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58-498: A boil , also called a furuncle , is a deep folliculitis , which is an infection of the hair follicle . It is most commonly caused by infection by the bacterium Staphylococcus aureus , resulting in a painful swollen area on the skin caused by an accumulation of pus and dead tissue. Boils are therefore basically pus-filled nodules. Individual boils clustered together are called carbuncles . Most human infections are caused by coagulase-positive S. aureus strains , notable for

116-512: A bone marrow sample , if needed. Reticulocyte counts, and the "kinetic" approach to anemia, have become more common than in the past in the large medical centers of the United States and some other wealthy nations, in part because some automatic counters now have the capacity to include reticulocyte counts. A reticulocyte count is a quantitative measure of the bone marrow 's production of new red blood cells. The reticulocyte production index

174-460: A hyperdynamic circulation : tachycardia (a fast heart rate), bounding pulse , flow murmurs , and cardiac ventricular hypertrophy (enlargement). There may be signs of heart failure . Pica , the consumption of non-food items such as ice, paper, wax, grass, hair or dirt, may be a symptom of iron deficiency; although it occurs often in those who have normal levels of hemoglobin . Chronic anemia may result in behavioral disturbances in children as

232-434: A body part can cause localized anemic effects within those tissues. Fluid overload (hypervolemia) causes decreased hemoglobin concentration and apparent anemia: Certain gastrointestinal disorders can cause anemia. The mechanisms involved are multifactorial and not limited to malabsorption but mainly related to chronic intestinal inflammation, which causes dysregulation of hepcidin that leads to decreased access of iron to

290-462: A boil opens, can help speed healing. The area must be kept clean, hands washed after touching it, and any dressings disposed of carefully, in order to avoid spreading the bacteria. A doctor may cut open or " lance " a boil to allow it to drain, but squeezing or cutting should not be attempted at home, as this may further spread the infection. Antibiotic therapy may be recommended for large or recurrent boils or those that occur in sensitive areas (such as

348-497: A direct result of impaired neurological development in infants, and reduced academic performance in children of school age. Restless legs syndrome is more common in people with iron-deficiency anemia than in the general population. The causes of anemia may be classified as impaired red blood cell (RBC) production, increased RBC destruction (hemolytic anemia), blood loss and fluid overload ( hypervolemia ). Several of these may interplay to cause anemia. The most common cause of anemia

406-421: A number of bone marrow tumors . Causes of increased breakdown include genetic disorders such as sickle cell anemia , infections such as malaria , and certain autoimmune diseases like autoimmune hemolytic anemia . Anemia can also be classified based on the size of the red blood cells and amount of hemoglobin in each cell . If the cells are small, it is called microcytic anemia ; if they are large, it

464-425: A peripheral blood smear occurs when there are two simultaneous populations of red blood cells, typically of different size and hemoglobin content (this last feature affecting the color of the red blood cell on a stained peripheral blood smear). For example, a person recently transfused for iron deficiency would have small, pale, iron deficient red blood cells (RBCs) and the donor RBCs of normal size and color. Similarly,

522-453: A person transfused for severe folate or vitamin B12 deficiency would have two cell populations, but, in this case, the patient's RBCs would be larger and paler than the donor's RBCs. A person with sideroblastic anemia (a defect in heme synthesis, commonly caused by alcoholism, but also drugs/toxins, nutritional deficiencies, a few acquired and rare congenital diseases) can have a dimorphic smear from

580-414: A physician, which may include culturing of the lesion. Evaluation can further include imaging, such as an ultrasound, to evaluate for formation of an abscess or other complications. A boil may clear up on its own without bursting, but more often it will need to be opened and drained. This will usually happen spontaneously within two weeks. Regular application of a warm moist compress , both before and after

638-410: A severe infection, an individual may experience fever , swollen lymph nodes , and fatigue . A recurring boil is called chronic furunculosis. Skin infections tend to be recurrent in many patients and often spread to other family members. Systemic factors that lower resistance commonly are detectable, including: diabetes , obesity , and hematologic disorders . Boils may appear on the buttocks or near

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696-436: Is a blood disorder in which the blood has a reduced ability to carry oxygen . This can be due to a lower than normal number of red blood cells , a reduction in the amount of hemoglobin available for oxygen transport, or abnormalities in hemoglobin that impair its function. The name is derived from Ancient Greek ἀν - (an-)  'not' and αἷμα (haima)  'blood'. When anemia comes on slowly,

754-412: Is a calculation of the ratio between the level of anemia and the extent to which the reticulocyte count has risen in response. If the degree of anemia is significant, even a "normal" reticulocyte count actually may reflect an inadequate response. If an automated count is not available, a reticulocyte count can be done manually following special staining of the blood film. In manual examination, activity of

812-447: Is a schematic representation of how to consider anemia with MCV as the starting point: Other characteristics visible on the peripheral smear may provide valuable clues about a more specific diagnosis; for example, abnormal white blood cells may point to a cause in the bone marrow . Microcytic anemia is primarily a result of hemoglobin synthesis failure/insufficiency, which could be caused by several etiologies: Iron-deficiency anemia

870-758: Is a severe form of anemia, in which the hematocrit is below 10%. Refractory anemia, an anemia which does not respond to treatment , is often seen secondary to myelodysplastic syndromes. Iron-deficiency anemia may also be refractory as a manifestation of gastrointestinal problems which disrupt iron absorption or cause occult bleeding . Transfusion dependent anemia is a form of anemia where ongoing blood transfusion are required. Most people with myelodysplastic syndrome develop this state at some point in time. Beta thalassemia may also result in transfusion dependence. Concerns from repeated blood transfusions include iron overload . This iron overload may require chelation therapy . The global market for anemia treatments

928-502: Is a simplified schematic of this approach: * For instance, sickle cell anemia with superimposed iron deficiency; chronic gastric bleeding with B 12 and folate deficiency; and other instances of anemia with more than one cause. ** Confirm by repeating reticulocyte count: ongoing combination of low reticulocyte production index, normal MCV and hemolysis or loss may be seen in bone marrow failure or anemia of chronic disease, with superimposed or related hemolysis or blood loss. Here

986-423: Is blood loss, but this usually does not cause any lasting symptoms unless a relatively impaired RBC production develops, in turn, most commonly by iron deficiency . Anemias of increased red blood cell destruction are generally classified as hemolytic anemias . These types generally feature jaundice , and elevated levels of lactate dehydrogenase . The roots of the words anemia and ischemia both refer to

1044-450: Is called macrocytic anemia ; and if they are normal sized, it is called normocytic anemia . The diagnosis of anemia in men is based on a hemoglobin of less than 130 to 140 g/L (13 to 14 g/dL); in women, it is less than 120 to 130 g/L (12 to 13 g/dL). Further testing is then required to determine the cause. Treatment depends on the specific cause. Certain groups of individuals, such as pregnant women, can benefit from

1102-932: Is estimated at more than USD 23 billion per year and is fast growing because of the rising prevalence and awareness of anemia. The types of anemia treated with drugs are iron-deficiency anemia, thalassemia , aplastic anemia, hemolytic anemia , sickle cell anemia , and pernicious anemia, the most important of them being deficiency and sickle cell anemia with together 60% of market share because of highest prevalence as well as higher treatment costs compared with other types. Treatment for anemia depends on cause and severity. Vitamin supplements given orally ( folic acid or vitamin B 12 ) or intramuscularly ( vitamin B 12 ) will replace specific deficiencies. Apart from that, iron supplements, antibiotics, immunosuppressant, bone marrow stimulants, corticosteroids, gene therapy and iron chelating agents are forms of anemia treatment drugs, with immunosuppressants and corticosteroids accounting for 58% of

1160-502: Is not a reliable sign. A blue coloration of the sclera may be noticed in some cases of iron-deficiency anemia. There may be signs of specific causes of anemia, e.g. koilonychia (in iron deficiency), jaundice (when anemia results from abnormal break down of red blood cells  – in hemolytic anemia ), nerve cell damage (vitamin B 12 deficiency), bone deformities (found in thalassemia major) or leg ulcers (seen in sickle-cell disease ). In severe anemia, there may be signs of

1218-487: Is one of the six WHO global nutrition targets for 2025 and for diet-related global targets endorsed by World Health Assembly in 2012 and 2013. Efforts to reach global targets contribute to reaching Sustainable Development Goals (SDGs), with anemia as one of the targets in SDG 2 for achieving zero world hunger. A person with anemia may not have any symptoms, depending on the underlying cause, and no symptoms may be noticed, as

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1276-546: Is primarily a failure of DNA synthesis with preserved RNA synthesis, which results in restricted cell division of the progenitor cells. The megaloblastic anemias often present with neutrophil hypersegmentation (six to 10 lobes). The nonmegaloblastic macrocytic anemias have different etiologies (i.e. unimpaired DNA globin synthesis,) which occur, for example, in alcoholism. In addition to the nonspecific symptoms of anemia, specific features of vitamin B 12 deficiency include peripheral neuropathy and subacute combined degeneration of

1334-507: Is rare in men and postmenopausal women. The diagnosis of iron deficiency mandates a search for potential sources of blood loss, such as gastrointestinal bleeding from ulcers or colon cancer. Mild to moderate iron-deficiency anemia is treated by oral iron supplementation with ferrous sulfate , ferrous fumarate , or ferrous gluconate . Daily iron supplements have been shown to be effective in reducing anemia in women of childbearing age. When taking iron supplements, stomach upset or darkening of

1392-425: Is rarely used as is painful, invasive and is hence reserved for cases where severe pathology needs to be determined or excluded. In the morphological approach, anemia is classified by the size of red blood cells; this is either done automatically or on microscopic examination of a peripheral blood smear. The size is reflected in the mean corpuscular volume (MCV). If the cells are smaller than normal (under 80 fl ),

1450-489: Is the most common blood disorder, affecting about a fifth to a third of the global population. Iron-deficiency anemia is the most common cause of anemia worldwide, and affects nearly one billion people. In 2013, anemia due to iron deficiency resulted in about 183,000 deaths – down from 213,000 deaths in 1990. This condition is most prevalent in children with also an above average prevalence in elderly and women of reproductive age (especially during pregnancy). Anemia

1508-557: Is the most common type of anemia overall and it has many causes. RBCs often appear hypochromic (paler than usual) and microcytic (smaller than usual) when viewed with a microscope. The Mentzer index (mean cell volume divided by the RBC count) predicts whether microcytic anemia may be due to iron deficiency or thalassemia, although it requires confirmation. Macrocytic anemia can be further divided into "megaloblastic anemia" or "nonmegaloblastic macrocytic anemia". The cause of megaloblastic anemia

1566-423: Is typically diagnosed on a complete blood count . Apart from reporting the number of red blood cells and the hemoglobin level, the automatic counters also measure the size of the red blood cells by flow cytometry , which is an important tool in distinguishing between the causes of anemia. Examination of a stained blood smear using a microscope can also be helpful, and it is sometimes a necessity in regions of

1624-431: The mean of an age- and sex-matched reference range . It is difficult to directly measure RBC mass, so the hematocrit (amount of RBCs) or the hemoglobin (Hb) in the blood are often used instead to indirectly estimate the value. Hematocrit; however, is concentration dependent and is therefore not completely accurate. For example, during pregnancy a woman's RBC mass is normal but because of an increase in blood volume

1682-776: The tumbu fly in Africa usually presents with cutaneous furuncles. Risk factors for furunculosis include bacterial carriage in the nostrils, diabetes mellitus , obesity , lymphoproliferative neoplasms , malnutrition , and use of immunosuppressive drugs . People with recurrent boils are as well more likely to have a positive family history, take antibiotics, and to have been hospitalised, anemic , or diabetic; they are also more likely to have associated skin diseases and multiple lesions. Other causes include poor immune system function such as from HIV/AIDS , diabetes , malnutrition , or alcoholism . Poor hygiene and obesity have also been linked. It may occur following antibiotic use due to

1740-473: The "kinetic" approach more useful philosophically, morphology will remain an important element of classification and diagnosis. Limitations of MCV include cases where the underlying cause is due to a combination of factors – such as iron deficiency (a cause of microcytosis) and vitamin B12 deficiency (a cause of macrocytosis) where the net result can be normocytic cells. The "kinetic" approach to anemia yields arguably

1798-690: The anemia continues slowly (chronic), the body may adapt and compensate for this change. In this case, no symptoms may appear until the anemia becomes more severe. Symptoms can include feeling tired, weak, dizziness , headaches, intolerance to physical exertion , shortness of breath, difficulty concentrating, irregular or rapid heartbeat, cold hands and feet, cold intolerance , pale or yellow skin, poor appetite , easy bruising and bleeding, and muscle weakness . Anemia that develops quickly, often, has more severe symptoms, including, feeling faint , chest pain , sweating, increased thirst, and confusion. There may be also additional symptoms depending on

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1856-490: The anemia is initially mild, and then the symptoms become worse as the anemia worsens. A patient with anemia may report feeling tired , weak, decreased ability to concentrate, and sometimes shortness of breath on exertion . These symptoms are unspecific and none of the symptoms alone or in combination show a good predictive value for the presence of anemia in non-clinical patients. Symptoms of anemia can come on quickly or slowly. Early on there may be few or no symptoms. If

1914-498: The anemia is said to be microcytic ; if they are normal size (80–100 fl), normocytic; and if they are larger than normal (over 100 fl), the anemia is classified as macrocytic . This scheme quickly exposes some of the most common causes of anemia; for instance, a microcytic anemia is often the result of iron deficiency . In clinical workup, the MCV will be one of the first pieces of information available, so even among clinicians who consider

1972-442: The anus, the back, the neck, the belly, the chest, the arms or legs, or even in the ear canal. Boils may also appear around the eye, where they are called styes . The most common complications of boils are scarring and infection or abscess of the skin , spinal cord , brain , kidneys , or other organs. Infections may also spread to the bloodstream ( bacteremia ) and become life-threatening. S. aureus strains first infect

2030-403: The bacteria's ability to produce coagulase , an enzyme that can clot blood. Almost any organ system can be infected by S. aureus . Boils are bumpy, red, pus -filled lumps around a hair follicle that are tender , warm, and painful. They range from pea-sized to golf ball-sized. A yellow or white point at the center of the lump can be seen when the boil is ready to drain or discharge pus. In

2088-448: The basic idea of "lack of blood", but anemia and ischemia are not the same thing in modern medical terminology. The word anemia used alone implies widespread effects from blood that either is too scarce (e.g., blood loss) or is dysfunctional in its oxygen-supplying ability (due to whatever type of hemoglobin or erythrocyte problem). In contrast, the word ischemia refers solely to the lack of blood (poor perfusion ). Thus ischemia in

2146-419: The bone marrow can also be gauged qualitatively by subtle changes in the numbers and the morphology of young RBCs by examination under a microscope. Newly formed RBCs are usually slightly larger than older RBCs and show polychromasia. Even where the source of blood loss is obvious, evaluation of erythropoiesis can help assess whether the bone marrow will be able to compensate for the loss and at what rate. When

2204-416: The cause is not obvious, clinicians use other tests, such as: ESR , serum iron, transferrin , RBC folate level , hemoglobin electrophoresis , renal function tests (e.g. serum creatinine ) although the tests will depend on the clinical hypothesis that is being investigated. When the diagnosis remains difficult, a bone marrow examination allows direct examination of the precursors to red cells, although

2262-408: The circulation. There are a number of definitions of anemia; reviews provide comparison and contrast of them. A strict but broad definition is an absolute decrease in red blood cell mass, however, a broader definition is a lowered ability of the blood to carry oxygen . An operational definition is a decrease in whole-blood hemoglobin concentration of more than 2 standard deviations below

2320-456: The condition of those follicles is usually not called folliculitis, as that term is usually reserved for the separate set of disease entities comprising infected and inflamed hair follicles with causes other than acne. This condition can develop into a more severe skin condition, such as cellulitis or abscess . Most carbuncles , boils , and other cases of folliculitis are infected with Staphylococcus aureus . Folliculitis starts with

2378-442: The cord with resulting balance difficulties from posterior column spinal cord pathology. Other features may include a smooth, red tongue and glossitis . The treatment for vitamin B 12 -deficient anemia was first devised by William Murphy , who bled dogs to make them anemic, and then fed them various substances to see what (if anything) would make them healthy again. He discovered that ingesting large amounts of liver seemed to cure

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2436-422: The development of resistance to the antibiotics used. An associated skin disease favors recurrence. This may be attributed to the persistent colonization of abnormal skin with S. aureus strains, such as is the case in persons with atopic dermatitis . Boils which recur under the arm, breast or in the groin area may be associated with hidradenitis suppurativa (HS). Diagnosis is made through clinical evaluation by

2494-480: The disease. George Minot and George Whipple then set about to isolate the curative substance chemically and ultimately were able to isolate the vitamin B 12 from the liver. All three shared the 1934 Nobel Prize in Medicine . Normocytic anemia occurs when the overall hemoglobin levels are decreased, but the red blood cell size ( mean corpuscular volume ) remains normal. Causes include: A dimorphic appearance on

2552-497: The feces are commonly experienced. The stomach upset can be alleviated by taking the iron with food; however, this decreases the amount of iron absorbed. Vitamin C aids in the body's ability to absorb iron, so taking oral iron supplements with orange juice is of benefit. In the anemia of chronic kidney disease, recombinant erythropoietin or epoetin alfa is recommended to stimulate RBC production, and if iron deficiency and inflammation are also present, concurrent parenteral iron

2610-464: The groin, breasts, armpits, around or in the nostrils, or in the ear). An antibiotic should not be used for longer than one month, with at least two months (preferably longer) between uses, otherwise it will lose its effectiveness. Furuncles at risk of leading to serious complications should be incised and drained if antibiotics or steroid injections are not effective. These include furuncles that are unusually large, last longer than two weeks, or occur in

2668-500: The hemoglobin and hematocrit are diluted and thus decreased. Another example would be bleeding where the RBC mass would decrease but the concentrations of hemoglobin and hematocrit initially remains normal until fluids shift from other areas of the body to the intravascular space. The anemia is also classified by severity into mild (110 g/L to normal), moderate (80 g/L to 110 g/L), and severe anemia (less than 80 g/L) in adults. Different values are used in pregnancy and children. Anemia

2726-461: The infected person. S. aureus strains also produce enzymes and exotoxins that likely cause or increase the severity of certain diseases. Such diseases include food poisoning , septic shock , toxic shock syndrome , and scalded skin syndrome . Naturally the cause is bacteria such as staphylococci that are present on the skin. Bacterial colonisation begins in the hair follicles and can cause local cellulitis and inflammation. Myiasis caused by

2784-646: The introduction of a skin pathogen to a hair follicle. Hair follicles can also be damaged by friction from clothing , an insect bite, blockage of the follicle, shaving , or braids that are very tight and close to the scalp. The damaged follicles are then infected by Staphylococcus spp. Folliculitis can affect people of all ages. Iron-deficiency anemia is sometimes associated with chronic cases. Most simple cases resolve on their own, but first-line treatments are typically topical medications. Folliculitis may recur even after symptoms have gone away. Anemic Anemia or anaemia ( British English )

2842-433: The market share. A paradigm shift towards gene therapy and monoclonal antibody therapies is observed. Nutritional iron deficiency is common in developing nations. An estimated two-thirds of children and of women of childbearing age in most developing nations are estimated to have iron deficiency without anemia with one-third of them having an iron deficiency with anemia. Iron deficiency due to inadequate dietary iron intake

2900-472: The middle of the face or near the spine. Fever and chills are signs of sepsis and indicate immediate treatment. Staphylococcus aureus has the ability to acquire antimicrobial resistance easily, making treatment difficult. Knowledge of the antimicrobial resistance of S. aureus is important in the selection of antimicrobials for treatment. Folliculitis Although acne can often involve superficial infection and inflammation of some hair follicles,

2958-588: The most clinically relevant classification of anemia. This classification depends on evaluation of several hematological parameters, particularly the blood reticulocyte (precursor of mature RBCs) count. This then yields the classification of defects by decreased RBC production versus increased RBC destruction or loss. Clinical signs of loss or destruction include abnormal peripheral blood smear with signs of hemolysis; elevated LDH suggesting cell destruction; or clinical signs of bleeding, such as guaiac-positive stool, radiographic findings, or frank bleeding. The following

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3016-523: The sideroblastic anemia alone. Evidence for multiple causes appears with an elevated RBC distribution width (RDW), indicating a wider-than-normal range of red cell sizes, also seen in common nutritional anemia. Heinz bodies form in the cytoplasm of RBCs and appear as small dark dots under the microscope. In animals, Heinz body anemia has many causes. It may be drug-induced, for example in cats and dogs by acetaminophen (paracetamol), or may be caused by eating various plants or other substances: Hyperanemia

3074-564: The skin and its structures (for example, sebaceous glands , hair follicles ) or invade damaged skin (cuts, abrasions). Sometimes the infections are relatively limited (such as a stye , boil, furuncle, or carbuncle), but other times they may spread to other skin areas (causing cellulitis , folliculitis , or impetigo ). Unfortunately, these bacteria can reach the bloodstream ( bacteremia ) and end up in many different body sites, causing infections (wound infections, abscesses, osteomyelitis , endocarditis , pneumonia ) that may severely harm or kill

3132-400: The symptoms are often vague, such as tiredness , weakness , shortness of breath , headaches , and a reduced ability to exercise . When anemia is acute, symptoms may include confusion , feeling like one is going to pass out , loss of consciousness , and increased thirst . Anemia must be significant before a person becomes noticeably pale . Additional symptoms may occur depending on

3190-481: The underlying cause. In more severe anemia, the body may compensate for the lack of oxygen-carrying capability of the blood by increasing cardiac output . The person may have symptoms related to this, such as palpitations , angina (if pre-existing heart disease is present), intermittent claudication of the legs, and symptoms of heart failure . On examination, the signs exhibited may include pallor (pale skin, mucosa , conjunctiva and nail beds ), but this

3248-497: The underlying cause. Anemia can be temporary or long term and can range from mild to severe. Anemia can be caused by blood loss , decreased red blood cell production, and increased red blood cell breakdown . Causes of blood loss include bleeding due to inflammation of the stomach or intestines , bleeding from surgery , serious injury , or blood donation . Causes of decreased production include iron deficiency , folate deficiency , vitamin B 12 deficiency , thalassemia and

3306-516: The use of iron pills for prevention. Dietary supplementation , without determining the specific cause, is not recommended. The use of blood transfusions is typically based on a person's signs and symptoms. In those without symptoms, they are not recommended unless hemoglobin levels are less than 60 to 80 g/L (6 to 8 g/dL). These recommendations may also apply to some people with acute bleeding. Erythropoiesis-stimulating agents are only recommended in those with severe anemia. Anemia

3364-436: The world where automated analysis is less accessible. A blood test will provide counts of white blood cells, red blood cells and platelets. If anemia appears, further tests may determine what type it is, and whether it has a serious cause. although of that, it is possible to refer to the genetic history and physical diagnosis. These tests may also include serum ferritin , iron studies , vitamin B 12 , genetic testing, and

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