Lab Rats In Lab Coats

ALT, AST, and ALP

The standard D-dimer threshold is not applicable in pregnant or post-op patients, as D-dimer levels are often high in this patient group.

Also, it has a high negative predictive value, but a low positive predictive value. In other words: if a D-dimer is negative, then most likely the patient doesn't have DVT. But if it's positive, then it means essentially nothing. Also, you should use D-dimer only on patients with low Wells score.

A negative D-dimer can help rule out DVT without venous ultrasound ONLY in patients with low pretest probability (low Wells score). It is not helpful for patients with intermediate or high pretest probability.

DVT diagnosis

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Green & King Index It's more accurate than Mentzer index, since it includes RDW, but it's not as easy to calculate at the bedside.

Mentzer Index It's a quick bedside formula that helps you distinguish IDA from B-thalassemia trait. It's an easy and fast screening tool, but not very accurate.

IDA presents with ↓Hb, borderline or ↓MCV, and ↑RDW-CV. Thalassemia presents with ↓Hb, ↓MCV, and importantly, with normal RDW-CV (which distinguishes it from IDA). Multiple formulae use this information to calculate whether a patient has IDA or thalassemia based on CBC alone. They are quite useful, but not definitively diagnostic. For that, you'll need Hb electrophoresis.

RDW-CV (Red cell Distribution Width) measures anisocytosis, i.e. whether RBCs vary significantly in size or not (the higher the RDW the higher the variation in RBC size). In IDA, there is an increase in reticulocytes which are bigger than normal RBCs, which is why you see high RDW in IDA.

Extremely small erythrocytes (MCV < 35-40 fL) or fragmented RBCs (like schistocytes as seen in MAHA/TTP/HUS) fall below the lab machine's threshold sizing window (30 fL) and are miscounted as platelets.

And you also have "familial opposable triphalangeal thumbs duplication"

It's also present in Holt-Oram syndrome (Heart-hand syndrome, or atrio-digital dysplasia)

Tri-phalangeal thumb Seen in Diamond-Blackfan anemia

Alright guys, we finished the color wheel, just like Thanos

Bot: That could be seen after administration of methylene blue Methylene Blue acts by reacting within RBC to form leukomethylene blue, which is a reducing agent of oxidized hemoglobin converting the ferric ion (fe+++) back to its oxygen carrying ferrous state(fe++). Dose commonly used is 1-2mg/kg of 1% Methylene Blue solution.

Bot: صوب منها purple urine bag syndrome، والصوب الثاني traffic light urine