Every 7th urban Indian is prone to Bronchitis

Symptoms of Acute Bronchitis

Most of India’s urban populace is highly prone to respiratory infections and problems due to the dangerously high air pollution levels in all major cities across the country. Air we breathe in travels through the bronchial tube to reach our lungs. Problem begins when these tubes get inflamed and mucus builds up. It leads to coughing and shortness of breath which is known as bronchitis. It is very important to identify the symptoms in the beginning and get yourself treated by a doctor immediately.

Look out for these symptoms of acute bronchitis.

1. Prolonged Cough - If your coughing goes beyond ten days, it could be bronchitis. If you have been coughing so long, check if the mucus is coloured too.

2. Shortness Of Breath - If you are facing shortness of breath despite not being asthmatic, you should see a doctor.

3. Chest Pain - Chest pain and chest tightness could be a symptom of acute bronchitis as breathing troubles might cause problems in such areas.

4. Sore Throat - Sore throat with persistent coughing is also a symptom for acute bronchitis.

5. Flu Like Symptoms - Most children show very different symptoms of bronchitis. They might show flu like signs of runny nose, sore throat, back or muscle pain and chills.

6. Weight Loss - You might also experience unexplained weight loss.

7. Barking Cough - Deep, barking cough is a sure shot symptom of something serious and you need a consult a specialist immediately.

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What is Drooling?
Full blood count

Too Much Social Media Tied to Poor Teen Mental Health

Study found those on social media sites more than 2 hours a day were more likely to have problems

Teens who frequently use social media are more likely to say they struggle with mental health concerns that are not being addressed, new Canadian research reveals.

At issue is the amount of time adolescents spend browsing and posting on sites such as Facebook, Twitter or Instagram.

"It is difficult to speculate what mechanisms may link the use of social networking sites to mental health problems," said study author Dr. Hugues Sampasa-Kanyinga, from the department of epidemiology at Ottawa Public Health in Ottawa, Canada.

While the study did not prove a cause-and-effect link, Sampasa-Kanyinga noted that the "use of social networking sites can lead to poor mental health, and poor mental health may be a reason why youth use social networking sites. That said, it could be that kids with mental health problems are seeking out interactions as they are feeling isolated and alone. Or it could be that greater time online exposes one to more opportunities for cyberbullying, for instance."

Sampasa-Kanyinga and study co-author Dr. Rosamund Lewis reported their findings online recently in the journal Cyberpsychology, Behavior, and Social Networking.

In the study, the researchers analyzed part of a youth health survey that tallied responses from more than 750 students who were enrolled in grades 7 through 12 (average age of 14) in Ottawa.

Just over a quarter said they accessed social networking sites for more than two hours every day, while about a fifth said they never did or did so rarely. More than half (54 percent) said they surfed such sites, but for two hours or less daily.

Nearly two-thirds described their mental health status as either "excellent" or "very good." About a fifth said their mental state was "good," while about 17 percent described it as "poor."

In addition, about a quarter said they had mental health support needs that were going unmet, while the remainder said they were getting the help they felt they needed. About 13 percent said they had contemplated suicide.


Read also: Moderate Coffee Drinking and Seniors' Brain Health

Ultimately, the study authors determined that teens who accessed online sites two or more hours per day were more likely to describe their mental health as "poor" and less likely to have their own perceived needs for mental health support addressed.


High use of social networking was also linked to a higher risk for psychological distress and a higher likelihood for having had suicidal thoughts.

Sampasa-Kanyinga said some of the problem might lie in the anonymity of social networks, which boosts the risk for cyberbullying. Such sites also encourage teens to compare themselves to others, she noted, while making alcohol and cigarettes more appealing and accessible.

Nevertheless, she stressed that "everything is a matter of balance," and cautioned against drawing a direct cause-and-effect link between social networking and poor mental health among teens.

"A simple use of social networking sites cannot fully explain by itself the occurrence of mental health problems," Sampasa-Kanyinga said. "There are several factors that could interact to explain mental health outcomes," she said, including substance use, bullying, body image andweight concerns, and family history and context.

That said, she advised parents to limit their child's social networking time to under two hours a day, while remaining on the lookout for mood changes, dietary shifts, sleep issues and unusual behavior.


Scott Campbell, an associate professor of communication studies at the University of Michigan in Ann Arbor, described the study as "interesting," while suggesting that the effort "actually raises more questions than it helps answer."

Campbell, who was not involved with the study, pointed out that asking teens to quantify hours spent online is unreliable, given that Internet use -- unlike, say, movies -- is not easily measured in blocks of time. He also said that "the social implications of social network sites are highly dependent on how people use them, not just how much they use them."

"Generally speaking," Campbell said, "I would add that too much of anything is going to have negative implications, whether it be kale or social media." But he said more research would be needed to develop "a more nuanced picture of how different uses of social network sites by youth are associated with mental health indicators."

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Moderate Coffee Drinking and Seniors' Brain Health

But those who upped daily intake actually had higher odds for a precursor to dementia, researchers say

A study of more than 1,400 Italian seniors finds links between patterns of coffee consumption and their risk for "mild cognitive impairment" -- declines in memory and thinking that are often a precursor to dementia.

The study could only point to associations, not cause-and-effect, the investigators said. But prior research has suggested that caffeine might impact neurological health.

In the study, a team led by Dr. Vincenzo Solfrizzi of the University of Bari Aldo Moro, looked at the coffee consumption of 1,445 Italians aged 65 to 84. The participants' mental health was also tracked for a median of three-and-a-half years.

Reporting earlier this week in the Journal of Alzheimer's Disease, the research team found that people who consistently drank about one or two cups of coffee per day had a lower rate of mild cognitive impairment (MCI) than those who never or rarely drank the brew.

The beneficial association was not found among people whose habitual coffee intake exceeded two cups per day, Solfrizzi's group added.

And in what they called an "interesting" finding, the researchers found that the rate of MCI actually rose over time for seniors who bumped up their daily intake by a cup of coffee or more daily. Those participants had a rate of MCI that was about one-and-a-half times higher than that of long-term, moderate coffee drinkers (one to two cups per day) whose daily intake didn't increase.

The bottom line, according to the study authors: "Older individuals who never or rarely consumed coffee and those who increased their coffee consumption habits had a higher risk of developing MCI" compared to moderate coffee drinkers.

How might java influence brain health? According to the authors, mouse studies suggest that caffeine may have a "neuroprotective" effect in minimizing damage from the buildup of amyloid protein plaques -- long linked to Alzheimer's disease. And while "moderate" levels of caffeine have seemed to boost memory in rodents, higher doses may hinder it, Solfrizzi's team said.

Moderate caffeine intake might also help the aging brain by boostinginsulin sensitivity, cutting the odds for type 2 diabetes. Diabetes has long been linked to a higher risk for memory woes, the researchers said.

Still, more research is needed to strengthen the notion that one of the world's favorite drinks might help ward off dementia.

"Larger studies with longer follow-up periods should be encouraged . . . so hopefully opening new ways for diet-related prevention of dementia and Alzheimer's disease," the Italian team concluded.

What Is Drooling?

What Is Drooling?

Drooling is defined as saliva flowing outside of your mouth unintentionally. It is often a result of weak or underdeveloped muscles around your mouth.

The glands that make your saliva are called the salivary glands. You have six of these glands, and they are located on the bottom of your mouth, in your cheeks, and near your front teeth. These glands typically make 2 to 4 pints of saliva a day. When these glands make too much saliva, you may experience drooling.

Drooling is normal in the first two years of life. Infants do not often develop full control of swallowing and the muscles of the mouth until they are between 18 and 24 months old. Drooling often occurs when a baby is teething. It can also occur in people who have neurological disorders such as cerebral palsy.

What Conditions Cause Drooling?

Drooling can be a symptom of a medical condition, developmental delay, or taking certain medications. Anything that leads to excessive saliva production, difficulty swallowing, or problems with muscle control may lead to drooling.

Some of the medical conditions that affect muscle control over the lips and tongue and cause drooling include:

• cerebral palsy
• multiple sclerosis
• stroke
• Parkinson’s disease

Other conditions that can lead to drooling are:

• allergies
• acid reflux or heartburn
• pregnancy
• above-the-neck infections such as strep throat, tonsil infection, or sinus infections
• Drooling Risk Factors

Age

Drooling begins after birth and peaks between 3 and 6 months as infants become more active.

Neurological Disorders

Certain medical conditions can put you at risk for drooling. If a disease that decreases control of facial muscles affects you, you are more likely to drool.

Diet

Diets high in acidic content often cause excessive saliva production.

Medical Conditions

Drooling is usually caused by excess saliva in the mouth. Medical conditions such as throat infections and pregnancy can increase saliva production. Allergies, tumors, and sinusitis can impair swallowing.

How Is Drooling Treated?

Drooling is not always treated. Treatment will not be advised for someone under the age of 4 or who drools during sleep.

Treatment is recommended when drooling is severe; for example, if saliva drips from your lip to your clothing or your drooling interferes with your daily activities and creates social problems. Excessive drooling can also lead to inhaling saliva into the lungs, which can cause pneumonia.

Therapy

Speech and occupational therapists help teach positioning and posture control to help improve lip closure and swallowing. Therapists may also suggest you see a dietitian to modify the amount of acidic foods in your diet.

Appliance/Dental Device

A special device placed in the mouth helps with lip closure during swallowing. This option works best if you have some swallowing control.

Drugs

Certain medications help reduce saliva production. Medications include:

Scopolamine: comes as a patch and is placed on your skin to deliver the medication slowly throughout the day. Each patch lasts for 72 hours.
Glycopyrrolate (Robinul): given as an injection or in the form of a pill. Robinuldecreases your saliva production but can cause dry mouth as a result.
Atropine sulfate: given as drops in the mouth; usually used for patients during end-of-life care when they are having difficulties with drooling.
These medications can have side effects such as dry mouth, irritability, skin flushing, urinary retention, constipation, headaches, and nosebleeds.

Botox Injections

Botox injections may help reduce symptoms of drooling by tightening facial muscles.

Surgical Treatment

Several procedures are approved for the treatment of drooling. The most common is a procedure that reroutes the salivary ducts to the back of the mouth to prevent drooling outside of the mouth. Another procedure removes your salivary glands completely.

***

Digestive Diseases and Hepatitis A

What Are the Symptoms of Hepatitis A?

Hepatitis A is inflammation of the liver caused by the hepatitis A virus.

When symptoms occur, they may include:

• Jaundice (condition causing yellow eyes and skin, dark urine)
• Abdominal pain
• Loss of appetite
• Nausea
• Fever
• Diarrhea
• Fatigue

Children often have hepatitis A with few symptoms.

A person can spread the hepatitis A virus about a week before his or her symptoms appear and during the first week of having symptoms. People with no symptoms can also spread the virus.


How Is Hepatitis A Transmitted?

The hepatitis A virus is found in the stool of people with hepatitis A. It is spread from person to person by putting something in your mouth that has been contaminated with the stool of an infected person.

Therefore, hepatitis A is most commonly transmitted in drinking water or food contaminated with the stool containing the virus.

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It is spread easily where there is poor sanitation or poor personal hygiene.

Other ways to get hepatitis A include:

• Eating fruits, vegetables, or other foods that were contaminated during handling
• Eating raw shellfish harvested from water contaminated with the virus
• Swallowing contaminated water or ice

Who Is at Highest Risk of Hepatitis A?

• Those who are the highest risk of hepatitis A infection include:
• People living with or having sex with an infected person.
• People traveling to countries where hepatitis A is common.
• Men who have sex with men.
• Injecting and noninjecting drug users.
• Children and employees in child care settings.

How Is Hepatitis A Diagnosed?

Blood tests can diagnose hepatitis A.

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Are There Any Long-Term Effects of Hepatitis A?

Hepatitis A causes acute (short-lived) infection. The liver heals itself over a few weeks to months. Usually the virus doesn't cause any long-term problems or complications. However, according to the CDC, 10% to 15% of people with hepatitis A will have prolonged or relapsing symptoms over a six- to nine-month period. Rarely, patients will develop acute liver failure, which can be fatal, or require a liver transplant.

What's the Treatment for Hepatitis A?
There are no treatments that will cure hepatitis A. Your health care provider may monitor your liver function tests to be sure your body is healing appropriately.

Is There a Hepatitis A Vaccine?

Yes. Vaccination against hepatitis A is recommended for people older than 1 year old who:

• Are traveling to areas of the world with increased hepatitis A infection.
• Are men who have sex with other men.
• Have a blood clotting problem.
• Are injecting and noninjecting drug users.
• Have chronic liver disease.

The vaccine is given in two divided doses.

Can Hepatitis A Be Prevented?

Vaccination is your best defense against hepatitis A. In addition, if you come in contact with someone with hepatitis A you can receive a specific medication called immune globulin within two weeks of contact.

Good hygiene is also important. Always wash your hands with soap and water after using the bathroom, before and after handling food, and after changing a diaper.

Full Blood Count

Synonyms: FBC, complete blood count (USA), CBC (USA)

Background

There are a number of reasons why you might request a full blood count (FBC). A cursory glance at the FBC report will give you an idea about the presence of anaemia, infection or blood disorders. However, closer scrutiny will reveal a great deal more. This article will give you an overview of the main parameters measured and what they assess.

The FBC should be evaluated along with a blood film report - see separate article Peripheral Blood Film. Follow the links provided for more information about the related pathology.



Preliminaries

A sample of peripheral blood destined for FBC analysis should be sent to the laboratory in an EDTA bottle and preferably analysed within four hours of collection. Samples that were difficult to obtain (eg, lengthy venepuncture using a narrow gauge needle such as a small butterfly) may result in abnormalities due to cell lysis or clotting. In a hospital setting, it as also important to avoid taking a sample from the same site as an infusion in order to avoid haemodilution. There is a variety of techniques that blood analysers use to identify the various components and these may differ from laboratory to laboratory, so refer to your local laboratory's normal values when assessing your results. NB: the values provided in this article are a guide rather than a fixed indicator of limits.

It is helpful to group results in terms of:

• Red cell parameters
• White cells
• Platelets

You can then look in more detail at the additional information relating to the red and white blood cells.

Red cell parameters

Haemoglobin concentration
Haemoglobin (Hb) concentration - 

guideline normal values: 13.0-18.0 g/dL in adult males and 11.5-16.5 g/dL in adult, non-pregnant females.

This is usually the first parameter on a results form. It defines anaemia when low but may also be high in a number of other conditions. The identification of the type of anaemia is aided by:

• Mean cell volume (MCV) - guideline normal values: 77-95 fL. This is a good starting point for the evaluation of anaemia and usefully classifies anaemia into macrocytic and microcytic anaemias.
• Mean cell haemoglobin (MCH) - guideline normal values: 27.0-32.0 pg. High values are found in macrocytosis and low values are seen in iron deficiency.
• Mean cell haemoglobin concentration (MCHC) - guideline normal values: 32.0-36.0 g/dL. This is of particular use in the evaluation of microcytic anaemias. High values are seen in severe or prolonged dehydration, hereditary spherocytosis andcold agglutinin disease. MCHC is low in iron deficiency anaemia and thalassaemia.

Abnormal Hb levels
-Anaemia with low MCV (microcytic):

• Iron-deficiency anaemia - look at serum ferritin level.
• Anaemia of chronic disorders.
• Alpha/beta thalassaemia.

-Anaemia with normal MCV (normocytic):

• Recent bleeding.
• Anaemia of chronic disease (including renal disease).
• Combined iron and B12/folate deficiency.
• Most non-haematinic deficiency causes.

-Anaemia with high MCV (macrocytic):

• Folate or B12 deficiency.
• Hypothyroidism.
• Haemolytic anaemia.
• Liver disease.
• Alcohol excess.
• Marrow dysplasia and failure syndromes.
• Secondary to anti-metabolite drug therapy - eg, hydroxyurea.
• Aplastic anaemia.
• Sideroblastic anaemia (can also be microcytic).

High Hb
-It is important first to ascertain the validity of this result if it does not tie in with known clinical findings. At this point, exclude dehydration and diuretic therapy which may both increase the haematocrit (Hct).
-Anoxia is the major stimulus to red blood cell production and therefore an elevated Hb may be found:

• Where there has been recent travel to high altitude (>3,000 m).
• In hypoxic respiratory conditions - eg, chronic obstructive pulmonary disease (COPD).
• Heavy cigarette smoking (as a result of increased carboxyHb levels).
• Ventilatory impairment secondary to gross obesity and alveolar hypotension.

Secondary causes such as:

• Spurious polycythaemia (pseudopolycythaemia or Gaisbock's syndrome) - hypertensive, obese, cigarette smokers who drink to excess.
• Primary proliferative polycythaemia (polycythaemia rubra vera) - plethoric facies with a history of pruritus after change of environmental temperature/bathing, and splenomegaly.
• Inappropriate erythropoietin excess - this occurs in a variety of benign and malignant renal disorders. May also be a rare complication of some tumours - eg, hepatoma, uterine fibroids and cerebellar haemangioblastoma.

-In these patients, there must be an additional evaluation of the risk of thrombosis.

Hct or packed cell volume (PCV)

Guideline normal values (Hct): 0.40-0.52 in adult males and 0.36-0.47 in adult females.

These terms are sometimes used interchangeably. Essentially, the PCV measures the red cells that have settled to the bottom of a micro-capillary tube after this has been centrifuged. The Hct is similar but derived using automated blood counters. These values are high in polycythaemia of any cause and low in anaemia of any cause.

Red cell count (RCC)

Guideline normal values: 4.5-6.5 x 1012/L in adult males and 3.8-5.8 x 1012/L in adult females.

This is useful in the diagnosis of polycythaemic disorders and thalassaemias where the RCC is high, and of hypoproliferative anaemias and aplasias where it is low.

Red cell distribution width (RDW)

RDW measures the range of cell size in a sample of blood. The term anisocytosis refers to how great this range is. It may be of value in some anaemias. For example, a microcytic anaemia with a normal RDW suggests a beta thalassaemia trait, whereas the same anaemia with a high RDW points towards iron deficiency. Interpretation of this measurement tends to be more the preserve of haematology staff.

White cells

The FBC provides a total white cell count (WCC)/white blood cell count (WBC) and an automated differential WCC. Typically, this includes information about:

• Neutrophils
• Lymphocytes
• Monocytes
• Eosinophils
• Basophils

The FBC report often shows the % of each type of white cell but, unless the absolute WCC is known (as x 109), it may be of limited value.

Neutrophils (polymorphs or polymorphonucleocytes)
Guideline normal values: 2-7.5 x 109/L, comprising 40-75% of WBCs.
-Raised in:

• Bacterial infections.
• Trauma.
• Surgery.
• Burns.
• Haemorrhage.
• Inflammation.
• Infarction.
• Polymyalgia rheumatica.
• Polyarteritis nodosa.
• Myeloproliferative disorders.
• Certain drugs - eg, steroids.
• Transient leukaemoid reaction in Down's syndrome.
• Mild increase: stress (eg, postoperatively), exercise.
• Moderate increase: heat strokes, patients with solid tumours.
• Large increase in numbers may be seen in leukaemias, disseminated malignancy and severe childhood infections.

-Decreased in:

• Viral infections.
• Certain drugs - eg, carbimazole, sulfonamides, methotrexate.
• Severe sepsis (consumption by attempt to combat infection).
• Hypersplenism.
• Systemic lupus erythematosus.
• Rheumatoid arthritis (destroyed by chronic inflammatory process) - with splenomegaly: Felty's syndrome.
• Vitamin B12 or folate deficiency.
• Chronic benign neutropenia of infancy/childhood - usually resolves by age 4.
• Bone marrow failure (impaired production).
• Brucellosis.
• Typhoid.
• Kala-azar.
• Tuberculosis (TB).

-Chronic idiopathic neutropenia is an often severe neutropenia which usually runs a benign course - this is a diagnosis of exclusion.

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Lymphocytes

Guideline normal values: 1.3-3.5 x 109/L, comprising 20-45% of WBCs.
-Raised in:

• Viral infections - eg, Epstein-Barr virus (EBV), cytomegalovirus, rubella.
• Characteristic of infectious mononucleosis.
• Toxoplasmosis.
• Whooping cough.
• Brucellosis.
• TB.
• Syphilis.
• Chronic lymphocytic leukaemia (CLL).
• Large numbers of abnormal/atypical lymphocytes are characteristically seen in EBV infection (these are T lymphocytes reacting against EBV-infected B lymphocytes).
• Normal infants and children aged <5 have a higher proportion and concentration than adults.

-Decreased in:

• Steroid therapy.
• Systemic lupus erythematosus.
• Uraemia.
• Legionnaire's disease.
• AIDS.
• Marrow infiltration.
• Post-chemotherapy/radiotherapy.

Eosinophils

Guideline normal values: 0.04-0.44 x 109/L, comprising 1-6% of WBCs.
-Raised in:

• Asthma/allergy.
• Parasitic infestations (especially invasive helminths).
• Polyarteritis nodosa.
• Skin disease such as eczema, pemphigus, urticaria.
• Malignant diseases (including eosinophilic leukaemia).
• Following irradiation.
• Löffler's syndrome.
• During the convalescent phase of infections.
• As part of the hypereosinophilic syndrome.
• Eosinophilia-myalgia syndrome.

Monocytes

Guideline normal values: 0.20.8 x 109/L. comprising 2-10% of WBCs.
-Raised in:

• Acute and chronic infections (especially TB, brucellosis, protozoan disease).
• Malignant disease (especially M4 and M5 acute myeloid leukaemia andHodgkin's disease).
• Myelodysplasia.

Basophils

Guideline normal values: up to 0.01 x 109/L, comprising 0-1% of WBCs.
-Raised in:

• Viral infections.
• Urticaria.
• Hypothyroidism.
• Post-splenectomy.
• Chronic myeloid leukaemia (CML).
• Ulcerative colitis.
• Malignancy.
• Systemic mastocytosis (or urticaria pigmentosa).
• Haemolysis.
• Polycythaemia rubra vera.

The platelet count

The normal platelet count is 150-400 x 109/L. Below is a list of the common or important causes of raised or decreased platelet counts, which is by no means exhaustive.

Causes of thrombocytopenia (decreased platelet count)

-Decreased platelet production:
  -Hypoplasia of megakaryocytes:

• Aplastic anaemias.
• Leukaemias.
• Myelofibrosis.
• Marrow invasion - eg, granulomata, metastatic tumour, leukaemia.
• Viral infections.
• Ionising radiation causing marrow suppression.
• Chemical toxicity - eg, chemotherapy, toxins, medication-induced, alcohol excess.
• HIV.

  -Ineffective thrombopoiesis:

• Vitamin B12 deficiency.
• Folic acid deficiency.

-Increased platelet destruction:
  -Immune-mediated platelet destruction:

• Drug-induced immune thrombocytopenia.
• Alloimmune thrombocytopenia - eg, neonatal, post-transfusion.
• Autoimmune thrombocytopenia - eg, idiopathic immune thrombocytopenia, secondary immune thrombocytopenia due to infections, rheumatological diseases and lymphoproliferative disorders.

  -Non-immune-mediated platelet destruction:

• Disseminated intravascular coagulation.
• Prosthetic intravascular devices.
• Thrombotic thrombocytopaenic purpura.
• Massive haemorrhage and destruction.
• Extracorporeal circulation devices.

-Increased splenic sequestration:

• Splenomegaly.
• Portal hypertension.

Although the underlying cause needs to be addressed, it is worth noting that most patients with a platelet count of >30 x 109/L need no specific therapy. Clearly, aspirin should be avoided.

Causes of thrombocytosis/thrombocythaemia (increased platelet count)

This is a platelet count of > 450 x 109/L. It may be due to a primary myeloproliferative disorder or to a secondary reactive feature.

-Essential or primary thrombocytosis:
-This is defined as a non-reactive chronic myeloproliferative disorder that causes chronic elevation of platelet count.
-These patients are at risk of a haemorrhage (the platelets are dysfunctional) or thrombosis or both.
-Disorders include:

• Primary thrombocythaemia.
• Polycythaemia rubra vera.
• Chronic granulitic leukaemia.
• Idiopathic myelofibrosis.

-Reactive or secondary thrombocytosis:

• Acute infective or inflammatory disorders.
• Chronic inflammatory disorders - eg, TB, rheumatological disorders.
• Post-splenectomy or splenic hypofunction/hypoperfusion or congenital asplenia.
• Trauma (including surgery).
• Acute haemorrhage.
• Iron-deficiency anaemia.
• Malignancy (eg, lung and breast cancer).
• Some leukaemias (particularly CLL or CML).

Platelet distribution width (PDW)

PDW measures the range of platelet size in a sample of blood. This gives an idea of the amount of active platelet release. Interpretation of this is generally the remit of haematology staff.


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