Fibrosis Information and Courses from MediaLab, Inc.

Measuring the amount of iron deposited in the liver is considered definitive for iron overload. This may be done by liver biopsy, computed tomography (CT), or magnetic resonance imaging (MRI). Demonstrating iron in parenchymal liver cells helps determine disease severity. Liver sections obtained by biopsy are stained with Perls Prussian blue which stains iron present in parenchymal cells. A photomicrograph of this reaction is shown.Although liver biopsy may not be necessary for diagnosing hereditary hemochromatosis (HH), it offers the advantage of detecting liver fibrosis if present. Molecular tests for mutations associated with HH are considered the gold standard of current HH testing. Liver biopsy is not needed for diagnosing all patients suspected of having HH, but may be ordered in some cases.

A bone marrow biopsy involves removing a small portion of the bone marrow without destroying the architecture of the marrow. This type of biopsy is necessary when the marrow cannot be aspirated (dry tap) due to a disease process, and also provides additional information complementary to that derived from the aspirate: biopsy specimens are more accurate for assessing cellularity, and infiltrative processes, such as metastatic carcinoma, fibrosis, amyloid, and lymphoma. A biopsy specimen is processed as follows: touch preparation tissue section

Theophylline is used as a bronchodilator for treatment of moderate to severe asthma and chronic obstructive pulmonary disease (COPD). TDM is needed for theophylline because the kinetics of the drug are highly variable. It has a narrow therapeutic window, and overdose can result in elevated heart rate, arrhythmia, and CNS excitability. Clearance of the drug is increased in children, smokers, persons with cystic fibrosis, and persons with hyperthyroidism. Elimination is slowed in congestive heart failure and in the elderly.

In this photograph of blood cells from yet another submitted slide, we find cells resembling lymphoblasts with increased nuclear/cytoplasmic ratios and dense, finely meshed nuclear chromatin. In addition, note the extrusion of delicate strands of cytoplasm from the outer cell membranes (blue arrow). These are cells connoting hairy cell leukemia (HCL). Under scanning electron microscopy, the cytoplasmic extensions appear to be either slender microvilli or delicate pseudopods. The most helpful confirmatory finding is the detection of acid phosphatase isoenzymne 5 in the cytoplasm of suspected hairy cells by staining. The enzyme concentrates primarily in golgi bodies and in the nuclear membrane and its staining is not inhibited by the addition of tartrate. Stated in another way, hairy cells on the peripheral smears are detected by their staining positively for tartrate-resistant acid phosphatase. Be suspicious of HCL if marrow resists aspiration-a consequence of reticulin fibrosis of the marrow in HCL.