Michael Laposata, Author at Neurology Advisor - Page 6 of 8

Michael Laposata

All articles by Michael Laposata

Altered Urinary pH

Differential Diagnosis Respiratory or metabolic acidosis Respiratory or metabolic alkalosis Defect in renal tubular secretion and reabsorption Don't Miss – Dangerous Situations Severe acidosis or alkalosis could result in a lethal outcome in the short term and should be addressed immediately. Commonly Encountered Situations There are many causes of acidosis and alkalosis with altered urinary…

Abnormal Test Result in the Lipid Profile

Differential Diagnosis Elevated total cholesterol Elevated LDL cholesterol Decreased HDL cholesterol Increased fasting triglyceride Suggested Additional Lab Testing Total cholesterol level Can be performed on serum or plasma Can be obtained fasting or non-fasting HDL cholesterol Can be performed on serum or plasma Can be obtained fasting or non-fasting LDL cholesterol level Pt must be…

Abnormal Platelet Aggregation Studies

Differential Diagnosis Acquired causes of platelet dysfunction: Ingestion of aspirin or aspirin-like compounds or NSAIDs Impaired renal function Myeloproliferative disease Exposure to cardiopulmonary bypass Presence of a paraprotein Congenital causes of platelet dysfunction: Storage pool disease Glanzmann thrombasthenia Bernard-Soulier syndrome Disorders of thromboxane production or action Suggested Additional Lab Testing Platelet aggregation studies with characteristic…

Abnormal Liver Function Tests: Elevations in ALT and AST, Which Predominate Over Elevations of Alkaline Phosphatase (ALP), 5'-NT, and/or Gamma Glutamyltransferase (GGT)

Differential Diagnosis If the diseases in the list below increase in severity, there may be findings suggestive of cirrhosis with or without hepatic failure: Viral hepatitis, multiple forms (see chapters on Viral Hepatitis A, B, and C) Hemochromatosis Wilson disease Alpha-1-antitrypsin deficiency Hepatocellular carcinoma Suggested Additional Lab Testing Total bilirubin and unconjugated bilirubin are markedly…

Abnormal Liver Function Tests: Elevated Serum Bilirubin and/or Predominant Elevations in ALP, 5'-NT, and/or Gamma Glutamyltransferase (GGT)

Differential Diagnosis Red blood cell (RBC) hemolysis from a variety of causes Obstruction of the biliary tract from any of the several possibilities Intrahepatic biliary diseases: primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) Hereditary conjugated hyperbilirubinemias: Dubin-Johnson syndrome, Rotor syndrome Hereditary unconjugated hyperbilirubinemias: Criggler-Najjar syndrome type I, Criggler-Najjar syndrome type II, Gilbert syndrome Suggested…

A Positive Test for Hypercoagulability

Differential Diagnosis Presence of factor V Leiden (can be heterozygous or homozygous) Presence of prothrombin 20210 mutation (can be heterozygous or homozygous) Presence of antiphospholipid antibody; could be manifested as lupus anticoagulant or anticardiolipin antibodies or anti-beta 2 glycoprotein 1 antibodies (IgG, IgM, IgA) Elevated homocysteine Deficiency of protein C not produced by Coumadin or…

Antiphospholipid Antibody Syndrome

At a Glance Antiphospholipid antibodies include anticardiolipin antibodies, the lupus anticoagulant, and antibeta-2 glycoprotein 1 antibodies. The current classification criteria for antiphospholipid syndrome include both laboratory criteria and clinical criteria. The laboratory criteria are the presence of an elevated concentration of antiphospholipid antibodies, which includes a positive test for the lupus anticoagulant, present on 2…

Platelet Function Disorder Produced by Glycoprotein IIb/IIIa Inhibitors

At a Glance Glycoprotein IIb/IIIa inhibitors in clinical use include tirofiban (Aggrastat), eptifibatide (Integrilin), and abciximab (ReoPro). These compounds are very potent antiplatelet agents. They are commonly used in procedures involving cardiac catheterization. In a small percentage of cases, these drugs can also induce a significant thrombocytopenia, with platelet counts often less than 10,000 per…

Von Willebrand Disease – Acquired

At a Glance In the vast majority of cases of von Willebrand disease, the disease is an inherited bleeding disorder. Only very rare acquired cases arise in association with multiple myeloma and related disorders, as a result of neutralizing antibodies to von Willebrand factor, or in patients with aortic stenosis in which there is destruction…

Von Willebrand Disease – Congenital

At a Glance Von Willebrand disease is an inherited bleeding disorder with only very rare acquired cases. A family history of bleeding, especially one that affects both males and females, should prompt consideration of von Willebrand disease. Because it is a mild bleeding disorder in most patients, many patients report a negative bleeding history. The…

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