Sandbox:Sogand

Anemia

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sogand Goudarzi, MD [2]

Abnormal hematosis

year	author	past history	imaging finding
		Past medical history was unremarkable	coronory angiography	intracoronary imaging	CTCA

Staging for mycosis fungoides and Sezary syndrome
Skin (T)
T1	Limited patches, papules, and/or plaques covering <10% of the skin surface. May further stratify into T1a (patch only) versus T1b (plaque patch)
T2	Patches, papules, or plaques covering 10% of the skin surface. May further stratify into T2a (patch only) versus T2b (plaque patch).
T3	One or more tumours (1-cm diameter)
T4	Confluence of erythema covering 80% body surface area
Node (N)
N0	No clinically abnormal peripheral lymph nodes; biopsy not required
N1	Clinically abnormal lymph nodes; histopathology Dutch grade 1 or NCI LN0-2
N1a	Clone negative
N1b	Clone posetive
N2	Clinically abnormal peripheral lymph nodes; histopathology Dutch grade 2 or NCI LN3
N2a	Clone negatove
N2b	Clone posetive
N3	Clinically abnormal peripheral lymph nodes; histopathology Dutch grades 3e4 or NCI LN4; clone positive or negative
NX	Clinically abnormal peripheral lymph nodes; no histologic confirmation
Visceral (M)
M0	No visceral organ involvement
M1	Visceral involvement (must have pathology confirmation and organ involved should be specified)
Blood (B)
B0	0 Absence of significant blood involvement: 5% of peripheral blood lymphocytes are atypical (Sezary) cells B0a Clone negative B0b Clone positive
B1	Low blood tumour burden: >5% of peripheral blood lymphocytes are atypical (Sezary) cells but does not meet the criteria of B2 B1a Clone negative B1b Clone positive
B2	High blood tumour burden: 1000/mL Sezary cells with positive clone

T

Mycosis fungoides

Stage IA-IIA

Stage IIA

Stage III

Stage IV

• Expectane policy • Topical steroides [IV-A] • nb-UVB[III,A] • PUVA [III-A] • Topical mechlorethamine [II,B] • Local RT [IV,A]

• Skin direct therapy(SDT) + local radiotherapy • ST[III+A] • (SDT+) retiods[III,B] • (SDT+) IFN a {III,B] • TSEBT [III,A]

• (SDT+) retinoides • (SDT+) IFNa • ECPI INFa +/- rtinoides • Low dose MTX • [IV-B]

• Gemcitabine • Liposomal doxorubicin • Brentuximab vedotin[II,B]

• (SDT+) retinoides [III,B] • (SDT+) IFNa [III,B] • Retinoides +IFN a [II,B] • TSEBT [IV,A]

• Gemcitabin [IV,B] • Liposomal doxorubicin [IV,B] • Brentuximabvedotin [II,B] • Combinatio Cht [Iv,B] • AlloSCT[V,C]

TSEBT[LV,B]

• Combination Cht [IV,B] • AlloSCT [V,C]

Differentiating [disease name] from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]

On the basis [symptom 1], [symptom 2], and [symptom 3], [disease name] must be differentiated from disseminated intravascular coagulation (DIC) , thrombotic thrombocytopenic purpura (TTP),systemic vasculitis , [disease 4], [disease 5], and [disease 6].

Diseases	Clinical manifestations							Para-clinical findings																		Gold standard	Additional findings
	Symptoms			Physical examination
								Lab Findings													Occur				Histopathology
	Diarrhea	Abdominal pain	decrease urin	Physical exam 1	Physical exam 2	fd	CBC	PC	PT	PTT	FDP	D-dimer	LDH	haptoglobin	Coombs test	PBS	BUN	Cr	S/C		Pediatric	Adult		Imaging 3
Disseminated intravascular coagulation (DIC)								NL/_	↑	↑	↑	↑
Hemolytic uremic syndrome							Hemolitic anemia		NL	NL	NL	↑	↑	↑			↑	↑			+++	+
Thrombotic thrombocytopenic purpura (TTP)																					+	+++
Systemic vasculitis
Diseases	Symptom 1	Symptom 2	Symptom 3	Physical exam 1	D	Physical exam 3		Lab 1	Lab 2	Lab 3											Imaging 1	Imaging 2		Imaging 3	Histopathology	Gold standard	Additional findings
Differential Diagnosis 4
Differential Diagnosis 5
Differential Diagnosis 6

Differentiating between Hemoglobinopathies

				Gene type	Red blood cell (RBC) count g/dl				Hemoglobin pattern	Differentiating Symptoms
					Hemoglobin g/dl	MCH /pg	Hemoglobinpattern
Alpha Thalassemia				-+/++	Normal	Normal	Normal		Normal	None
				-+/-+ --/++	Normal or low	<26	Normal		Normal	Mild anemia
				--/-+	8 to 10	<22	HbH &asymp 10 to 20%		HbH 10 to 20%	Chronic hemolytic anemia
				Hb Bart’s hydrops fetalis --/--	<6	<20	Hb Bart’s 80 to 90%, Hb Portland &asymp; 10 to 20%, HbH <1%		Hb Bart’s 80 to 90%, Hb Portland 10 to 20%, HbH <1%	Life-threatening fetal anemia
β-thalassemia	Heterozygous			&β/++	9 to 15		HbA2 >3.2%
				&β/+-			HbF 0.5 to 6%
				&β/--		19 to 25
	Compound heterozygous			&beta; + /&beta; 0
	Homozygous			&beta;+/&beta;+	<7
				&beta; 0 /&beta; 0
Sickle cell Disease					6 to 9
HBC

Pathophysiology

1. The pathophysiolgy of xxx disease in unknown.
2. But it may follow xxx pathway
   • It is believed that xxx might work on yyy to produce zz.

Pathology

• Idiopathic
• Itarogenic
• cardiac

References

History & clinical symptoms

Blood test

hemolysate

Diagnosis of abnormal hemoglobins

Diagnisis of β-thalassemia

Dignisis of α-thalassemia

Alkaline electrophoresis • acid electrophoresis •HPLC

Electrophoresis HPLC • HbA2,Hbf

Electrophoresis HPLC • DNA testing

Evidence of abnormality,comparison of mobility with that of known abnormalities, if HBS suspected: solubility test

Separation/quantification

Evalution of all data and findings

Evalution of all data and findings

Diagnisis of β-thalassemia

Dignisis of α-thalassemia

DNA sequencing if needed

DNA sequencing if needed(thalassemia major, thalassemia intermedia

Evaluation of all data and findings(including blood count ethnic and origin

Diagnosis of hemoglobinopathy