandemia. Colonia Obrera, CDMX. 03 de agosto 2024

[mcatmemoranda]

In the evaluation of suspected biliary tract disease the complete blood count with differential (CBC with diff.) is most frequently utilized to assess the possibility of bacterial infection. Acute bacterial infection typically results in neutrophilic leukocytosis i.e. an increased number of white blood cells (WBC count >10,500) with an elevated percentage of neutrophils (>70%). Besides an increase in total neutrophil count, immature neutrophils, also known as bands, are often present. This is known as a "left shift" with greater than 5% bands considered abnormal.

Cholelithiasis and choledocholithiasis do not cause leukocytosis, neutrophilia, or a left shift, as there is no infection or significant inflammation present.

Acute cholecystitis is classically associated with leukocytosis, elevated neutrophil count, and a left shift. Although many texts describe leukocytosis as a requisite diagnostic finding in patients with acute cholecystitis, this is not the case. While an elevated WBC count is typical, up to 32% of patients presenting with acute cholecystitis have a normal WBC count.(1)

Patients with cholangitis nearly always exhibit leukocytosis, neutrophilia, and a left shift, as this is often a suppurative and rapidly progressive infection. The WBC count often exceeds 20,000.

In gallstone pancreatitis, WBC count may or may not be elevated and is thus not diagnostically specific, but a WBC count greater than 16,000 at presentation is one of Ranson's criteria and is established as a poor prognostic sign.

When utilizing WBC count to evaluate any patient, it is important to bear in mind that many of the most vulnerable patients including the elderly, immunocompromised, and those with overwhelming infection may be those least capable of mounting a WBC response. Thus, laboratory studies, especially WBC count and differential, are useful adjuncts in the diagnosis of biliary tract disease but must be considered in the context of information gained from the history, physical exam, and other laboratory and imaging studies.

Source: http://d3tfb844wwci5y.cloudfront.net/assets/chole/html/h05.html

[lindamcsherry]

Foot Amputated Due to Use of Invokana, Lawsuit Alleges

A Texas man alleges that his right foot was removed due to the side effects of Invokana, joining a growing number of individuals nationwide who claim that the controversial diabetes drug increased their amputation risk. 

In a complaint (PDF) filed in the U.S. District Court of New Jersey, Celso Carillo indicates that Johnson & Johnson and it’s Janssen Pharmaceuticals subsidiary introduced and sold a diabetes treatment that is unfit for human use.

Carillo was prescribed Invokana in September 2015, for the treatment of type 2 diabetes. However, a year later, in September 2016, he was hospitalized with symptoms of necrotizing fasciitis, diabetic foot infection, severe sepsis and gas gangrene in his foot. He also suffered acute kidney injury, bandemia and had a partial right foot amputation.

The lawsuit alleges that the use of Invokana resulted in having his right foot amputated in December 2016, leaving him with permanent and disfiguring injuries.

Invokana (canagliflozin) was introduced in March 2013, as the first member of a new generation of diabetes drugs, known as sodium-glucose cotransporter 2 (SGLT2) inhibitors, which works in a unique way by impacting some normal kidney functions. Other members of this class include Invokamet, Jardiance, Farxiga, Xigduo and others, but Invokana has remained the biggest seller, amid aggressive marketing.

In December 2015, the FDA required Johnson & Johnson to add new diabetic ketoacidosis warnings to Invokana, indicating that the medication increases the risk of this serious condition, which typically results in the need for emergency treatment to avoid life-threatening injury. Prior to the update, the Invokana warnings failed to alert consumers about the importance of seeking immediate medical attention if they experience symptoms like abdominal pain, fatigue, nausea, respiratory problems or vomiting.

In May 2017, the FDA required an Invokana warning update regarding the risk of leg and foot amputation, which manufacturers of other similar diabetes drugs claim is a unique risk with Invokana.

“Defendants failed to adequately warn consumers and physicians about the risks associated with Invokana and the monitoring required ensuring their patients’ safety,” the lawsuit states. “Consumers of Invokana and their physicians relied on the Defendants’ false representations and were misled as to the drug’s safety, and as a result have suffered injuries including diabetic ketoacidosis, kidney failure, sepsis, cardiovascular problems, and the life threatening complications thereof.”

Carillo’s complaint will be consolidated with other Invokana lawsuits pending in the federal court system, which are currently consolidated for pretrial proceedings before one judge in New Jersey.

Following coordinated discovery and any bellwether trials held to help gauge how juries may respond to certain evidence and testimony that is likely to be repeated throughout the litigation, if Invokana settlements or another resolution for the claims is not reached, Bottner’s case and hundreds of others may later be remanded back to U.S. District Courts nationwide for individual trial dates.

The post Foot Amputated Due to Use of Invokana, Lawsuit Alleges appeared first on AboutLawsuits.com.

[mcatmemoranda]

Buffy coat = WBCs and platelets in anticoagulated centrifuged blood.

Delivery of O2 to tissues = CO x Hbg X percent saturation (CO = Cardiac Output)

Transfusion reactions = anaphylaxis (occurs in IgA deficient pts; the first time the pt receives blood, he is sensitized to IgA; the next time the pt receives blood, he has anaphylactic reaction to IgA); hemolytic transfusion reaction (due to ABO mismatch [rarely occurs], or other antigens that don’t get screened for that cause the recipient to recognize the donated blood antigens as foreign and attack it-> fever and hemolysis); febrile transfusion reaction (due to WBCs in donor blood being recognized as foreign by recipient; causes fever a couple hours after transfusion; no hemolysis); Transfusion-Related Acute Lung Injury (TRALI; it’s ARDS induced by inflammation following transfusion; capillaries dilate-> non-cardiogenic pulmonary edema); TACO = Transfusion-Associated Circulatory Overload (the pt already has volume overload, e.g. HFrEF, and then is given several units of blood-> volume overload-> HTN and cardiogenic pulmonary edema).

If platelets are less than 10,000; if platelets are less than 50,000 and pt is bleeding; or if platelets are less than 100,000 and pt is about to have neurosurgery, then give platelets.

Clotting factors are in FFP, cryoprecipitate, or concentrated factor.

Fresh Frozen Plasma (FFP) = contains all clotting factors + vWF; given in bleeding pts with increased PT, PTT, INR

Cryoprecipitate = factors 8 and 9, vWF, fibrinogen (clotting factor 1); not used as much anymore because hemophiliacs can just get concentrated factor of the clotting factor they’re missing. Hemophilia A needs factor 8; hemophilia B needs factor 9; hemophilia C needs factor 11.

IVIG and albumin can be transfused.

If a pt has low WBCs, you can’t transfuse WBCs; you have to stimulate the pt’s bone marrow to make WBCs, using Granulocyte Colony Stimulating Factor (G-CSF)-> increased neutrophils.

CBC with differential will give you WBC count and the percentage of WBCs that are neutrophils, bands, lymphocytes, monocytes, eosinophils, and basophils. Normal: 80% neutrophils, 0% bands (if there are bands, there’s an infection), 15% lymphocytes, 5% monocytes, 0% eosinophils, 0% basophils (but in the video he said eosinophils and basophils are about 1 to 2%).

Normal WBC = 4,000 to 12,000. More than 12,000 WBCs = leukocytosis = sepsis. Less than 4,000 WBCs = leukopenia. Neutropenia = low number of neutrophils. Absolute neutrophil count less than 1,000 = neutropenia. Absolute neutrophil count = Total WBCs x percent neutrophils. If absolute neutrophil count less than 1,000, go on neutropenia precautions because increased risk of infection.

If WBCs are increased, look at the differential to find out why. Increased neutrophils without bands = inflammation, steroids.

Increased neutrophils with bandemia = bacterial infection.

Acutely ill pt with increased WBCs and lymphocytosis = viral infection; could also be cancer.

Eosinophilia = fungal or parasitic infection

Eosinophilia can be “NAACP” = Neoplasm, Asthma/Allergies/Atopy, Addison’s disease, Collagen vascular disease, Parasites.

Increased basophils = myeloproliferative diasease (CML)

Blood smear assesses for blasts; blasts = leukemia

Flow cytometry takes blood with unknown cells and tags them with fluorescent antibodies; then the cells are passed through a laser beam, which identifies the markers on the cells. T cells have single digit CD markers (CD3, CD4, CD8). B cells have double digit CD markers (CD19, CD20, CD21, CD22). Hematopoietic stem cells have CD34. Reed-Sternberg cells (B cell [Hodgkin] lymphoma) have CD15 and CD30.

PT and INR tell you the same thing; INR is an internationally standardized report of PT that’s easier to communicate. INR tells you how anticoagulated the pt is compared to a normal person. So INR of 1 is normal (1:1). A pt with an INR of 2 is two times more anticoagulated than a normal person, and so on. We were never taught this in my school and I never understood what exactly PT and INR were. They mentioned them, but didn’t explain it well.😒 It seems so simple the way Dustyn explained it.

[mcatmemoranda]

Recommended Laboratory Studies to Investigate First Trimester Vaginal Bleeding

CBC: The main utility of the CBC is for the Hemoglobin / Hematocrit. The white blood cell (WBC) count is limited in its usefulness to detect infection (and thus a septic abortion) during pregnancy because most pregnant patients have a mild leukocytosis. Nevertheless, if significantly elevated, or associated with a bandemia, this test would need to be factored into the consideration of a septic abortion.

Wet mount preparation for trichomonas, as well as PCR testing for gonorrhea and chlamydia: All sexually transmitted infections can cause vaginal bleeding. These tests should be obtained in this clinical context, despite a previously normal recent result.

Progesterone: Laboratory testing for progesterone is most useful in extreme situations. If the result is >25, it is highly associated with a sustainable intrauterine pregnancy. If the result is <5, it is highly associated with an evolving miscarriage or ectopic pregnancy. Levels between 5 and 25 have minimal diagnostic value in distinguishing intrauterine from ectopic pregnancy. Algorithms for the diagnosis of ectopic pregnancy emphasizing progesterone measurements have been associated with a higher use of surgical management and often miss ectopic pregnancy since 85% of ectopic pregnancies will have a normal progesterone level. Nevertheless, the test remains valuable because of its positive and negative predictive value at the extremes of the reference range. In many labs, it is a common and quick test, which makes it frequently ordered.

Quantitative beta-human chorionic gonadotropin (quant. beta-hcg): This test has enormous significance, and when combined with the pelvic ultrasound, they are the definitive diagnostic modalities. However, in isolation, one beta-hCG can be challenging to interpret, especially without the ultrasound results. Human chorionic gonadotropin is secreted by the trophoblastic cells very early in embryonic life (day 7, post-ovulation). Additionally, testing for the beta-subunit is exquisitely sensitive (down to 5 mIU/mL) and specific (the placenta is the only normal tissue that excretes beta-hCG). By the expected date of menses, the beta-hCG is usually > or = 100 mIU/mL.

Furthermore, in a normal pregnancy, the beta-hCG approximately doubles every 48 hours for the first 6-7 weeks of gestation. However, an intrauterine pregnancy may not be conclusively detected until the quantitative beta-hCG reaches 1500-1800. To detect an intrauterine pregnancy by transabdominal ultrasound, the beta-hCG will typically be >5000 mIU/mL. In both ectopic gestations and spontaneous abortions, hCG levels are usually lower than normal and increase at less-than-normal rates during early gestation. Molar pregnancy and multiple gestations are both associated with higher-than-normal hCG levels.