learning issue 1

learning issue

1) side effect of steroid

short term

• increase in appetite, 
• difficulty sleeping (insomnia), 
• changes in mood and behavior, flushing (redness) of the face, and 
• short-term weight gain due to increased water retention. 

These side effects usually resolve after a few days once the steroids have been stopped.


long term

• Glaucoma
• Cataracts
• High-blood pressure
• Heart disease
• Diabetes mellitus
• Obesity
• Acid reflux/GERD
• Osteoporosis
• Myopathy
• Increase in certain types of infections
• Cushing syndrome

2)  iron overload

a) why iron overload in regular transfusion

there was no mechanism of removal of the ferritin@ iron from lysis of RBC in normal mechanism. thus requiring iron chelating therapy

b) then why does not all who receive transfusion require the iron chelating therapy?

depending on frequency, most eventually will... the starting of iron chelating therapy begins when ferritin level more than 1000microgram. usually = after 20 times transfusion since each blood unit contain around 200 mg

c) how about thalessemia intermedia who doesnt receive transfusion will it too developed iron overload?

yes. RBC breakdown is high due to 1) ineffective erythropoiesis 2) hypoxia 3) chronic anemia leads to release of > 1) growth differentiation factor 15 2)Von Hippel Lindau factor 3) hypoxia inducible transcription factor. this will lead to REDUCE HEPCIDIN (protein produced by liver as coded by HAMP gene to regulate iron transport across gut mucosa preventing excess absorption and maintaining normal iron level.) Thus will lead to increase duodenal iron absorption and increase release iron from RES system.