Pathology discussion forum

HbS polymerizes reversibly when deoxygenated to form a gelatinous network of fibrous polymers that stiffen the RBC membrane, increase viscosity, and cause dehydration due to potassium leakage and calcium influx. These changes also produce the sickle shape. Sickled cells lose the pliability needed to traverse small capillaries. They possess altered “sticky” membranes that are abnormally adherent to the endothelium of small venules. These abnormalities provoke unpredictable episodes of microvascular vasoocclusion and premature RBC destruction (hemolytic anemia) in the liver and spleen. The rigid adherent cells also clog small capillaries and venules, causing tissue ischemia, acute pain, and gradual end- organ damage. This venoocclusive component usually dominates the clinical course. Prominent manifestations include episodes of ischemic pain (i.e., painful crises) and ischemic malfunction or frank infarction in the spleen, central nervous system, bones, joints, liver, kidneys etc

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Transfusion therapy is reserved for individuals who have symptoms of anemia, cardiovascular instability, and continued and excessive blood loss from whatever source and who require immediate inter-vention. The management of these patients is less related to the iron deficiency than it is to the consequences of the severe anemia. Not only do transfusions correct the anemia acutely, but the transfused red cells provide a source of iron for reutilization, assuming they are not lost through continued bleeding. Transfusion therapy will stabilize the patient while other options are reviewed.

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Iron-deficiency states are associated with saturation levels <20%. There is a diurnal variation in the serum iron. A transferrin saturation >50% indicates that a disproportionate amount of the iron bound to trans-ferrin is being delivered to nonerythroid tissues. If this persists for an extended time, tissue iron overload may occur.

• Cushing ulcers refer to gastric, duodenal, and esophageal ulcers arising in those with intracranial disease. They have an elevated risk of perforation

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​Presents as a spontaneous mass llesion.Most frequently in young to middle-aged adults.

Female preponderance noted. Associated with long term use of anabolic hormones or ccontraceptives.

Typically, there is a central grey-white, depressed stellate scar from which fibrous septa radiate to the periphery. The central scar contains large vessels, usually arterial, that typically exhibit fibromuscular hyperplasia with eccentric or concentric narrowing of the lumen.

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-Upper gastrointestinal tract perforation

- Mesenteric infarction

- Torsion of an intra-abdominal viscus

- Retroperitoneal haematoma

- Ectopic pregnancy

- Macroamylasaemia

- Renal failure

- Salivary gland inflammation

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Severe violent pain at the left shoulder due to irritation of the left dome of diaphragm in case of splenic rupture.

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