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Hypoproteinemia - ICD-10, Symptoms, Causes, Treatment

Hypoproteinemia is the reduction in total protein concentration in plasma or serum that is lower than expected according to age, gender, physiological. Hypoproteinemia may result from a decrease in albumin and globulin concentration or a decrease in both albumin or globulin concentrations. Some basic types of  hypoproteinemia include

  • Panhypoproteinemia: It includes reduction in both types of proteins e.g hypoalbuminemia and hypoglobulinemia 
  • Hypoproteinemia: It includes reduction in one type of protein e.g hypoalbuminemia and normal globulin concentration 
  • Hypoproteinemia: It includes reduction in one type of protein e.g hypoglobulinemia and normal albumin.
Hypoproteinemia may be caused by protein synthesis reduction and seen in malnutrition and chronic liver disease. Protein malnutrition deprives the hepatic system for production of plasma proteins and is a common problem in hospitalized patients. In chronic liver disease, the protein synthesis machine is impaired, which means hypoproteinemia. Protein increased catabolism is observed in various inflammatory and neoplastic conditions. 

Excessive loss of protein may occur in the kidneys, the gastrointestinal tract, or the skin. Examples include nephrotic syndrome, inflammatory bowel disease, extensive burns, and any severe exudative process. The most serious loss can be seen in nephrotic syndrome where number of plasma proteins, in particular albumin, is passed through the glomeruli into the urine. Changes in total serum protein may cause changes in albumin, globulin, or both. For this reason, it may be useful to determine the ratio of the concentration of albumin to the concentration of globulin. 

Hypoproteinemia - ICD-10, Symptoms, Causes, Treatment

Hypoproteinemia Symptoms

Sign and Symptoms associated with hypoproteinemia may vary depending upon underlying cause. However, some commonly reported symptoms of hypoproteinemia are edema, tachycardia, asthenia, weight loss, diarrhea and polyuria. Some patients may also feel melena, ascites, rashes on body, swelling in extremities and tingling.

Hypoproteinemia Causes

Some common causes that are associated with Hypoproteinemia are as follows

  • Vasculitis
  • Hepatic impairment
  • Protein losing enteropathy
  • Ulcerative colitis
  • Enteritis
  • Granulomatosis
  • Severe infections
  • Drug induced Hypoproteinemia
  • Pyelonephritis
  • peritonitis
  • Pleuritis
  • Chronic heart failure

Hypoproteinemia Treatment

Treatment of hypoproteinemia is mainly consist of bolus infusion of protein in case of severe protein loss especially seen in chronic kidney disease patients. However, it is important treatment underlying cause along with bolus protein infusion to limit its further loss. If you have mild hypoproteinemia then your health care provider might recommend you tablets that increases protein synthesis in the body like ketosteril etc. 

Diet plan may also provides beneficial results e.g eating products that are rich in amino acids improve protein synthesis. Examples of such diet include protein shakes, milk, egg white, dates, red meat etc.

Hypoproteinemia ICD-10

Following code is used for Hypoproteinemia in ICD-10

E88.09--Other disorders of plasma-protein metabolism, not elsewhere classified--Billable
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What are schistocytes - Defintion, Symptoms, Causes, Diagnosis

Schistocytes (schistocytes) are fragments of erythrocytes that are small and irregular in shape. Since these cells are produced as a result of rupturing of the red blood cell (RBC's) apart, the schistocyte is about half the size of normal erythrocytes and may have a deeper red appearance. An increase in schistocytes can be seen in hemolytic anemia associated with burns and prosthetic implants and rejection of kidney transplants.

Basically, schistocytes are fragments of red blood cells (RBC's) formed by fragmentation of abnormal cells, for example, in pyropoikilocytosis associated with some genetic defect or mechanical injury, toxin or heat-induced change of pre-normal cells. When as a result of mechanical damage, schistocytes often coexist with keratocytes.

Many Schistocytes spiculated. Others have been left too little for their membrane cytoplasmic volume and therefore form microspherocytes (spheroschistocytes). In patients with burns schistocytes can be obeserved as microdiscocytes and microspherocytes. A rare form of red blood cell fragment, linear or filamentous structure is observed in sickle cell anemia. The most common causes of schistocytes are hemolytic anemia and microangiopathy. Schistocytes may be a characteristic of myelodysplastic syndrome which is common in erythroleukemias patients.

What are schistocytes - Defintion, Symptoms, Causes, Diagnosis

Schistocytes Symptoms

Physically it is difficult evaluate symptoms associated with schistocytes because it might be an outcome of any hemolytic disease or kidney disease.  It can only be confirmed via differential cell count or morphological assessment of blood. Many doctors recommend routine screening of blood 2-3 times in year to rule any hemolytic disease.

Schistocytes Causes

Schistocytes exhibit micro-enteropathic haemolytic anemia and are associated with various non-infectious diseases, particularly disseminated intravascular coagulation (DIC). Schistocytes are present with DIC whether caused by non-infectious disorder, for example, malignant tumor,  or underlying infectious disease for example, meningococcemia. Spherocytes are characteristic of gas gangrene, but can be found in various other diseases, including autoimmune hemolytic anemia, cirrhosis, transfusion reactions and severe burns.

Schistocytes Diagnosis

Schistocytes  are usually obtained from direct physical damage to red blood cells secondary to vascular abnormalities or turbulent blood flow. The shape of the fragments may vary from acute or triangular spiculated. Microangiopathic granulation has been reported in several different disorders, including disseminated intravascular coagulation (DIC), glomerulonephritis (GN). Hemangio sarcoma, myeloflbrosis, dyserythropoiesis and Chronic Toxic inoculation with doxorubicin. Schistocytes have also been identified as a common characteristic of disseminated intravascular coagulation.
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