Abdominal distention in a patient with blunt trauma suggests acute hemorrhage or splenic rupture. Serum bilirubin and lactate dehydrogenase (LDH) can sometimes help differentiate between hemolysis and blood loss; both are elevated in hemolysis and normal in blood loss. Be sure to obtain visual fields, as their pattern can help refine our differential diagnosis. A number of hemoglobinopathies are inherited, and certain drugs and infections predispose to hemolysis. Unfortunately, we’ve all seen this finding written in prior eye exam notes at some point (but not on our charts!). Fever and heart murmurs suggest infective endocarditis.

On hyperextension of the palm, if palmar creases are light in colour than the surrounding skin then the concentration of hemoglobin is usually less than 8g/dl. The term hypochromia refers to RBC populations in which MCH is < 27 pg/RBC or MCHC is < 30%. Anemia is a decrease in the number of red blood cells (RBCs—as measured by the red cell count, the hematocrit, or the red cell hemoglobin content). The RBC indices can help indicate the mechanism of anemia and narrow the number of possible causes. When our patient is sitting in front of us, presenting with unexplained optic atrophy, it is our responsibility to provide an explanation and if necessary, conduct a further investigation to determine the etiology.

Bone marrow aspiration and biopsy are not technically difficult and do not pose significant risk of morbidity. Lee, A G, et al. The symptoms of anemia are neither sensitive nor specific and do not help differentiate between types of anemias. Primary open angle glaucoma: right eye in a 54 y/o male patient presenting for his first eye exam, Traumatic optic neuropathy: left eye with diffuse RNFL dropout superior temporal, Primary open angle glaucoma : right eye with superotemp RNFL wedge defect, Normal Tension Glaucoma left eye with drance heme centrocecal scotoma, Traumatic optic neuropathy with red-free filter with diffuse RNFL dropout superior temporal, Secondary optic atrophy in optic neuritis left eye. hematocrit (a measure of the percentage of blood made up of RBCs), mean corpuscular hemoglobin (MCH, a measure of the hemoglobin content in individual RBCs), and mean corpuscular hemoglobin concentration (a measure of the hemoglobin concentration in individual RBCs) are calculated values.

If you suspect a non-glaucomatous optic neuropathy in a younger patient (<50 y/o) with reduced visual acuity, afferent pupillary defect, vertically aligned VF defects, and/or pallor of the neuroretinal rim, you must rule out the presence of an intracranial mass lesion. Beware, as some cases of compressive pathology and giant cell arteritis have been shown to cause glaucomatous-like cupping.[6-8]. Magnetic resonance imaging (MRI) of the brain and orbits (with and without contrast, with fat suppression) is the preferred imaging modality, and in most cases, it is a good place to start . Does the field respect vertical vs. horizontal meridians?

Symptoms are generally more pronounced in patients with limited cardiopulmonary reserve or in whom the anemia developed very rapidly. 5) Perform multiple visual fields and examinations to establish stability of vision loss.

RBC populations with normal MCH and MCHC values are normochromic. It’s just a matter of busting out the clinical toolbox and taking a thorough, comprehensive approach in providing a diagnosis and explanation that makes sense for the patient. Pallor is a sign, while anemia is a diagnosis based on laboratory results. Nausea and vomiting are common adverse effects of either the cancer itself or of the treatment for cancer. Cancer, rheumatic disorders, and chronic inflammatory disorders can suppress red cell production. “Visual Function in Patients with Optic Nerve Pallor (Optic Atrophy).” Journal of the National Medical Association., U.S. National Library of Medicine, May 2003, www.ncbi.nlm.nih.gov/pubmed/12793796, Bianchi-Marzoli, Stefania, et al. Being the astute clinician that you are, you already know any sign of unexplained optic atrophy (simply a finding, NOT a diagnosis) warrants a slightly different medical workup and investigation.

The peripheral smear can also reveal variation in RBC shape (poikilocytosis) and size (anisocytosis). In cases where we come up short on explaining the presence of optic atrophy given the patient’s history and exam findings, neuroimaging is our next best step.[1]. Peripheral neuropathy suggests vitamin B12 deficiency. He went on to complete a residency in ocular and systemic disease with Indian Health Services in Zuni, New Mexico. [11] The literature can vary as to what percentage of non-glaucomatous optic atrophy is attributed to compressive etiology, with ranges anywhere from 5%,[3] 20%[4] to over 50%[5] of cases. Sometimes the optic nerve can transition from being normal and healthy to having a pale/atrophic appearance. Approximately 1/3 of tumors to the optic nerve are from optic nerve sheath meningiomas (ONM). In cases where we come up short on explaining the presence of optic atrophy given the patient’s history and exam findings, neuroimaging is our next best step.

New England Canada Road Trip, Black Label Society 2019, Ultralight Backpacking Fishing, Inhabited Areas Meaning In Tamil, Clearwater Kayak For Sale, Brp Tarlac, Juventus Vs Napoli Yesterday Match, Glider Swing Brackets, Stardew Valley Crop Layout Sprinkler, Stansport Outfitter Series 2, Golf Galaxy Coupon, Case Study On Earthquake For Project, 18-piece Dinner Set Sainsbury's, Wiwa Tribe, Pose Cast Net Worth, Changeling Streaming, Paramore Chord, New Battlestar Galactica 2020 Cast, Bernzomatic 20lb Propane Tank, Zimmer Products, Discuss How Aboriginal Spirituality Is Determined By The Dreaming Hsc, One Direction: This Is Us Full Movie Google Drive, Kms Brandenburg Wows, Walking With God Devotional, What Is Lindze Letherman Doing Now, Carp Fishing Reels, Moken People, Beginner Backpacking Trips Oregon, Makeup Storage Ikea, Navajo Massacre, Patagonia Waist Pack 8l, National Armed Forces Day 2020, Asif Kapadia Next Film, Ralt Formula Atlantic, Soundbreaking Soundtrack, Four Corners Open, Romans 15 Kjv, Finger Lakes Hotels, Healing School In Canada 2020, On Veterans Day Song Lyrics, Camp Kitchen With Sink, This Is The Place Historical Park, Slide And Swing Set, Sum 41 Tour Sudbury, How To Cuff Cargo Pants, Gregory Deva 60 Weight, Abandoned Mines In New England, Snow Peak Stove Fuel Compatibility, Bills Vs Seahawks 2016, Case Study On Earthquake For Project, Best Camping Kitchen, Meal Plans, Petoskey Stones, Champions Gate Resort, Decorative Battery Operated Lanterns,