Important knowledge

⚡️Important piont in social history of patient with DM ▪︎educational state of family ( for Mx ) ▪︎socioeconomic state (income for choice of Mx) ▪︎overcrowding in house يلعب وية الجهال وياكل نستلة بالختلة + infection

⚡️Rota vaccine ⬇️ incidence of DM type 1

⚡️systemic review is very important in known case of DM presented with DKA to find the Tigger for DKA

⚡️cough of 100 day = pertussis

Aslo can cause calcium malabsorbtion

OSCE

⚡️Indication for Plasmapheresis (واجب د.عصام )

⚡️ABO blood group in first 4 months of age could be changed [مو اكيدة ممكن تتغير لذلك نستخدم فصيلة O ]

⚡️بالنسبة لل plasma فال AB blood group هو المتبرع العام لانه لاتحتوي على Ab لا لل A ولا لل B antigenm

⚡️blood transfusion ▪︎لايوجد تبرع دم الا في مركز الدم والتبرع الي يصير بالمستشفيات العادية فهو platelate وليس whole blood ▪︎ ابو ال polycythemia دمه لا يصبح للتبرع وانما يتم اتلاف الدم بعد سحبه

⚡️Indications of exchange transfusion (مال امتحان) ----------------- ▪︎term baby >20mg TSB ▪︎preterm >10mg TSB د . عصام

⚡️Criteria for blood used for exchange transfusion -------------------------------- ▪︎Compatible with both baby and mother (في حالة ال Rh incompatibility لازم نستخدم negative اما O او نفس فصيلة الطفل لكن في حالة ال ABO incompatibility نستخدم O دائما اما اذا كان combination ABO &Rh لازم نستخدم O negative ) ▪︎fresh (<72h) ▪︎whole blood ▪︎warm ▪︎leukoreducted (no WBC to reduce febrile reaction) ▪︎irradiated ▪︎volume = 85*2*baby weight 🔸️give 1 cc calcium gluconate for each 100cc blood (because anti coagulant put in pint impair calcium function which is important for platelate)

⚡️ exchange transfusion ▪︎دائما نستخدم ال umbilical vein ▪︎ال umbilical vein نكدر نستخدمة بسهولة قبل عمر الاسبوع لكن ورة الاسبوع يبدي يصير fibrosis ونحتاج نستعين بالجراحة العامة ▪︎ال umbilical vein يكون باتجاه ساعة 10 او 11 ▪︎ من تخلي catheter بال umbilical vein يجيك slow flow of blood

Kawasaki disease criteria

⚡️parvovirus B19 cause 3 diseases : -------------------------------------- ▪︎aplastic crisis in thalassemia & sickle cell anemia patients ▪︎hydrops fetalis ▪︎fifth disease [slapped check syndrome ,or Erythema infectiosum]

⚡️Characteristic features in scarlet fever -------------------------------- ▪︎skin flexure's rash (pastia sign or line ) ▪︎sandpaper rash ▪︎strawberry tongue (white then red ) ▪︎circum oral pallor ▪︎peeling or desquamation of fingers

💠normal total body iron is up to 4g 💠Each 250cc of packed RBC contain about 250mg of iron 💠Patient can be symptomatic after as few as 20 units(5g iron) 💠After 100 units (20-25g iron) Ptn almost always show symptoms of iron overload which includes ◽Glucose intolerance==> pancreatic alpha& beta cells damage ◽Cirrhosis ◽Cardiomyopathy ◽hypogonadism (pituitary damage==> no LH,FSH ◻️arthritis 💠Consider chelation (deferoxamine)after 20-25 units(5g of iron )of packed RBS if transfusions are ongoing