cabergolin!

<1 cm, no need to worry for pituitary dysfunction bc there is enough space for the others. is this a prolactinoma: secreting or non-secreting?

check thyroid (TSH and free T4), adrenal (ACTH and cortisol), and growth hormone (IGF-1) axis

and estrogen: check gonadal axis

PCOS, primary hypothyroidism (high TSH), primary prolactinoma due to pituitary tumor, mass effect, Cushings, MEN 1, pregnancy, drugs, marijuana, decreased kidney function (prolactin cleared via kidneys)

hypercalcemia due to hyperparathyroidism, possible MEN

hypothyroidism

autoimmune hemolytic anemia

problem list: anemia/fatigue, hepatosplenomegaly, icterus, PMHx of URTI/CLL

-brutinib is tyrosine kinase BTK inhibitor

subacute combined degeneration due to B12 deficiency. DCML, spinocerebellar, and lateral CST tract affected

rough pregnancy, history of anemia, over 40 years old

estimate iron stores in bone marrow and hyperplasia of RBCs, megakaryocyte hyperplasia.

poor diet, gastrectomy, peptic ulcer, colon polyps DJI iron fist bro (iron, folate, B12)

<3% is an underproduction issue, microcytic likely cause is blood loss from menorrhagia

leimyoma is common in women older than 40

prenatal vitamins, folate

unexplained IDA is not a final diagnosis-> most concerning cause is bullemia

diet, prenatal vitamins, etc

usually on wards anything <50 is abnormal

folate deficiency-> macrocytosis iron deficiency -> microcytosis normal MCV is due to some very large, some very small RBCs

normocytic anemia

differential: renal insufficiency, autoimmune disease, IDA, bowel absorption issue, folate deficiency, tapeworm, hemolytic anemia

too much lipid--> in liver disease and thalassemia, target cells can form

acute chest syndrome explains murmur and chest pain

FALSELY normal instead of LOW: G6PD-deficient red blood cells, specifically the older, more deficient ones, are destroyed during hemolysis, leaving behind younger, reticulocyte-rich cells with higher G6PD activity. A true G6PD deficiency is diagnosed using a genotyping test or retesting the patient after the hemolytic episode has resolved

Heinz bodies

TMP-SMX, fava bean, dapsone, primaquine, moth balls

heme is source of bilirubin, which is probably source of elevated unconjugated bilirubin.

high AST and normal ALT: RBCs have AST but not ALT inside them, so this represents more RBC breakdown as opposed to liver damage (both would be elevated).

higher reticulocyte=hemolysis

need LDH, bilirubin, haptoglobin, blood smear, Coombs test (looking for antibodies stuck to RBC), DAT (direct= RBCs have antibiotics already attached), IAT (indirect=Ab in plasma)

look for stones or prostatic obstruction

mechanical obstruction can lead to increased infection risk