This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!)

On the first episode of season 8 (named “Twenty Vicodin”, and featuring an interesting guest in the cast!), House is in prison after crashing his car into Cuddy’s living room. One of the prisoners has a fever, joint pain and a rash on his thigh, and House convinces the prison’s doctor that he has lupus. Later, after the prisoner breaks his arm from a minor hit and doesn’t stop bleeding from a small cut, House listens to his chest and discovers an “acoustic shadow”, meaning there is a mass in his lungs. After drinking some coffee the prisoner develops a severe allergic reaction (anaphylaxis) which causes his airway to swell up and almost kills him. House then realizes that the reason for the reaction was the high temperature of the coffee and diagnoses him with mastocytosis

Photo by fox

Danger level: Medium

What is it?

Our immune system is composed of many types of cells and partןcles. Mast cells belong to the immune system and are involved mostly in allergic reactions. These cells produce substances that cause some of the allergy symptoms, the most famous of them is histamine. In systemic mastocytosis  the amount of these mast cells increases significantly, causing the disease.

This is how a mast cell looks. Photo by Ed Uthman

Who gets it?

Systemic mastocytosis is an extremely rare disease – so rare that it’s frequency in the population is not known. It’s a bit more common in men than women, and appears mostly in children, though it may happen to adults (and then the most common age is 55).

What causes it?

The disease develops when a mast cell starts dividing uncontrollably (like in cancer). Since the mast cells keep dividing, there are too many of them – and they can form a tumor, circulate in the blood or accumulate in organs. Also, substances that mast cells produce like histamine are released in larger amounts than usually. All these processes can cause symptoms.

How does it feel?

Symptoms can appear in any organ where mast cells accumulate. This can cause skin rashes, bone pain and problems with the liver, spleen or bone marrow.

Substances that are produced in mast cells and released in large amounts (like histamine) can cause itching, flushing and symptoms in the digestive system (for example: abdominal pain, diarrhea, peptic ulcers and problems with the absorption of food).

Another important symptom is severe allergic reactions (also called anaphylaxis) which can be dangerous and cause difficulty breathing or a very low blood pressure. The most severe allergic reaction in mastocytosis is to bee stings.

In some cases flushing and low blood pressure can develop in response to certain drugs against inflammation (like in the “aspirin test” at the end of the episode), and any symptom can be worsened by these drugs, alcohol or narcotics.

Mastocytosis in toddlers

How is it discovered?

The doctor can suspect mastocytosis based on the symptoms and blood work, but the only definitive test is a bone marrow biopsy, in which a bone sample is taken from the lower back. An important test which can support the diagnosis before performing the biopsy is measuring the levels of histamine in the blood or urine.

How is it treated?

There is no cure for mastocytosis. Treatment is aimed at reducing symptoms, and this is done mostly by different types of pills (for example, anti-histamines which are usually used for allergies).

What happens after treatment?

There are different types of mastocytosis which are dangerous in different levels. In some cases patients have the same life expectancy as the normal population, but in the more violent types (which are, luckily, more rare) patients survive for several months only.

The bottom line – how do I avoid it?

Unfortunately, there is no known way to avoid mastocytosis.

Related posts:

1. Sickle Cell Disease – When the Shape of Your Blood Cells Can Kill You (As Seen On House MD)
2. Astrocytoma (Butterfly Tumor)–A Brain Tumor That Spreads To Both Sides (As Seen On Grey’s Anatomy)
3. Pheochromocytoma – A Rare Tumor That Can Cause Hypertension (As Seen on House MD)

This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!)

On episode 2 of season 7 (named “Selfish”), Della Carr collapses during indoor skating for a charity event for her brother’s disease – muscular dystrophy (which causes muscle weakness). Apparently she had an arrhythmia (problem with her heart rate). While the team prepares her for a test to see if she has a syndrome that causes arrhythmias, they find out she stopped producing urine, which means her kidneys are failing. Later she also starts to cough blood, and a lung biopsy finds she has a lung disease called LAM. She undergoes a lung transplant but the new lung is failing soon afterwards. After House talks to her brother, he reveals that for a year she had non-specific symptoms like ear pain, chest pain, hoarseness and a runny nose. He then diagnoses her with sickle cell trait.

[house 702 photo]

Photo by Fox

Photo by Fox

Danger level: Medium

What is it?

Sickle cell disease is an inherited disease which affects our red blood cells. It causes them to stick to each other and interrupt the blood flow in small vessels, so less blood gets to the organs.

Who gets it?

Sickle cell disease is a genetic disease, meaning that people inherit it from their parents. There is a defective gene in the disease (called “hemoglobin beta-chain”). When a person gets two defective copies passed on from their parents (one from the mother and one from the father) they are sick and have sickle cell disease. If they only inherit one copy (from their father or mother) they are carriers, and their condition is called sickle cell trait.

Sickle cell disease isn’t very rare – one out of 625 people in the United States has the disease.

It’s much more common in Afro-Americans – 8% have the sickle cell trait, compared to only 0.24% of white people. It’s also common in Africa, Greece, Turkey and India.

It can affect men and women alike.

What causes it?

Our red blood cells carry oxygen and bring it from our lungs to organs in our body. It’s necessary for them to survive. The molecule in the red blood cells that’s responsible for carrying the oxygen is called hemoglobin.

The defect in the gene in sickle cell disease causes hemoglobin to be distorted, meaning the red blood cells get distorted as well. They look like a sickle (hence the name of the disease).

Normal and distorted red blood cells. Photo by NIH.

This causes the red blood cell to be sticky. The red blood cells stick to each other inside small blood vessels and clog them, and so less blood gets to the organs.

How does it feel?

Symptoms of sickle cell disease usually start when the baby is 6 months old. They include:

• Pain attacks (crises): This is the most common symptom. The pain can appear in the abdomen, bones, joints, and soft tissue. Each attack lasts for hours-days, it stars and ends suddenly. These crises are most common in small children . Some patients have lots of them and others have only a few or even none at all. Sometimes pain is accompanied by fever or general discomfort.
• Hand-Foot Syndrome: Swollen and painful hands and feet. This lasts 1-2 weeks and is common in very small children (6-18 months).
• Acute Chest Syndrome: Chest pain, fever, cough and difficulty breathing. This is a medical emergency, and if untreated can cause severe breathing problems and even death. It can happen in children and adults.
• Damage to internal organs: This happens when less blood gets to an organ- that organ might stop working. It can happen in many organs, like kidneys, liver and lung. When this happens in the brain, it can cause a stroke – 30% of the children with sickle cell disease have at least one stroke. When it happens in the spleen repeatedly, it causes it to stop working, and since the spleen is part of our immune system, this can cause frequent infections which can be life-threatening.
• Anemia: Sickle cells tend to break down and die, so there are less of them. Anemia causes paleness, weakness, difficulty in exercise and might cause a delay in growth and puberty. Since the anemia is chronic, most patients get used to it and don’t have a lot of symptoms.
• Jaundice: This is a yellowish shade of the skin and the white part of the eyes. It’s caused by the breaking down of sickle cells.

This video explains the disease and its symptoms.

How is it discovered?

A blood test can discover if there is an abnormal hemoglobin molecule in the blood. A genetic test can also be done, which tests for the bad gene. A genetic test can also be done during pregnancy, so it can be found if the baby will have the disease.

How is it treated?

The treatment focuses mainly on treating the symptoms and preventing pain crises – things such as treating infections with antibiotics, easing the pain with pain killers, etc. Also, a drug called hydroxyurea can help. It causes the body to create a different type of hemoglobin, which helps.

What happens after treatment?

The treatment isn’t meant to cure the disease but to help with the symptoms. The life expectancy in sickle cell disease is around 50-60 years, and the most common causes of death are organ failure (especially kidney) and infections.

And what about sickle cell trait? This is when only one copy of the gene is defected, and less then a half of the hemoglobin is distorted. They usually live normally without any symptoms, except in rare cases (like on the House episode).

The bottom line – how do I avoid it?

If both parents have the sickle cell trait or the disease itself, it’s important to perform a prenatal test as explained before.

People who have sickle cell disease already can sometimes avoid the pain crises: drink enough water (to avoid dehydration), avoid smoking and high altitudes (which cause a decrease in the level of oxygen in the blood), avoid cold places, and when exercising rest frequently and drink a lot.

Related posts:

1. Mastocytosis – It’s Not A Tumor, But Its Growth in Your Body Can Kill You (As Seen On House MD)
2. Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency – When Certain Conditions Can Destroy Blood Cells
3. Behçet’s Disease – Inflammation of Your Blood Vessels, Throughout the Body (As Seen on House MD)

This week, more than 1,000 people got sick and 16 died in an outbreak of HUS – a disease related to the bacteria E. coli. Initially cucumbers imported from Spain were blamed to be contaminated with the bacteria, but today this theory was proved wrong, and the source of the infection remains a mystery. What exactly is HUS, and what can you do to avoid it?

Initially, Germans have been warned not to eat cucumbers. (Photo by kobiz7)

Danger Level: High

What is it?

Hemolytic Uremic Syndrome (HUS) is a disease that causes anemia, renal failure and a low platelet count in the blood.

Who gets it?

Most cases of HUS develop in young children, but it can certainly happen in adolescents and adults as well.

It can affect men and women alike.

It’s usually not very common, occurring to 0.5-2 people out of 100,000 in the US per year.

What causes it?

The most common cause for HUS is infection with E. Coli bacteria. E. coli (or by its full name, Escherichia coli) is actually a large group of germs, some of them live in the intestines of healthy people. The type of E. coli which causes HUS is a violent type, which produces a toxin called Shiga-Like Toxin. The toxin is absorbed to the blood through the intestines, and damages the cells that create the most internal layer of blood vessels – especially in the kidney but also in other organs. This damage causes all the symptoms of HUS.

You can get infected with this type of E. coli by eating contaminated and undercooked meat or produce, drinking unpasteurized contaminated milk or swimming in contaminated pools and lakes. It can also be transferred by contact with infected people, for example – in day-cares.

E. coli (Photo by Phil Moyer)

There are other not-common causes for HUS, including:

• Other infections: Some other bacterial and viral infections can also cause HUS, but this is much less common.
• Medications: Several medications can (rarely) cause HUS, including birth control pills, some chemotherapy drugs and cyclosporine – which is used to suppress the immune system (for example after an organ transplant).
• Other diseases: Systemic Lupus Erythematosus (SLE), Preeclampsia and inflammation in the kidneys after radiation treatments.
• Some cases are genetic.

How does it feel?

1. Food Poisoning: The first symptoms are food-poisoning symptoms caused by the E. coli bacteria themselves. This can include abdominal pain, a fever, vomiting and diarrhea which usually becomes bloody at some point. these symptoms appear 5-10 days before all the other symptoms.
2. Anemia: This causes the sick person to look pale and be pretty tired, weak and irritable.
3. Bleeding: There might be external bleeding (from the nose of mouth) or bleeding under the skin, which looks like small unexplained bruises. this is caused by a low number of platelets, which are the cells in our body responsible for blood clots.
4. Kidney Failure: Can cause the body to produce less urine.

The story of 16-year-old Aly, who recovered from HUS

How is it discovered?

When suspecting HUS, the doctors will draw some blood. They will check several things: Complete Blood Count will let them know if there is anemia or low platelets, and kidney function tests will determine if there is kidney failure. They will also look at the blood under a microscope. Other tests that might be needed are a urine test (to look for blood in the urine) and a stool sample (to look for the germs).

How is it treated?

The treatment is given in the hospital, and the goal is to relieve the symptoms:

• The most important part of the treatment is dialysis treatments until the kidneys start working again. If the disease is diagnosed early enough, dialysis might not be needed. The doctors can save the kidneys from failing by giving a lot of fluids.
• The anemia is treated with blood transfusions, and the bleeding problems with platelet transfusions.
• Another possible treatment is plasma-exchange (also called plasmapheresis) – in which blood is removed from the body and blood from a donor is returned back. This is used to remove elements that cause the disease from the blood.

Although the cause is an infection, antibiotics are not part of the treatment.

Dialysis treatment.

What happens after treatment?

In most cases (about 90%, and especially in children), if the disease is discovered early enough and treated correctly, the patient recovers. The other 10% might die or remain with chronic kidney failure which will require dialysis treatments for the rest of their life or a kidney transplant. Some of the people who recover will develop kidney problems or hypertension later in life.

The bottom line – how do I avoid it?

The best way to avoid HUS is to avoid food-poisoning with E. coli – this can be done in several ways:

• Treating foods carefully: You should wash hands often when cooking, keep meat in the refrigerator or freezer, wash fruit and vegetables under running water, cook meat thoroughly without leaving pink areas (if you have a thermometer for cooking, cook to a temperature of at least 160°F [70°C]).
• Avoiding certain foods: Especially undercooked meat, unpasteurized milk and cider. Drink only clean water. Remember that the contaminated food will not necessarily look spoiled of taste bad.
• Avoid swimming in dirty lakes and pools.
• If you have diarrhea – wash hands often.

Related posts:

1. Everything You Need To Know About Fast Food – An Infographic
2. In the News – Hodgkin’s Disease
3. Naphthalene Poisoning – When Mothballs Kill More Than Just Moths (As Seen on House MD)

This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!)


On episode 10 of season 2, named “Failure To Communicate”, a reporter named Fltecher Stone collapses and hits his head on a desk. After that he has aphasia – a condition in which a person speaks but doesn’t know they speak the wrong words. He also can’t write properly (a condition called dysgraphia). After trial and error (lots of it, as usual), it’s discovered the patient has cerebral malaria, meaning he has an infection called malaria, that has also reached his brain, causing his symptoms. He got that when going to an exotic place in order to get a brain surgery for a different disease he has.

Danger level: High

What is it?

Malaria is an infection of red blood cells caused by a parasite that’s transmitted by mosquitoes. It kills about 1 million people each year worldwide.

Who gets it?

Modern medicine has made malaria quite rare in the United States and most other developed countries. In other places, though, it still remains common. Worldwide, about 300-500 million people are infected with malaria, with 1-2 million dying of it each year (most of them African children under 5 years of age).

This doesn’t mean you can’t see malaria in your neighborhood if you live elsewhere. Visitors from other places, immigrants, and even plain travelers (like the one on the House episode) can have the disease.

Map of malaria spread around the world (from the WHO website). Areas in shades of blue are those with active malaria spread.

If you visit these areas, you’re naturally more prone to get infected. Some people are at risk of having a severe case of malaria:

• Young children and infants
• Travelers from a place where there is no malaria (that’s because there is some immunity to malaria in people living in malaria-infected places)
• Pregnant women and their fetus

What causes it?

Malaria is caused by a bite from a female mosquito infected with germs (or, more correctly, parasites).

There are 4 types of parasites that can cause malaria. They are called: Plasmodium falciparum (the most common one – accounting for 80% of cases), plasmodium vivax, plasmodium ovale, and plasmodium malariae.

Image by the country of Los Angeles public health website

Once a female mosquito bites a person with malaria, the parasite gets into its blood stream. Once inside the mosquito, the parasite reproduces and migrates to its salivary glands. Now, when the mosquito bites another person, parasites are injected along with its saliva.

Inside the infected person, the parasites move to the liver, where they multiply and mature. This takes about 1-3 weeks. Then they leave the liver and get into the infected person’s blood cells, where they multiply again, causing the cells’ rupture. The parasite is then free to infect more red blood cells.

This video shows the process using beautiful animation:

In rare cases, there’s no need for a mosquito in order for the infection to pass form one person to another. Examples of such rare cases are transmission of the infection from a mother to her fetus, transfusion of blood contaminated with malaria, or injection with a needle that was used by a malaria infected person.

How does it feel?

Symptoms usually take a few weeks to a few months to appear after the infection, but they may also appear after years.

Once red blood cells begin to rupture and release parasites into the blood stream, a shaking chill appears, followed by high fever. Once body temperature falls again, the person sweats profusely. This ritual of shaking, fever, and sweating repeats in attacks.

Other things that can be felt are fatigue, headaches, body aches, and nausea.

If you’re infected with the plasmodium falciparum type of parasite, the infection can be more dangerous. Since here the infected red blood cells stick to the walls of small blood vessels and clog them, blood supply to organs in the body is interrupted, causing damage to these organs. Examples of such organs include the brain (causing cerebral malaria – like was seen on House), lungs, kidneys, and gastrointestinal tract.

How is it discovered?

When a doctor suspects a person has malaria, a blood sample is taken from them and looked at under a microscope to see the parasites, like can be seen in this picture:

How is it treated?

There are drugs that when taken kill the plasmodium parasites. The type of drug given depends on which of the four types of plasmodium parasites the person got infected with. An example of such a drug is chloroquine.

What happens after treatment?

Most people improve within 24-48 hours of starting taking the drugs, although with plasmodium falciparum, fever can persist for 5 days. Without treatment, malaria can be deadly.

The bottom line – How do I avoid it?

If you know you’ll be travelling to a place where there’s malaria, consult your doctor a few months ahead about drugs you can take before, during and after your trip, that can help protect you.

When you are in one of those countries, you should take measures to avoid contact with mosquitoes. This includes sleeping under a net (preferably sprayed with permethrin, an insecticide), covering your skin (especially from dusk till dawn, the most active mosquito times), spraying your clothing and skin with permethrin, and treating the home you live in with insecticides and with screens on the doors and windows.

Related posts:

1. Amebiasis– A Very Common Infection You May Not Even Have Heard of (As Seen on House MD)
2. Gas Gangrene – An Infection That Can Rapidly Kill Your Muscles (As Seen on House MD)
3. Meningitis – The Brain Infection That Could Kill You, and How To Recognize It

This is part of our House MD Project series.

On episode 19 of season 1, called “Kids”, a young diver named Mary arrives at the hospital during a meningitis scare, but her symptoms don’t fit those of meningitis. What she does have is neck pain which only happens when she twists her neck side to side, and a sort of rash on her lower abdomen.

Photo by Fox.

Later internal bleeding and seizures caused by brain bleeding are added to the symptoms. The final straw comes when it’s found out she’s also pregnant. Combining it all together, her pregnancy has caused a disease called thrombotic thrombocytopenic purpura which explains all of her symptoms.

What we usually do here as part of the House MD Project is tell you what happened in the episode and then explain the disease. This time, the disease was already covered here on A Disease A Day (it was actually the first ever article written on the site). You can read about it in the following link:

TTP – Thrombotic Thrombocytopenic Purpura – A Rare Disease That Could Kill You

Related posts:

1. Early Pregnancy Symptoms Explained
2. Renal Oncocytoma–Cuddy’s Kidney Tumor Explained (As Seen on House MD)
3. TTP – Thrombotic Thrombocytopenic Purpura – A Rare Disease That Could Kill You

A few days ago Bob asked the following question in the health forums:

Hi Guys,
My mother, after having a mild stroke, was said to have "Hyperviscosity" of her blood.
The doctors are still not sure, but they say she has "Waeldenstrom’s Macroglobulinemia" or something like that.
Is it common? Never heard of it. BTW she’s 68 YO.
I would really like to know if there’s a cure for it.
Thanks DAD dudes!!
Bob

 

Read on, Bob, to find out about the disease.

Danger level: High

Health forums category: Cancer

What is it?

Waldesntrom’s macroglobulinemia (WM) is a type of cancer in the blood.

Who gets it?

The disease is quite rare – only about 1,500 cases are diagnosed in the US each year (in the UK, about 10 people out of a million get it each year).

It’s more common in white people (only about 5% of patients are of African origin).

WM is a little more common in men than in women, and it tends to happen around age 65.

What causes it?

Our blood contains many types of cells. One of these types is white blood cells. These cells belong to our immune system and are meant to fight infections.

Like there are many types of cells in the blood, there also several types of white blood cells (five types, actually). One of these types is lymphocytes. To make things even more complicated, lymphocytes themselves are divided into T cells and B cells (and that’s where the complication stops).

Lymphocytes. In WM, this cell goes bad.

WM is a disease of B cell lymphocytes. There are 2 problems these cells cause in this disease:

1. B cells produce molecules called antibodies. Think of them as the weapons used by these cells to kill the bad guys. There is a type of antibody called IGM, which looks something like this:
    
   In WM B cells create too much of this antibody. The blood is then filled with these IGMs floating about. Because of their large structure, they cause the blood to become less liquid and more sticky, or viscous. The condition is then called hyperviscosity syndrome. This can lead to things such as nosebleed, dizziness, gum bleeding and blurred vision.
2. In WM, like in other cancers, B cells multiply uncontrollably. They start infiltrating organs in the body.

How does it feel?

Some people don’t feel anything when they have WM. When people do have symptoms, they can include:

a. Weakness

b. Fatigue

c. Bleeding from the nose or gums

d. Weight loss

e. Bruises in the skin

When the condition is more severe (meaning the blood is thicker) other things which may occur include:

a. Blurring or loss of vision

b. Neurological problems – These include headaches, dizziness, and vertigo.

c. Sometimes a stroke or coma may also ensue.

How is it discovered?

A few tests are done to discover WM:

1. Blood tests: They discover, among other things, the high level of IGM in the blood.
2. A bone marrow biopsy: A sample of bone from the back of the pelvis is taken using a needle. It is then examined under a microscope.

How is it treated?

There’s no cure for WM. If someone doesn’t have any symptoms, usually no treatment is needed. If symptoms are present, though, usually chemotherapy is used.

In cases of hyperviscosity syndrome, where high levels of IGM are present in the blood, a treatment called plasmapharesis is used. In it blood from the patient is removed and circulated through a machine that separates the plasma (which contains the IGMs) from other parts of the blood (such as red and white blood cells). The blood cells are then returned to the patient, along with a plasma substitute.

What happens after treatment?

With treatment, people may live with the disease for longer than 10 years (this is considered good, since in the past people only survived for about 5 years after the diagnosis).

The bottom line – How do I avoid It?

Unfortunately, there is no known way to prevent WM.

Related posts:

1. Wegener’s Granulomatosis–A Rare Inflammation in Blood Vessels that Can Lead to Death (As Seen on House MD)
2. TTP – Thrombotic Thrombocytopenic Purpura – A Rare Disease That Could Kill You
3. Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency – When Certain Conditions Can Destroy Blood Cells

Danger level: Medium

What is it?

Iron deficiency anemia is a type of anemia caused by a lack of iron in the body.

Who gets it?

Iron deficiency anemia is common. In the United States it affects about 1-2% of people.

There are groups of people more likely to have iron deficiency anemia:

1. Women – Women of childbearing age lose blood monthly in their period. This puts them at risk for iron deficiency anemia. Pregnancy also causes a higher demand for iron, which may bring about iron deficiency anemia.
2. Infants and children – Newborn infants have stores of iron which should last for their first months of life, after which a supplementation is recommended if they are breast fed, or iron-fortified formulas are recommended if they are formula fed. Children need extra iron during growth spurts (it’s important for muscle development).
3. Vegetarians – Our main source of iron is meat. Since vegetarians don’t eat meat, they are at greater risk of iron deficiency anemia. (The iron in grains and vegetables isn’t absorbed as well as the iron in meat).
4. People with decreased absorption of iron in the intestines – Such as people with celiac disease.

Unless you’re a hamster, eating only vegetables can bring about iron deficiency anemia. Photo by shhexycorin.

If you have iron deficiency anemia and you are not included in one of those groups, the cause may be a hidden source of bleeding within your body, such as a peptic ulcer, hemorrhoids, cancer or other causes.

What causes it?

Iron is needed by the body to make hemoglobin. As you can read in our anemia article, hemoglobin carries oxygen in our red blood cells to reach all parts of the body. When there’s not enough iron, hemoglobin cannot be formed, which leads to iron deficiency anemia.

How does it feel?

As with all cases of anemia, iron deficiency anemia causes you to feel weak and tired easily. You may look pale. If it is severe, you may feel short of breath. Other things which can appear are headaches and irritability.

Other, less common things which can occur in iron deficiency anemia include:

1. Pica – This is a phenomenon in which people eat things that aren’t considered food, such as clay, coal, soil, ice.
2. Spoon-shaped nails
3. Angular Chelitis – These are wounds in the corners of the mouth.
4. Glossitis – This is an inflammation of the tongue, which causes it to swell and change color.

And others…

How is it discovered?

There are blood tests which can discover if you have iron deficiency anemia:

1. Complete blood count (CBC) – It checks, among other things, the level of hemoglobin. It also allows the doctor to see the blood under a microscope, which gives clues to the cause of the anemia.
2. Blood tests to check your levels of iron

If the doctor suspects you have a bleeding somewhere in your body which causes the anemia, they may check your stool for blood or examine your digestive tracts to look for a cause.

How is it treated?

The treatment is simple: iron. It may be taken as a pill or given as an injection (in people who can’t absorb the iron properly due to a problem in their intestines, or those who have side effects when taking the pill).

What happens after treatment?

Most people begin to feel better after a few days of treatment. The treatment is needed for several months, though, to build up the iron in the body.

The bottom line – How do I avoid it?

You can avoid it by eating foods rich in iron, such as red meat, pork, seafood, poultry, eggs, iron fortified cereals/bread/pasta, beans, peas, dark green leafy vegetables (such as spinach), nuts and seeds, and dried fruit (like raisins and apricots). Iron coming from meat is absorbed better than the other types.

It’s also known that drinking citrus juice while eating iron containing foods helps with its absorption.

Related posts:

1. Anemia – All About It
2. Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency – When Certain Conditions Can Destroy Blood Cells
3. Ornithine Transcarbamylase Deficiency– What If You Couldn’t Eat Steaks? (As Seen on House MD)

First of all – What is anemia?

Anemia, according to Wikipedia’s definition, is “a decrease in normal number of red blood cells or less than the normal quantity of hemoglobin in the blood”.

What does this mean, in plain English?

First, red blood cells: Our body needs oxygen to function. This oxygen has to reach each and every organ in our body. The oxygen is placed inside our red blood cells, which travel throughout the body in our blood vessels and deliver the oxygen to all organs. The oxygen in the blood cells is carried in a special molecule called hemoglobin

Hemoglobin. Oxygen is delivered in it to all body parts. Photo by Zephyris.

As the definition above says, anemia can happen if one of these two things occurs:

1. When you don’t have enough red blood cells – This can happen if you have less than the normal amount of blood (for example, when you bleed from somewhere in your body).
2. When you have the normal amount of red blood cells, but not enough hemoglobin

How does anemia feel?

When you have anemia, not enough oxygen is delivered to your organs. This can cause fatigue, difficulty breathing when you do physical activity, and if you have a heart condition, it can even bring about angina pectoris.

People with anemia look pale. Their heart rates can be faster (the heart is trying to move more oxygen to the body, so it will move the blood faster). The blood pressure of people with anemia can change as well – it tends to fall when they stand up (“dizzy spells”).

According to the type of anemia (we’ll get to that later), other things can happen as well. This picture sums it up:

What are the causes?

There are many types of anemia. Its causes can be divided into two main groups:

Here’s a rundown of what’s in each group. Please note: Each of the diseases below will be featured in future posts and linked back here, so it’s worth bookmarking this page and returning to it from time to time.

Group 1 – Problems in the production of blood cells

There are a few diseases in this group:

1. Iron deficiency anemia: This is a common cause of anemia. Iron is needed by the body to make hemoglobin. If you don’t have enough of it, the body can’t produce enough hemoglobin. Reasons for this include bleeding from somewhere in your body (such as when you have a period), not eating enough foods that contain iron or problems in absorbing the iron, and times at which more iron is needed (such as during pregnancy).
2. Thalassemia: This is a genetic disease in which there is a problem with the production of hemoglobin.
3. Anemia of chronic inflammation: Sometimes, people with chronic diseases may have anemia due to their illness. Examples of such illnesses include chronic infections, HIV, cancers and others.
4. Folate or vitamin B12 deficiency: Folate (folic acid) and B12 are needed for the production of red blood cells (as well as other cells in the body). If you have a deficiency in any of these, you’ll have anemia. Folate is present in leafy green vegetables and fruit, and B12 is present in foods of animal origin (such as meat. This is why vegetarians can have a deficiency).
5. Other reasons: Other things can also cause problems in the production of red blood cells. These include liver diseases, alcoholism, problems with the thyroid gland, certain medications and others.

Group 2 – Increased destruction or loss of blood cells

1. Blood loss – When you are injured and lose blood, such as after a car accident or a gunshot wound, you lose blood. This causes anemia and your body will not be able to transfer oxygen to your organs efficiently. That is why blood transfusions are often given after an injury.
2. Hemolysis– This is a Greek word (hemo = blood, lysis = to break open) which means the destruction of red blood cells. There are a few diseases which cause this:a. G6PD Deficiency – A genetic problem which causes the red blood cells to be more susceptible to damage, which causes their destruction.

   b. Sickle cell anemia – Another genetic disease. It causes the hemoglobin to have a strange shape, which causes the red blood cells to get destroyed.

   c. Hereditary spherocytosis – Yet another genetic disease. In this disease there’s a change of shape in the cover of the red blood cells, which causes them to be more susceptible to destruction.

   d. Paroxysmal nocturnal hemoglobinuria – A disease in which there’s a problem with the cells from which red blood cells are created.

   e. Autoimmune hemolytic anemia – In this disease, antibodies (the molecules in our body responsible for fighting infections) attack the red blood cells and destroy them, for unknown reasons.

   f. Microangiopathic hemolytic anemia – This is a complicated name for a groups of diseases. The common thing they all have is that the red blood cells are destroyed inside our blood vessels. Diseases here include thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), and disseminated intravascular coagulation (DIC).

   g. Hypersplenism – Our red blood cells don’t live forever. They live for about 120 days, and then get destroyed, mainly in the spleen. When our spleen gets bigger it tends to trap more red blood cells and so they get destroyed even when they are not old. Reasons for that includes tumors, infections and others.

How can the doctor tell if you have anemia?

First of all, if you have the right symptoms mentioned above, such as feeling tired and being pale.

Second, they will run a blood test, in which the hemoglobin will be low. (The normal values are 12-14 in women and 14-16 in men). Other lab tests help the doctor understand which anemia you have.

Related posts:

1. Iron Deficiency Anemia – A Common Type of Anemia
2. Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency – When Certain Conditions Can Destroy Blood Cells
3. Multiple Myeloma – Bone Marrow Cells Taking Over

Danger level: Medium

What is it?

G6PD deficiency is a hereditary disease causing anemia in certain situations.

Who gets it?

G6pd deficiency is an inherited disease. Its mode of inheritance is X-linked. This means that the mutation is caused in the X chromosome (one of our 46 chromosomes). For reasons beyond the scope of this article, this means that it almost always occurs only in males.

It’s most common in people of Mediterranean (Italian, Greek, Arab, Sephardic Jewish) or African origin (in the US, it occurs in about 10% of African Americans). It affects about 200 million people worldwide.

What causes it?

G6PD is an enzyme in our body which helps the body produce gluthatione. Gluthatione is a molecule which helps to protect the body against free radicals, which are harmful molecules. These molecules can damage our red blood cells under certain conditions.

In G6PD deficiency, like the name says, there’s a deficiency in the G6PD enzyme. This means that people with the disease don’t produce enough gluthatione to fight the free radicals, which puts their red blood cells at risk.

The bright side – the red blood cells aren’t at risk all the time, but only in certain situations which raise the level of free radicals:

1. Taking certain drugs – Such as dapsone, primaquine, sulfamethoxazole, doxorubicin, methylene blue.
2. Infections
3. Certain foods – Such as fava beans. The interesting thing is that people with G6PD deficiency don’t even have to eat the beans in order to cause damage to the blood cells – it’s enough that they inhale their pollen.
4. Diabetic ketoacidosis – This is a condition that can happen to people with diabetes.

How does it feel?

Most of the time, people with G6PD deficiency are well. When the conditions mentioned above occur, there is a destruction of red blood cells, which leads to anemia and sometimes jaundice (yellowing of the skin). The destruction of red blood cells is called hemolysis. It can happen within hours of exposure to the condition (drug, food, etc.).

The level of the deficiency in G6PD (meaning how much of it exists in the body) will determine how bad the condition will get. Sometimes the hemolysis can stop once you stop taking the drug (this is more common in people of African origin), but it can also continue after you’ve stopped taking it. In severe cases, damage to the kidneys can occur.

The most important thing here is what can happen to babies with G6PD deficiency. A lot of babies have jaundice on their first days. In G6PD deficiency, this jaundice can be prolonged, which can cause damage to the brain.

How is it discovered?

There are a few things that can be done to discover the disease:

1. A blood smear – In which some drops of blood are smeared against a piece of glass and then looked at under a microscope. Certain things can be seen in G6PD deficiency because of the destruction of blood cells.
2. Checking the level of G6PD – To see that it’s indeed low.

How is it treated?

Since the destruction of blood cells usually stops by itself, no treatment is usually necessary. In severe cases, blood transfusions might be necessary.

In babies with jaundice, usually a treatment with a special kind of light helps to resolve the problem.

The bottom line – How do I avoid it?

You can’t prevent having the defect in the gene which causes the deficiency in G6PD. What you can do is avoid the things mentioned above which can trigger the destruction of blood cells (not eat any fava beans (or smell their pollens), avoid the dangerous drugs, avoid infections).

Related posts:

1. Sickle Cell Disease – When the Shape of Your Blood Cells Can Kill You (As Seen On House MD)
2. Iron Deficiency Anemia – A Common Type of Anemia
3. Multiple Myeloma – Bone Marrow Cells Taking Over

A few days ago a court decision was made that ruled in favor of treating Daniel Hauser’s Hodgkin’s lymphoma, in spite of his parents’ objections. Since then, his mother took him and fled, putting the boy at risk.

We’ll explain the disease here, as well as the implications of treatment and of not treating it.

Danger level: High

What is it?

Hodgkin’s disease is a type of lymphoma – a cancer of the lymphatic system. The lymphatic system in our body is involved in draining fluid and waste products from the body, as well as producing white blood cells which protect the body from infections.

Who gets it?

In the US there are about 7,500 new cases of Hodgkin’s each year. It happens to about 3 out of 100,000 people. It’s more common in America and Europe than in Japan and China.

Hodgkin’s disease is more common in males than females, especially in children.

It tends to occur in two age groups: in people 15-35 years old and in those age 50 and more.

What causes it?

The white blood cells which are created in the lymphatic system are called lymphocytes. Their role is to fight infections. In lymphoma, these cells begin to multiply uncontrollably, which produces malignant cells. These cells can invade other tissues in the body.

A lymphocyte. These cells take over the body in lymphoma.

How does it feel?

Our lymphatic system contains organs called lymph nodes. They are found throughout the body, and act as “traps” for germs and other foreign things. When germs enter the body, some of them reach the lymph nodes. There they are presented to the lymphocytes, which learn that the body has an infection, and start multiplying in order to fight the infection in other places in the body. When they multiply, the lymph nodes enlarge. This is why, for example, when we have an inflammation in our throat, a lump can be felt in our neck – the white blood cells there multiply, which causes the lymph node to enlarge.

The lymphatic system. The green circles are the lymph nodes (you can click the picture for a bigger version).

Since in Hodgkin’s the lymphocytes multiply as well, the lymph nodes will get bigger. They are usually not painful, but one interesting feature is that they might hurt after you drink alcohol (for unknown reasons).

Other things which happen in the disease:

1. Enlargement of the spleen – As you can see in the picture above, the spleen is also part of our lymphatic system (in the picture it’s the oval shaped green mass on the right of the picture). It gets larger too in the disease. In some cases, the liver can enlarge as well.
2. “B symptoms” – This is a group of symptoms which characterize lymphomas. They include 3 things:
   a. Weight loss – Usually of more than 10% of the body weight over 6 months.
   b. Fever – Of more than 38 degrees Celsius (or 100.4 Fahrenheit).
   c. Night sweats – This doesn’t mean the sweat you usually experience on hot days. This sweating is profuse, often causing you to change sheets during the night.
   Sometimes an itchy skin may be present as well.
3. Cyclical fever – Some people will have fever that goes up for a few days, then goes down for several days or weeks, and then up again, in cycles. This phenomenon is called “Pel-Ebstein” Fever.

Since the lymphatic organs grow, they can press other organs in the body, which may cause:

1. Difficulty breathing – If the tumor presses the airways.
2. Back pain and even paralysis – When the tumor presses the spinal cord.

And others.

How is it discovered?

When one of the lymph nodes is enlarged and the doctor suspects you have Hodgkin’s disease, they will take a sample of that node, in a process called a biopsy. It can be done by cutting a piece of that node or taking the whole node out.

The sample of the node will be looked at under the microscope. One of the most characteristic things that can be seen under the microscope in Hodgkin’s are cells called Reed-Sternberg cells, which look like the eyes of an owl (if you have good enough imagination), as in this picture:

Once the microscope shows it’s Hodgkin’s, additional tests are done, including blood tests, and images of the body (X-rays, CT scans, etc.) to see where the tumor has spread to.

How is it treated?

Therapy for Hodgkin’s disease may include the following, depending on how severe the disease is:

1. Chemotherapy
2. Radiation therapy
3. Sometimes bone marrow transplantation

What happens after treatment?

In patients in whom the disease is discovered early, more than 90% are cured as a result of treatment. Even in people with an advanced disease, more than 75% of them can live for years without the disease.

There is currently no known way to prevent the disease.

Related posts:

1. In The News – Plague – The Next Swine Flu?
2. Kawasaki Disease – A Childhood Disease That Can Endanger The Heart
3. TTP – Thrombotic Thrombocytopenic Purpura – A Rare Disease That Could Kill You