Nathalie van der Velde, Bruno H. Ch. Stricker, Huib A. P. Pols, Tischa J. M. van der Cammen (2007) Risk of falls after withdrawal of fall-risk-increasing drugs: a prospective cohort study
British Journal of Clinical Pharmacology 63 (2) , 232–237 doi:10.1111/j.1365-2125.2006.02736.x

Onderzoek naar stinkende ziekte geeft inzicht in bloedvergiftiging [31 juli 2007]

De infectieziekte melioidose kan leiden tot ernstige, vaak zelfs dodelijke bloedvergiftiging (sepsis). Het immuunsysteem van patiënten met de ziekte brengt bepaalde eiwitten sterker tot expressie dan de afweer van gezonde mensen, schrijven onderzoekers van de afdeling Experimentele Moleculaire Geneeskunde van het AMC in een artikel in het tijdschrift PloS Medicine dat vandaag verschijnt. Remming van deze eiwitten biedt mogelijk aangrijpingspunten voor een betere behandeling van melioidose en van sepsis in het algemeen. De bacterie die de aandoening veroorzaakt staat sinds enkele jaren op de lijst van mogelijke bioterroristische wapens.

Immuuncellen gebruiken bepaalde eiwitten op hun celoppervlak om een afweerreactie op gang te brengen. Deze Toll-like receptoren (TLRs) beoordelen ziekteverwekkers op hun gevaarlijkheid, en zetten het immuunsysteem vervolgens aan tot een gepaste reactie. Onderdeel daarvan is de aanmaak van cytokines (giftige, bacteriedodende stoffen), die zorgen voor een ontstekingsrespons in het lichaam. Als te veel TLRs worden aangemaakt, ontstaan ook veel cytokines, waardoor de afweer ontspoort. Dat kan resulteren in extreem heftige, soms zelfs levensbedreigende ontstekingsreacties. Dit gebeurt bijvoorbeeld bij sepsis door melioidose.

Melioidose is een ernstige tropische ziekte die vooral in Zuidoost-Azië (met name in Thailand) en Noord-Australië veel slachtoffers maakt. Oorzaak is de bacterie Burholderia pseudomallei. Melioidose kenmerkt zich door abcessen die overal in het lichaam kunnen ontstaan en vreselijk stinken. Vandaar ook de bijnaam ‘smelliodose’, vrij vertaald ‘stinkidose’. Behandeling met breed-spectrum-antibiotica helpt vaak onvoldoende. Als de bacterie zich blijft vermenigvuldigen ontstaat soms sepsis (bloedvergiftiging), wat uiteindelijk kan leiden tot orgaanfalen.

Besmetting verloopt vaak via wondjes in de huid, waardoor de in de bodem levende bacil het lichaam binnendringt. Andere mogelijke infectiebronnen zijn besmet water of ingeademde besmette stofdeeltjes.

Er is de laatste jaren meer aandacht voor de Burholderia pseudomallei omdat de Amerikaanse gezondheidsautoriteiten de ziekteverwekker beschouwen als een mogelijk bioterroristisch wapen. Een bacterie wordt op de lijst van dergelijke wapens geplaatst op grond van een aantal factoren. Belangrijk is onder andere dat de betreffende bacil een ernstige ziekte veroorzaakt die in veel gevallen dodelijk verloopt, relatief makkelijk is op te kweken maar moeilijk te behandelen, veel angst aanjaagt en zich gemakkelijk verspreidt, bijvoorbeeld via de lucht.

*** 1. ALGEMENE KLACHTEN **************************************

8 Voelt u zich ziek ?

Bij elke vraag vragen:
1. Sinds hoelang ?
2. Wat was het tijdsverloop bij het ontstaan?
3. Verbetert of verergert het ?
4. Waarmee gaat het gepaard ?
10 Lusteloosheid ? Wanneer ? Welk deel van het etmaal?
12 Moeheid ? Wanneer ? Welk deel van het etmaal ?
14 Koorts ? Hoe hoog ?
14 Koorts ? Gedurende welke tijd ?
14 Koorts ? Wat is temperatuursverloop ?
14 Koorts ? Gepaard met koude rillingen ?
14 Koorts ? Hoe vaak koude rillingen ?
22 Koorts gehad vroeger? Hoe hoog ?
22 Koorts gehad vroeger ? Hoe lang geleden ?
22 Koorts gehad vroeger ? Hoe lang duurde dit toen?
23 Veranderde eetlust?
24 Overmatige dorst ? Gepaard met normale of grote hoeveelheid urine ?
24 Overmatige dorst ? Gepaard met normale of kleinere hoeveelheid urine ?
26 Gewichtsverandering ? Hoeveel kilo ?
28 Overmatig transpireren ?
29 Jeuk ?
30 Meer vatbaar voor infecties ?

*** 2. TRACTUS CIRCULATORIUS ********************************

32 Kortademigheid ? Bij rust ?
32 Kortademigheid ? Bij inspanninglast? En in welke mate ?
32 Kortademigheid ? Op een bepaalde tijd v.d. dag?
32 Kortademigheid ? Bij plat liggen ?
38 op hoeveel kussens slaapt u ?
39 Dikke enkels ? Wanneer heeft U last van dikke enkels?
41 's Nachts plassen Hoeveel keer ?
43 Pijn op de borst ? Hoevaak ?
43 Pijn op de borst ? Localisering ?
43 Pijn op de borst ? Wat is de aard ?
43 Pijn op de borst ? Is er uitstraling van pijn ?
43 Pijn op de borst ? Wat is de duur van een aanval ?
43 Pijn op de borst ? Bij inspanning ?
43 Pijn op de borst ? Gaat het over bij rust ?
43 Pijn op de borst ? Gaat het over na nitrobaat ?
43 Pijn op de borst ? Hoe lang na nitrobaat gebruik gaat het over?
43 Pijn op de borst ? In samenhang met hoesten, ademhalen, slikken, bukken,
43 Pijn op de borst ? In samenhang met koude, platliggen of emoties ?
43 Pijn op de borst ? In samenhang met ademhaling ?
43 Pijn op de borst ? In samenhang met hoesten ?
57 Pijn op de borst gehad vroeger ? Hoe lang geleden ?
58 Hartkloppingen ? Hoe vaak ?
58 Hartkloppingen ? Regelmatig of onregelmatig ?
58 Hartkloppingen ? Hoeveel slagen per minuut ?
58 Hartkloppingen ? Acuut begin en eind ?
58 Hartkloppingen ? Wanneer treden zij op ?
58 Hartkloppingen ? Gepaard met verminderde of vermeerderde urine produktie ?
65 Langzame hartslag ?
66 Overslaan van hartslag ?
67 Bewustzijnsverlies ? Duurt dit lang ?
67 Bewustzijnsverlies ? Hoe vaak ?
67 Bewustzijnsverlies ? Hoe lang geleden ?
67 Bewustzijnsverlies? Waardoor veroorzaakt ?
69 Pijn in kuiten bij lopen ? Na welke afstand ?
69 Pijn in kuiten bij lopen ? Bij stilstaan over ?
72 Koude handen of voeten ? Gepaard met kleursveranderingen ?
72 Koude handen of voeten ? Gepaard met pijn ?
75 Dik, pijnlijk been? Op dit moment pijn ?
78 Dik, pijnlijk been gehad vroeger ? Hoe lang geleden ?
79 Open benen nu of vroeger ?
80 Verhoogde bloeddruk? Hoe lang geleden is dat vastgesteld ?
31 Moest u bij uw zwangerschappen dieet houden ?

*** 3. TRACTUS RESPIRATORIUS ****************************

82 Hoest ? (Droog of productief ?) Welk deel van de dag en
82 Hoest ? (Droog of productief ?) Waardoor wordt dit uitgelokt ?
82 Hoest ? (Droog of productief ?) Gepaard met piepen en brommen op de borst ?
82 Hoest ? (Droog of productief ?) Zij er seizoensinvloeden?
86 Slijm opgeven ? Hoeveel ?
86 Slijm opgeven ? Hoe ziet het eruit ?
86 Slijm opgeven ? verandert het van aspect ?
86 Slijm opgeven ? stinkt het sputum ?
91 Bloed ophoesten ? Hoe lang geleden?
91 Bloed ophoesten ? Hoeveel ?
94 Piepende ademhaling ? bij in- of uitademen ?
96 kortademigheid in aanvallen?
96 waardoor wordt dit opgewekt ? Kortademigheid
96 hoe lang geleden ?
103 Kortademigheid gehad vroeger ?
104 Vaak erg verkouden ?
105 Hooikoorts ?
106 Ernstige keelontsteking vroeger gehad ?
107 Heesheid ?

*** 4. TRACTUS DIGESTIVUS ******************************

108 Stinkende adem ?
109 Pijnlijke mondhoeken ?
110 Tand(wortel) ontstekingen?
111 Makkelijk bloedend tandvlees ?
112 Zwelling(en) in mondholte ?
113 Wonden in de mond ?
114 Pijnlijke tong ?
115 Verdikkingen in de tong ?
116 Droge mond ?
117 Pijnlijke keel?
118 Moeilijk openen van de mond ?
119 Slikklachten ?
120 Prop in de keel ?
121 Dikwijls verslikken ?
122 Niet zakken van voedsel? Op welke hoogte blijft het steken ?
122 Niet zakken van voedsel? bij vast of vloebaar voedsel ?
122 Niet zakken van voedsel ? waardoor minder ?
126 Pijn bij het slikken ? waar gelocaliseerd?
128 Hik ?
129 Pijn in de buik ? gedurende welke periode ?
129 Pijn in de buik ? welk deel van de buik ?
129 Pijn in de buik? straalt pijn uit ?
129 Pijn in de buik ? waarnaar toe uitstralend?
129 Pijn in de buik ? welk karakter ?
129 Pijn in de buik ? welk deel van het etmaal ?
129 Pijn in de buik ? waardoor verergering?
129 Pijn in de buik ? waardoor verlichting ?
139 Pijn in de buik gehad vroeger ? hoe lang geleden ?
140 Zuurbranden ? welk deel van het etmaal ?
140 Zuurbranden ? waardoor wordt dit uitgelokt ?
140 Zuurbranden ? waardoor wordt dit minder ?
144 Overmatig vocht in de mond ? (Hartwater ?)
145 Boeren ? 146 Voedsel niet verdragen ?
147 Misselijkheid ?
148 Braken ? hoe vaak ?
148 Braken? op welk deel van het etmaal ?
148 Braken ? waardoor uitgelokt?
148 Braken ? gaat dit met grote kracht ?
148 Braken ? welke hoeveelheid ?
148 Braken ? hoe ziet het eruit ?
148 Braken ? hoe lang na de maaltijd ?
156 Verstoppingen ?
157 Diarrhee ?
158 en
159 om de hoeveel tijd ontlasting ? Ontlasting
158 gepaard met buikkrampen ? Ontlasting
158 defaecatie zelf pijnlijk? Ontlasting
158 hoe is de gebondenheid ? Ontlasting
158 hoeveel ontlasting per keer ?
158 welke kleur ? Ontlasting
158 bloed of slijm bijmenging? Ontlasting
158 stinkt de ontlasting ?
167 Aambeien ?
168 Gele huid en geel oogwit ?

*** 5. TRACTUS UROGENITALIS ***********************************

169 hoeveel maal per dag urineren ?
169 hoe lang geleden het laatst?
173 Verandering in urineerpatroon ?
172 Pijn bij het urineren?
174 Laten lopen van urine ?
175 Moeilijke mictie ?
176 Persen bij urineren ?
177 Slappe straal bij urineren ?
178 Nadruppelen?
179 Afbreken van de straal ?
180 Niet voelen aankomen van de plas ?
181 Vreemde kleur urine ?
182 Vies ruikende urine ?
183 Bloed in urine ? Hoe lang geleden ?
183 Bloed in urine ? Hoevaak al gehad ?
186 Pijn in de zij ? straalt of straalde pijn uit ?
186 Pijn in de zij ? waarnaar toe uitstraling ?
186 Pijn in de zij ? wat is de aard van de pijn
186 Pijn in de zij ? in samenhang met urineren ?
186 Pijn in de zij ? hoe vaak ?
193 Pijn in de zij gehad vroeger ? hoe lang geleden ?
194 Hoe oud bij eerste menstruatie ?
194 Op welke leeftijd hield de menstruatie definitief op ?
194 Daarna wel eens bloedverlies ?
194 Om de hoeveel tijd menstruatie?
194 Hoeveel vaginaal bloedverlies per keer
200 Vaginale afscheiding ? hoe ziet dit eruit ?
202 hoeveel kinderen heeft u ?
202 hoeveel levend geboren ?
202 hoeveel overleden binnen maand ?
202 hoeveel miskramen?
207 Heeft U bij de geboorte zeer zware kinderen gehad ?
208 Impotent ?

*** 6. TRACTUS LOCOMOTORIUS *********************************

209 Pijn in de gewrichten ? waar gelocaliseerd ?
209 Pijn in de gewrichten ? aangedane gewrichten rood ?
209 Pijn in de gewrichten? aangedane gewrichten gezwollen ?
209 Pijn in de gewrichten ? aangedane gewrichten warm?
209 Pijn in de gewrichten ? Bewegingsbeperking in de aangedane gewrichten ?
209 Pijn in de gewrichten ? Zijn klachten verspringend ?
217 Zijn de gewrichten stijf?
218 Verdwijnt de stijfheid bij gebruik van de gewrichten?
219 Na hoeveel tijd verdwijnt dit bij gebruik v.d.gewrichten?
210 Hoe lang geleden pijn gehad ?
220 Pijn in gewrichten gehad vroeger ?
221 Pijn in de nek ?
222 Rugpijn ? waar gelocaliseerd?
222 Rugpijn ? straalt het uit ?
222 Rugpijn ? waar naar toe straalt dit uit ?
222 Rugpijn ? waardoor verergert dit ?
227 Bewegingsbeperking van de rug ?
228 Verkromming van de rug ?
229 Pijn in de armen?
230 Pijn in de benen ?
231 Krachtsverlies in armen/benen ? waar gelocaliseerd ?
233 Pijn in de botten ? waar gelocaliseerd ?

*** 7. TRACTUS HAEMOPOETICUS ********************************

235 Bleke huidskleur ?
236 Rode huidskleur ?
237 Blauwe plekken, bloeduitstoringen huid- of slijmvliesbloedingen ?
237 Blauwe plekken, bloeduitstoringen huid- of slijmvliesbloedingen? Spontaan?
237 Blauwe plekken, bloeduitstoringen huid- of slijmvliesbloedingen ? Plaats?
240 Nabloeden bij kleine wondjes ?
241 Nabloeden bij kiestrekken of tandtrekken of veel bloedingen bij bevalling?
242 Klierzwellingen ? op welke plaats ?
242 Klierzwellingen ? waardoor wordt pijn uitgelokt ?
242 Klierzwellingen ? pijnlijke klieren
247 Klierzwellingen gehad vroeger ? Hoe lang geleden ?

*** 8. TRACTUS ENDOCRINOLOGIE ********************************

249 Zwellingen in de hals ?
250 Kouwelijkheid ?
251 Slecht warmte verdragen ?
252 Nerveusiteit ?
253 Drift of huilbuien ?
254 Trillen van de handen ?
255 Buitensporige haaruitval ? waar gelocaliseerd ?
257 Buitensporige haargroei ? waar gelocaliseerd ?
259 Verandering toonhoogte van stem?
260 Verandering maat van (hand)schoen ?

*** 9. TRACTUS CENTRAAL ZENUWSTELSEL***************************

261 Achteruitgaand gezichtsvermogen? hoe is het rechts ?
261 Achteruitgaand gezichtsvermogen? hoe is het links ?
261 Achteruitgaand gezichtsvermogen? Moeilijkheden bij veraf/dichtbij zien?
265 Zwarte vlekken voor ogen ?
266 Dubbel zien ? In een bepaalde richting ?
268 Pijn in beide ogen ?
270 Achteruitgaand gehoor ? Aan welk oor ?
272 Oorpijn? gepaard met afscheiding in oor
274 Oorsuizen ?
275 Vermindert smaakvermogen ?
276 Duizeligheid ? Wat is de aard
276 Duizeligheid? Speciaal bij opstaan uit liggende of zittende houding ?
279 Hoofdpijn ? waar gelocaliseerd ?
279 Hoofdpijn ? welk deel van het etmaal ?
282 Sufheid ?
283 Verlammingen ? Waar gelocaliseerd?
286 Verlammingen gehad vroeger ? Hoe lang geleden ?
287 Stoornissen in tastzin ? Waar gelocaliseerd ?
290 Stoornissen gehad in tastzin vroeger ? Hoe lang geleden ?
291 Doof gevoel in handen/voeten? Waar gelocaliseerd ?
293 Prikkelingen in handen/voeten ? Waar gelocaliseerd ?
295 Krampen in handen of voeten ? Waar gelocaliseerd?
297 Onwillekeurige bewegingen? Waar gelocaliseerd ?
297 Onwillekeurige bewegingen? In welk deel van etmaal ?
300 Spraakstoornissen ? Wat voor soort ?
302 Last van toevallen gehad vroeger? Hoe lang geleden ?
302 Last van toevallen gehad vroeger? Hoeveel maal gehad?
305 Slaapstoornissen ? Wat voor soort ?
307 Somber zijn ? Welk deel van het etmaal ?

*** 10. TRACTUS HUIDAFWIJKINGEN ******************************

309 Huidafwijkingen ? Op welk gedeelte van lichaam ?
309 Huidafwijkingen? Welke vorm ?
309 Huidafwijkingen ? Hoeveel zijn of waren er?
309 Huidafwijkingen ? Welke kleur ?
309 Huidafwijkingen ? Veranderde vorm of kleur ?
309 Huidafwijkingen ? Hoe zag de afwijking er aanvankelijk uit ?
309 Huidafwijkingen ? Veranderde de afwijking tegelijkertijd ?
309 Huidafwijkingen ? Kwam er vocht uit ?
309 Huidafwijkingen ? Hoe zag dit vocht eruit ?
309 Huidafwijkingen ? Gepaard met jeuk ?
309 Huidafwijkingen ? Waren zij pijnlijk?
309 Huidafwijkingen ? Ontstaan na gebruik van geneesmiddelen?
309 Huidafwijkingen ? Ontstaan na contact met een speciale stof?
323 Huidafwijkingen gehad vroeger ? Hoe lang geleden ?

*** 11. VERDERE GEGEVENS **************************************

325 Ziekten: Komen er specifieke ziekten voor in de familie?
326 Eetgewoonten: wat eet u in een etmaal ?
327 Roken, inhaleren: Rookt u ? En inhaleert u ?
328 Heeft u vroeger gerookt ?
329 Hoe lang geleden voor het laatst ? .
330 Drinkgewoonten: Hoeveel per dag ?
331 Hoeveel drinkt U en wat voor alcoholische dranken ?
332 Ten behoeve van de trombosedienst: Gebruikt u pijnstillers (aspirine)?
333 Bent u bij de trombosedienst?
334 Gebruikt u de pil ? .

1006 Medicijnen: Welke medicijnen gebruikt u ? .
1010 Speciale reacties op medicijnen ?
1013 Wat zijn uw hobby's ?
1011 Wat is uw gezinssamenstelling?
1012 Hoe is uw woonomstandigheid.
1007 Wat is uw beroep ?
1008 Wat zijn uw vroegere ziekten ?
1014 Allergieen / huisdieren ?

***********EINDE ANAMNESE****************************************



History Taking list (in English)

***1. General complaints ******************************

8. Are you feeling ill?
10. Restlees? Irritable?
11. What part of the day?
12. Are you feeling tired?
13. What part of the day?
14. Do you have fever?
16. What temperature
18. During what time?
19. Did the temperature change?
15. Is it attended by chills?
17. How often do you have chills?
20. How long ago did you have them?
21. How long did it last this time?
22. Have you been having fever before?
23. Did you have any change in appetite?
24. Excessively thirsty?
25. Attended with usual, smaller or larger quantity of urine?
26. Was there any change in your weight?
27. How many kilos?
28. Excessive perspiration?
29. Itching?
30. Are you more susceptible to infections?

***2. Circulatory Tract ******************************

32. Shortness of breath?
33. While at rest?
34. While excercising? To what extent?
35. At a certain time of the day?
36. While lying down?
38. On how many pillows do you sleep?
39. Do you have swollen ankles?
40. When?
41. Do you urinate during the night?
42. How often?
43. Pain at the chest?
44. How often?
46. Localization?
47. Pain of what kind?
48. Radiation to other parts?
49. How long does the pain last?
50. While excercising?
51. Gone when at rest?
52. Gone after taking nitroglycerine?
53. How long after taking the nitro?
54. Is it connected with coughinh? breathing? swallowing? stooping? cold? lying down? emotions?
55. Connected with breathing?
56. Connected with coughing?
57. Did you have pain on the chest in the past?
58. Palpitations?
59. How often?
60. Regular or irregular heartbat?
61. How many beats per minute?
62. Do they start and stop suddenly?
63. When do they occur?
64. Attended with increased or diminished urine production?
65. A slow heartbeat?
66. A skipped beat?
67. Have you ever fainted (black-out)?
68. How long does this last? How often? How long ago? Evoked by what?
69. Do you have pain in the calfs while walking?
70. After what distance?
71. Does it pass over when you stop?
72. Cold hands or feet?
73. Attended with a change of colour?
74. Attended with pain?
75. Swollen and painful legs?
76. Pain at this moment?
77. How long ago?
78. Swollen painful legs before?
79. Sore legs at this time or in the past?
80. High blood pressure?
81. How long ago was it noticed?
31. Having a diet during pregnancies?

***3. Respiratory tract ******************************

82. Cough? Dry or productive?
83. What part of the day? What is it provoked by?
84. Attended by wheezing and humming on at the chest?
85. Influence of season?
86. Spit mucus?
87. How much?
88. What does it look like?
89. Does the sputum change in any way?
90. Does the sputum smell?
91. Do you cough up blood?
92. How long ago?
93. How much?
94. Wheezing?
95. During inspiration or expiration?
96. Shortness of breath?
99. Shortness of breath in attacks?
100. What is the attack evoked by?
102. How long ago?
103. Shortness of breath in earlier days?
104. Often a severe cold?
105. Hay-fever?
106. Severe angina in the past?
107. Hoarseness? Pain on the chest? How long ago? Where is it localised? Attended with breathing? Attended with coughing? Pain on the chest in the past?

***4. Digestive tract ******************************

108. Smelling breath?
109. Painful corners of the mouth?
110. Inflammation of teeth or roots of the teeth?
111. Quickly bleeding gums?
112. Swellings in the mouth?
113. Wounds in the mouth?
114. Painfull tongue?
115. Thickenings in the tongue?
116. Dry mouth?
117. Sore throat?
118. Difficulties with opening your mouth?
119. Complaints with swallowing?
120. Lumps in the throat?
121. Doyou often choke?
122. Impaired passage of food?
123. Where does it get stuked?
124. With solid or liquid food?
125. What is it decreased by?
126. Pain while swallowing?
127. Where localised?
128. Hiccups?
129. Pain in the belly?
131. During what period?
132. What part of the belly?
133. Does it radiate?
134. Where does it radiate to?
135. How could you describe the pain (character of the pain)?
136. What part of the day?
137. What makes it worse?
138. What relieves it?
130. How long ago?
139. Did you have pain in the belly in the past?
140. Do you suffer from heartburn?
141. What part of the day?
142. What is it evoked by?
143. What is it relieved by?
144. Excessive salivation?
145. Burping? * Decreased appetite? * Change of weight?
146. Food-intolerance?
147. Nausea?
148. Vomiting?
149. How often?
150. What part of the day?
151. What is it evoked by?
152. Forceful vomiting?
153. In what quantity?
154. What does it look like?
155. How long after the meal?
156. Constipation?
157. Diarrhoea?
158. Defecation?
159. With what frequences?
160. Attended with gripes?
161. Is the defecation painful?
162. How is the consistency?
163. What quantity of faeces at a time?
164. Of what colour?
165. Is it mixed with blood or mucus?
166. Does the defecation smell unpleasant?
167. Hemorrhoids?
168. Yellowish skin and sclera? Itching?

***5. Urogenital tract ******************************

169. Urinating.....
170. How many times a day do you urinare?
171. How long ago for the last time?
172. Pain while urinating?
173. Changes in the pattern - urinating at night?
174. Are you able to hold your urine?
175. Difficult micturtion?
176. Forcefull urination?
177. Weak flow of urine?
178. Dripping after words?
179. Sudden cease of micturation; interrupted flow of urine?
180. Lost precognition of micturation?
181. Strange colour of the urine?
182. Unpleasant smelling of the urine?
183. Blood in the urine?
184. How long ago?
185. Had it how many times? -Pain in the belly?
186. Pain in the side?
187. How long ago?
188. Does or did it radiate?
189. Where does it radiate to?
190. Character of the pain? -What kind of pain?
191. Attended with urinating?
192. How many times/how often?
193. Have you had pain in the side in the past?
189. Where does it radiate to?
190. Character of the pain? -What kind of pain?
191. Attended with urinating?
192. How many times/how often?
193. Have you had pain in the side in the past?
194.
195. At what age first menstruation?
196. At what age did the menstruation finally stop?
197. Did occasional loss of blood occur after wards?
198. Within how many days did the menses occur/how frequent?
199. Extent of blood loss from vagina at a time?
200. Vaginal discharge?
201. What does it look like?
202.
203. How many children do you have?
204. How many were born alive?
205. How many died within one month?
206. Miscarriages?
207. Did you give birth to any heavy children?
208. Impotent?

***6. Locomotory tract ******************************

209. Pain in the joints?
211. Where is it localised?
212. Are the joints concerned red?
213. Are the joints concerned swollen?
214. Are the joints concerned warm?
215. Is there impaired movement in the joints concerned?
216. Do the complaints migrate to other joints?
217,
218,
219. Stiffness.....
217. Are the joints stiff?
218. Does the pain disappear when the joints are used?
219. How long does it take before it disappears while using the joints?
210. How long ago did you have pain?
220. Have you been having pain in the past?
221. Pain in the neck?
222. Pain in the back?
223. Where is it localised?
224. Does it radiate?
225. Where does it radiate to?
226. By what is it worsened?
227. Impairment of movement of the back?
228. Crooked back?
229. Pain in arms?
230. Pain in legs?
231. Loss of power in arms or legs?
232. Where is it localised?
233. Pain in the bones?
234. Where is it localised?

***7. Hemopoetic tract ******************************

235. Pale skin colour?
236. Red skin colour?
237. Bruises, hemorrhages bleedings of skin or mucus membrane?
238. Develop spontaneously?
239. On what spots?
240. Small wounds keep bleeding?
241. Wounds keep bleeding after teethextraction or confinement?
242. Swelling of glands?
244. On what spot?
243. How long ago?
245. What is this pain evoked by?
246. Painfull glands?
247. Swellings on the glands in the past?
* Excessive sweating (tract 1)
* Itching (tract1)
* See tract 1-30
More susceptible to infectious?

***8. Endocrine tract ******************************

23. (tract 1)
24. (tract 1)
26. (tract 1)
28. (tract 1)
29. (tract 1)
30. (tract 2)
31. (tract 5)
207.
249. Swelling in frontpart of the neck?
250. Chillness?
251. Intolerance of warmth?
252. Nervousness?
253. Cryingspells? * Palpitations?
254. Trembling hands?
255. Excessive loss of hair?
256. On special spots?
257.Excessive hairgrowth?
258. On special spots?
259. Changed pitch of voice?
260. Changed size of gloves, shoes? Menstruation?
See also tract 5.

***9. Nervous tract ******************************

261. Deminishing eyesight?
262. How is the right eye?
263. How is the left eye?
264. Difficulties with the sight far away or nearby?
265. Do you see black spots?
266. Double sight (diplopia)?
267. Whilst looking in a certain direction?
268. Pain in both eyes?
270. Deminishing hearing?
271. At which ear?
272. Pain in the ear?
273. Is it attended with discharge in the ear?
274. Do you have ringing in your ear?
275. Diminished sense of taste?
276. Dizziness?
277. Of what kind?
278. Especially when rising from a lying down or seating position?
279. Headache?
280. Where is it localized?
281. During which part of the day? * Less of consciousness (tract 2)?
282. Somnolence?
283. Paralysis?
285.Where is it localized?
284. How long ago?
286. Have you been having paralysis in the past?
287. Disturbances in the sense of touch (tactile sense)?
288. How long ago?
289. Where is it localized?
290. Have you had disturbances in the past?
291. Numbness in hands or feet?
292. Where is it localized?
293. Parasthesis in hands or feet (prickling feeling)?
294. Where is it localized?
295.Cramps in hands or feet?
296. Where is it localized?
297. Uncontrolled movements?
298. Where is it localized?
299. During which part of the day?
231. Loss of power in arms or feet (tract 6)?
300. Speech disturbances?
301. Of what kind?
119. (Tract 4)
229. (Tract 6)
302. Convulsions in the past?
303. How long ago?
304. How often have you been having them?
305. Disturbances of sleep?
306. Of what kind?
307. Dreaminess?
308. During what part of the day?
253. (Tract 8)

***10. Skin deformities ******************************

309. Skin deformities?
310. How long ago?
311. On which part of the body?
312. How does it look like?
313. How many are there/were there?
314. Which colour?
315. Changing form or colour?
316. What did the deformity look like at first?
317. Did this change simultaneously?
318. Was there moist discharge?
319. What did this moisture look like?
320. Was it attended by itching?
321. Were they painfull?
322. Did they develop after the use of mediction or contact with a specific substance?
323. Have you been having skin deformaties in the past?

***11. Supplementary information ******************************

324.
326. Nutrition habits? What do you eat during the day?
327. Do you smoke? Do you inhale?
328. Hove you been smoking in the past?
329. How long ago for the last time?
330. How much a day?
331. How much and what kind of alcoholics do you drink?
332. Do you use analgetics (c.q. aspirine)?
333. Are you being checked on your trombosis regularly?
334. Do you use the contraceptive pill?

1009. Do specific diseases occur in the family?
1006. What medication do you use?
1010. How do you respond to these?
1013. What are your hobbies?
1011. How is your family composed?
1012. How is your housing?
1007. What is your profession?
1008. What are your previous diseases?
1014. Allergies? Pets?

***End of history taking question list.


Basisreferenties o.a.
Min, F.B.M. en K.H. Ephraim
Computer assisted instruction voor het leren overzien van de anamnese. Proceedings Medisch Informatica congres '79 (red. J.L. Willems), Acco Leuven, Antwerpen 117-122 (1979)

Min, F.B.M.
Anamnese Training; een computersimulatieprogramma. Instituut voor Nucleaire Geneeskunde, Rijksuniversiteit Utrecht, interne uitgave (1978)

Formijne en Mandema
Anamnese en fysische diagnostiek. (19...)

Definitie van ADHD

Mensen die ADHD hebben, hebben veel moeite met concentratie, het houden van hun aandacht bij datgene waarmee waar mee ze bezig zijn. Tevens zijn ze hyperactief, erg druk in hun gedrag.
Samengevat zijn mensen met ADHD rusteloos, impulsief en hebben ze concentratieproblemen.

Bij wie komt het voor?

We weten nu dat ADHD op alle leeftijden voorkomt, dus niet alleen bij kinderen.
Het is wel zo dat het op kinderleeftijd begint en deze mensen hebben een grote kans dat ze het hun leven lang houden.
Kinderen zijn zich nog aan het ontwikkelen en zijn nog druk met leren, dus deze leeftijdsgroep heeft er erg veel last van op school.
Volwassenen hebben er erg veel last van in hun werk.
Ze zijn chaotisch, rusteloos, komen vaak te laat, praten druk en veranderen veel van baan.

Beloop in de tijd.

Van de mensen die voor ADHD behandeld worden houdt een derde deze aandoening, bij een derde blijft de klachten bestaan in een mildere vorm.
Bij de laatste eenderde verdwijnen de klachten helemaal.

Hoe vaak komt het voor.

Ongeveer een op de vijfentwintig kinderen heeft ADHD, dit zijn dus 60.000 a 100.000 kinderen in Nederland. Bij de jongvolwassenen komt het bij 1 a 3 % van de personen voor.
Het aantal ADHD patiënten blijft stabiel, maar het wordt steeds beter herkent, zodat het steeds vaker behandeld wordt.

Verschijnselen – Aandachtsproblemen

Het kind heeft de meeste dagen van de week, minimaal 6 van de volgende verschijnselen:
• Onvoldoende aandacht voor details, maakt achteloos fouten.
• Heeft moeite om de aandacht bij de taak of spel te houden.
• Wekt de indruk niet te luisteren.
• Volgt aanwijzingen of maakt opdrachten niet af.
• Het kind heeft moeite met het organiseren van dingen die het doet.
• Het kind gaat taken/opdrachten uit de weg, het kind vermijd dingen die geestelijke inspanning vragen. Of het heeft een hekel aan dit soort activiteiten.
• Het kind raakt vaak dingen kwijt.
• Het kind is snel afgeleid.
• Het kind is vergeetachtig.



Verschijnselen – Hyperactiviteit

Er is ook sprake van ADHD als het kind de meeste dagen van de week zes of meer verschijnselen heeft van hyperactiviteit:
• Het kind beweegt onrustig met handen en voeten en zit te draaien op zijn stoel.
• Staat op, als het moet blijven zitten.
• Gaat rondrennen of overal op klimmen op plaatsen waar dat niet hoort.
• Kan moeilijk rustig spelen of ontspannende dingen doen.
• Is de hele tijd in de weer en draaft maar door.
• Praat aan een stuk door.
Of van impulsiviteit:
• Het kind antwoordt al, voordat de vraag helemaal gesteld is. Hij gooit het antwoord er als het ware uit.
• Het heeft moeite om op zijn beurt te wachten.
• Het verstoort bezigheden van anderen.
Een kind heeft pas ADHD, als het deze verschijnselen duidelijk meer heeft dan kinderen van dezelfde leeftijd, als het dagelijkse doen en laten er flink door beperkt wordt, en als dat allemaal minstens 6 maanden duurt.
Verder moet het kind enkele verschijnselen al voor zijn 7e jaar hebben gehad.
Volwassenen kunnen ook ADHD hebben, maar alleen als ze deze aandoening ook als kind hadden.

Oorzaken
ADHD wordt door meerdere factoren veroorzaakt, vanuit de omgeving, persoonsgebonden factoren, maar ook erfelijk.
• Jongens hebben de aandoening 2 a 3 maal vaker dan meisjes.
• Volwassen mannen hebben het even vaak als volwassen vrouwen.
• Erfelijkheid speelt een grote rol.
• Kinderen van ouders met ADHD hebben 50% kans om het ook te krijgen.
• Broertjes en zusjes van kinderen met ADHD hebben 3 a 5 maal zoveel kans om het ook te krijgen.
• Neefjes en nichtjes hebben 2 a 3 maal zoveel kans.
• In de hersenen van mensen met ADHD zijn afwijkingen gevonden mbt. de anatomie en de activiteit van verschillende hersendelen.
• Het kind loopt extra risico als de moeder tijdens de zwangerschap: rookte, hoge bloeddruk had of veel alcohol gebruikte.
• Een laag geboorte gewicht is ook een risicofactor.

Indicaties

circulatiestilstand gevolgd door apnoe;
respiratoire insufficiëntie met circulatoir arrest.

Algemene handelwijze (in volgorde van belangrijkheid)

begin hartmassage met frequentie circa 80 per minuut;
begin beademing via mond-op-mond of via mond/neus-masker; tracht zo spoedig mogelijk over te gaan op beademing via endotracheale tube, zeker wanneer reanimatie naar verwachting langer gaat duren. Verhouding beademing: hartmassage dient 1:5 te zijn;
alarmeer reanimatieteam en meld duidelijk waar reanimatie plaats heeft (op afdeling cardiologie bevindt zich een eigen noodbel);
zorg voor hartritmediagnostiek/-bewaking, wat soms ook mogelijk is via paddles van defibrillator;
zorg voor intraveneuze toegangsweg; indien niet mogelijk via armvene, dan via v. jugularis interna, v. subclavia of v. femoralis. Als reanimatie niet direct succes heeft, geniet een centrale lijn de voorkeur. Als geen i.v. toegangsweg verkregen kan worden dan, indien mogelijk, intratracheaal medicatie toedienen (de gebruikelijke dosering dan 2-3 maal verhogen);
verzamel zo veel mogelijk informatie over de patiënt:
voorgeschiedenis;
actuele ziektegeschiedenis;
prognose;
behandelend specialist;
recent ECG;
recent laboratoriumonderzoek.
verricht een beperkt lichamelijk onderzoek:
centraal-veneuze druk (CVD);
ademgeruis (spanningspneumothorax);
palpatie abdomen (aneurysma aortae abdominalis).
bepaal (geregeld) arteriële bloedgasanalysewaarden, veneuze bloedgasanalysewaarden, elektrolyten, glucose en Hb.
reanimatiepogingen staken indien alle mogelijke onderliggende factoren/ oorzaken zo optimaal mogelijk zijn gecorrigeerd (correctie zuur/base-evenwicht (pH>7,20), correctie pO2(>8 kPa), correctie elektrolytenstoornis, correctie tamponade, correctie lichaamstemperatuur, antiaritmische therapie, enz.) en desondanks adem-hartstilstand blijft bestaan.

Specifieke protocollen:

ventrikel fibrilleren/VT met bewustzijnsverliesventrikeltachycardie zonder bewustzijnsverlies
asystolie
elektromechanische dissociatie
extreme bradycardie

Na 10de blok bij persisterend VF of VT:

massage en beademing
iedere 5 minuten: adrenaline 1 mg i.v.

indien men vanuit het specifieke protocol wederom in dit protocol terecht komt, dan dit protocol vervolgen waar dit verlaten is;
geen bicarbonaat in de eerste 15 minuten, nadien alleen als pH <7,1 in dosering van 50 ml bicarbonaat 8,4%;
adrenaline via de tube oplossen met NaCl 0,9% tot 10 ml;
calcium alleen bij hyperkaliëmie of overdosering calciumantagonisten;
magnesiumsulfaat overwegen bij diureticagebruik;

getriggerde ECV verrichten onder algehele anesthesie (bv. propofol);
na toediening propofol niet langer varen op bewustzijn, maar op pols, tensie en ademhaling.

indien men vanuit het specifieke protocol wederom in dit protocol terecht komt, dan dit protocol vervolgen waar dit verlaten is;
indien tussentijds ander ritme ontstaat: specifiek protocol volgen;
adrenaline via de tube oplossen met NaCl 0,9% tot 10 ml;
geen bicarbonaat in de eerste 15 minuten geven, nadien alleen als pH <7,1 in dosering van 50 ml bicarbonaat 8,4%;
eventueel defibrillatie overwegen.

diagnostiek van de oorzaak van EMD van het allergrootste belang zodat specifieke behandeling kan gegeven worden.

eventueel externe pacemaker inbrengen voor invasief pacen;
bij bewustzijnsverlies hartmassage toepassen;
bij insufficiëntie ademhaling (bij-)beademen;
bij adequate circulatie kan isoprenaline infuus worden gegeven op geleide van de hartfrequentie.
Non-invasief pacen

plaats pads op thorax- en rugzijde patiënt;
sluit de pads aan op defibrillator door connectie van de paddles los te halen en deze vast te maken aan de pads;
kies pacer op de monitor van de defibrillator;
stel pacing frequentie in en voer pacing energie op tot capture is bereikt en mechanische output verzekerd.

the short version



Hiking and camping in rural Latin America can lead to exposure to the biting insect which carries this serious disease. The only preventives are education and information. There are no preventive medications or vaccines. Treatment exists, although it is often not completely satisfactory.



the long version



Valle de los Naranjos, Venezuela. It is late afternoon and the sun is sinking behind the mountains, bringing the first shadows of the evening. Down in the valley a campesino is tilling the soil; the quiet of the approaching night is broken only by a crop duster which periodically flies overhead and disappears further down the valley. Bertoldo, the pilot, is on his final run of the day when suddenly the engine dies, sending the plane onto the plowed field an emergency landing. The campesino drags him, stunned but unhurt, from the plane and offers his home for the night, a poorly constructed dwelling common in rural areas of Latin America known as el rancho (the hut) with walls of adobe, a dirt floor and a roof of palm fronds. On his ride back to Valencia the next day, Bertoldo reflects on his good fortune that he had only a few insect bites to show for his adventure. Bertoldo’s luck was short-lived. Two weeks after the night spent in the campesino’s hut, he came down with a fever and the right side of his face became red and puffy. He grew progressively weaker and a few weeks later he was in heart failure. As the result of the bite of an insect known as the vinchuca, Bertoldo had become infected by a parasite, Trypansoma cruzi, the cause of Chaga’s Disease. Three months later Bertoldo was dead.



THE VINCHUCA






The carrier of the Chagas’ Disease parasite is an inch long insect which depends on the blood of mammals to survive. The insect has a limited flight range; although it is furnished with two pairs of wings, these are used mainly as a parachute. “Vinchuca”, derived from the Quechua word huinchucaum, means “one who lets himself fall down”. The vinchuca is nocturnal, hiding during the day in crevices of walls of peasant huts and among palm fronds of the roof, coming out at night to feed. It is attracted to exposed parts of the body and has a preference for the face. In Europe and North America it is called the kissing or assassin bug. When the vinchuca finds the exposed face of a human victim, it releases from its proboscis a stylet with fine teeth which perforates the skin. A second hollow stylet taps a blood vessel. The feeding process lasts at least twenty minutes during which the vinchuca ingests several times its own weight in blood. Feeding is painless and the subject rarely wakens. During the feeding defecation occurs, contaminating the bite wound with feces containing parasites. Following feeding, the irritation of the bite causes the sleeping victim to rub the site, facilitating the introduction of the organism into the blood. The parasites are also capable of penetrating the thin layer of cells covering the lining of the mouth, nostrils and eye if carried there by contaminated fingers.



THE DISEASE



After one or two weeks the bite area, usually the face, becomes swollen and inflamed. This swelling, called a “chagoma” after Dr. Carlos Chagas who first described it, represents a reaction to the parasite, some of which reach the bloodstream and invade internal organs. Fever, vomiting, shortness of breath, convulsions and rigidity of the neck are symptoms of the acute generalized form of the illness which may result in rapidly progressive heart disease. Usually, however, the skin inflammation subsides and the victim continues to live an apparently healthy life. Unrecognized infection (but with a positive blood test indicating latent disease) may continue and progress slowly for years, surfacing after ten or twenty years as chronic heart disease. During this time, irreversible heart failure may appear, often with death occurring within a year.



SOCIAL IMPLICATIONS



Chagas’ Disease is a serious health problem in rural Latin America affecting mostly poor rural families. Since the 1960s, migration of rural populations has brought the infection to the periphery of large cities; in some countries the disease has reached the interior of urban areas. Besides spreading the infection to towns, this migration poses an additional risk through blood transfusions. Poor people are eager to sell their blood; infected blood donors sometimes slip through screening procedures. A recent survey in Sao Paulo shows that an average of fifteen percent of blood donors carry the infection, ten percent in Buenos Aires.



IMPACT OF CHAGAS’ DISEASE ON THE INTERNATIONAL TRAVELER



Because of the nature of their travel, hikers and campers are particularly vulnerable to Chagas’ Disease; it is essential that they know something of the disease and how to avoid it. Business travelers spending the night in the periphery or suburbs of cities ought at a minimum to check for insects in bedrooms. Chagas’ Disease is insidious-a traveler passing through Latin America could become infected and may remain apparently healthy until the first signs of chronic heart disease appear years later. Cases of Chagas’ Disease are often not recognized by doctors outside of Latin America since the symptoms of the late form are the same as other forms of chronic heart disease.



TO PREVENT CHAGAS’ DISEASE DURING YOUR TRAVELS



When traveling in areas with Chagas’ Disease, do not sleep in native huts, since parasite-carrying vinchucas hide in palm-frond roofs and the cracks of walls.
When checking into modest or older hotels, search for hidden insects under the mattress, behind pictures, in drawers or in dark corners of the room.
Before bed, apply insect repellent (available in sprays, lotions and towelettes) to exposed areas of skin. Any commercial preparation containing DEET (N.N-diethyl-meta-toluamide) is suitable.
Use a pyrethrin-containing insecticide (spray or coils) to kill insects which may be present in your sleeping quarters. Spray under your bed, inside closets, drawers and behind pictures.
Use a permethrin (Permanone) preparation on bednetting and bed clothing if at risk for bites from this crawling insect.
Protect your hands with a piece of cloth, paper, plastic or gloves if it is necessary to handle an insect.
Consider using bed nets to prevent contact with insects. Put a cloth over the bed net to prevent infected feces falling on you from the ceiling.
When camping, choose a campsite away from palm trees and stone piles where insects often hide.
If you require medical or surgical treatment involving blood transfusions, avoid private hospitals (clinicas) where blood donors may not have been adequately screened; there is apparently no risk of becoming infected by a blood transfusion at a university or municipal hospital in a major city.
Adapted from material distributed by the International Association for Medical Assistance to Travelers

001 ABL Acute Bilineage Leukemia OL
002 AISA Acquired Idiopath Siderblastic Anemia OND
003 ALD Adrenoleukodystrophy IMD
004 ALL Acute Lymphoblastic Leukemia ALL
005 AMCL Acute Mast Cell Leukemia OL
006 AMEGCT Amegakaryocy/Congenital Throm IPA IPA
007 AMF Acute Myelofibrosis OND
008 AML Acute Myelogeneous Leukemia AML
009 ATA Ataxia-Telangiectasia IIS
010 AUL Acute Undifferentiated Leukemia-MO OL
011 BGLUD Beta-glucuronidase Deficiency IMD
012 BL Burkitt Lymphoma NHL
013 BLSYND Bare Lymphocyte Syndrome IIS
014 BRCA Breast Cancer OM
015 BTHAL Beta Thalassemia Major IEA
016 C-HHYP Cartilage-Hair Hypoplasia IIS
017 CGD Chronic Granulomatous Disease OND
018 CHED Chediak-Higashi IIS
019 CID Combined Immunodeficiency IIS
020 CLL Chronic Lymphocytic Leukemia OL
021 CML Chronic Myelogeneous Leukemia CML
022 CMML Chronic Myelomonocytic Leukemia OL
023 CNSCA Central Nervous System Tumours OM
024 DIGRGE Di George Syndrome IIS
025 ETC Essential Thrombocythemia IPA
026 EWINGS Ewings Sarcoma OM
027 FA Fanconi Anemia IEA
028 FEL Familial Erythrophagocytic HIS
029 GAUCHR Gaucher's Disease IMD
030 GLTROM Glanzmanns Thrombastenia IPA
031 GLUCST Glucose Storage Disease IMD
032 HCL Hairy Cell Leukemia OL
033 HIS Histiocytic Disorders HIS
034 HISX Histiocytosis-X HIS
035 HIV HIV Infection OND
036 HL Hodgkin's Lymphoma HL
037 HLS Hurler Syndrome IMD
038 HPGC Hemophagocytosis HIS
039 HTS Hunter Syndrome IMD
040 HUNTER Hunter Syndrome (MPS-II) IMD
041 HURLER Hurler Syndrome (MPS-IH) IMD
042 I-CELL I-Cell Disease IMD
043 IEA Inherited Erythrocyte Abnormality IEA
044 IIS Inherited Immune System Disorder IIS
045 IMD Inherited Metabolic Disorder IMD
046 IMDNP Immune Deficiency + Neutropen IIS
047 IPA Inherited Platelet Abnormality IPA
048 JCML Juvenile Chronic Myelogeneous OL
049 KOSTMN Kostmann's Agranulocytosis IIS
050 KRABBE Krabbe Disease IMD
051 LAD eukocyte Adhesion Deficiency IIS
052 LN Lesch-Nyhan IMD
053 LYSOST Lysosomal Storage Disease IMD
054 MARLAM Maroteaux-Lamy (MPS-VI) IMD
055 MDS Myelodysplastic Syndromes MDS
056 MFMM Myelofibro Myeloid Metaplasia MDS
057 MLD etachromatic Leukodystrophy IMD
058 MM ultiple Myeloma PCD
059 MORQUO Morquio (MPS-IV) IMD
060 MPS ucopolysaccaridosis IMD
061 N-P Neiman-Pick Disease IMD
062 NB Neuroblastoma OM
063 NEUTAD Neutrophil Actin Deficiency OND
064 NEUTD Neutrophil Defect OND
065 NHL Non-Hodgkin's Lymphoma NHL
066 OAL Other Acute Leukemia OL
067 OCID Other Combined Immunodeficiency IIS
068 OHIS Other Histiocytic Disorders HIS
069 OIEA Other Erythrocyte Differentiation IEA
070 OIIS Other Immune System IIS
071 OIMD Other Inherited Disorders of Metabolism IMD
072 OIPA Other Abnormalities or Platelets OND
073 OL Other Leukemia OL
074 OM Other Malignancy OM
075 OMDS Other Myelodysplastic Disorder MDS
076 OMENN Omenn's Syndrome IIS
077 OMS Other Malignancy, Specify OM
078 OND Other Non-Malignant Disease OND
079 OOL Other Acute Leukemia OL
080 OPCD Other Plasma Cell Disorder PCD
081 OSCID Other SCID IIS
082 OST Osteopetrosis IMD
083 OTHER Other diseases OND
084 OTHHGP Other Hemoglobinopathy IEA
085 PCD Plasma Cell Disorder PCD
086 PCL Plasma Cell Leukemia PCD
087 PHILLY Prolymphocytic Leukemia OL
088 PNH Paroxysmal Nocturnal Hemoglobinurea MDS
089 PV Polycythemia Vera OND
090 RA Refractory Anemia OND
091 RAEB Refract Anemia-excess blasts MDS
092 RAEBIT Refract Anemia-excess blast tran MDS
093 RCA Pure Red Cell Aplasia IEA
094 RETDG Reticular Dysgenesis IEA
095 SAA Severe Aplastic Anaemia SAA
096 SANFIL Sanfillippo (MPS-III) IMD
097 SCA Sickle Cell Anemia IEA
098 SCHEIE Scheie Syndrome (MPS-IS) IMD
099 SCID Severe Combined Immunodeficiency IIS
100 SCLUNG Small Cell Lung Cancer OM
101 SF San Filippo IMD
102 TBSCID Absence of T&B Cells SCID IIS
103 THA Thalassemia IEA
104 TSCID Absence of T, Normal B SCID IIS
105 UIIS Unknown Immune System IIS
106 UIMD Unknown Disorders of Metabolism IMD
107 UIPA Unknown Abnormalities or Platelets OND
108 UMDS Unknown Myelodysplastic Disorder MDS
109 UNKN Unknown OND
110 UOL Unknown Acute Leukemia OL
111 UPCD Unknown Plasma Cell Disorder PCD
112 VARIMD Common Variable Immunodeficiency IIS
113 WAS Wiskott Aldrich Syndrome IIS
114 WMG Waldenstroms Macroglobulinemia PCD
115 WOLMAN Wolman Disease IMD
116 XLLPD X-linked Lymphoproliferative IIS

Leukemia
Types
Leukemia is classified by how quickly it progresses. Acute leukemia is fast-growing and can overrun the body within a few weeks or months. By contrast, chronic leukemia is slow-growing and progressively worsens over years.
Acute versus Chronic Leukemia The blood-forming (hematopoietic) cells of acute leukemia remain in an immature state, so they reproduce and accumulate very rapidly. Therefore, acute leukemia needs to be treated immediately, otherwise the disease may be fatal within a few months. Fortunately, some subtypes of acute leukemia respond very well to available therapies and they are curable. Children often develop acute forms of leukemia, which are managed differently from leukemia in adults.
In chronic leukemia, the blood-forming cells eventually mature, or differentiate, but they are not "normal." They remain in the bloodstream much longer than normal white blood cells, and they are unable to combat infection well.
Myelogenous versus Lymphocytic Leukemia Leukemia also is classified according to the type of white blood cell that is multiplying - that is, lymphocytes (immune system cells), granulocytes (bacteria-destroying cells), or monocytes (macrophage-forming cells). If the abnormal white blood cells are primarily granulocytes or monocytes, the leukemia is categorized as myelogenous, or myeloid, leukemia. On the other hand, if the abnormal blood cells arise from bone marrow lymphocytes, the cancer is called lymphocytic leukemia.
Other cancers, known as lymphomas, develop from lymphocytes within the lymph nodes, spleen, and other organs. Such cancers do not originate in the bone marrow and have a biological behavior that is different from lymphocytic leukemia.
There are over a dozen different types of leukemia, but four types occur most frequently. These classifications are based upon whether the leukemia is acute versus chronic and myelogenous versus lymphocytic, that is:
Acute Myelogenous (granulocytic) Leukemia (AML)
Chronic Myelogenous (granulocytic) Leukemia (CML)
Acute Lymphocytic (lymphoblastic) Leukemia (ALL)
Chronic Lymphocytic Leukemia (CLL)
Acute Myelogenous Leukemia (AML) Acute myelogenous leukemia (AML) - also known as acute nonlymphocytic leukemia (ANLL) - is the most common form of adult leukemia. Most patients are of retirement age (average age at diagnosis = 65 years), and more men are affected than women. Fortunately, because of recent advances in treatment, AML can be kept in remission (lessening of the disease) in approximately 60% to 70% of adults who undergo appropriate therapy. Initial response rates are approximately 65-75% but the overall cure rates are more on the order of 40-50%.
AML begins with abnormalities in the bone marrow blast cells that develop to form granulocytes, the white blood cells that contain small particles, or granules. The AML blasts do not mature, and they become too numerous in the blood and bone marrow. As the cells build up, they hamper the body's ability to fight infection and prevent bleeding. Therefore, it is necessary to treat this disease within a short time after making a diagnosis. AML, particularly in the monocytic M5 form, may spread to the gums and cause them to swell, bleed, and become painful. AML also may metastasize (spread) to the skin, causing small colored spots that mimic a rash.
Acute leukemia, such as AML, is categorized according to a system known as French-American-British (FAB) classification. FAB divides AML into eight subtypes:
undifferentiated AML (M0) - In this form of leukemia, the bone marrow cells show no significant signs of differentiation (maturation to obtain distinguishing cell characteristics).
myeloblastic leukemia (M1; with/without minimal cell maturation) - The bone marrow cells show some signs of granulocytic differentiation.
myeloblastic leukemia (M2; with cell maturation) - The maturation of bone marrow cells is at or beyond the promyelocyte (early granulocyte) stage; varying amounts of maturing granulocytes may be seen. This subtype often is associated with a specific genetic change involving translocation of chromosomes 8 and 21.
promyelocytic leukemia (M3 or M3 variant [M3V]) - Most cells are abnormal early granulocytes that are between myeloblasts and myelocytes in their stage of development and contain many small particles. The cell nucleus may vary in size and shape. Bleeding and blood clotting problems, such as disseminated intravascular coagulation (DIC), are commonly seen with this form of leukemia. Good responses are observed after treatment with retinoids, which are drugs chemically related to vitamin A.
myelomonocytic leukemia (M4 or M4 variant with eosinophilia [M4E]) - The bone marrow and circulating blood have variable amounts of differentiated granulocytes and monocytes. The proportion of monocytes and promonocytes (early monocyte form) in the bone marrow is greater than 20% of all nucleated (nucleus-containing) cells. The M4E variant also contains a number of abnormal eosinophils (granular leukocyte with a two-lobed nucleus) in the bone marrow.
monocytic leukemia (M5) - There are two forms of this subtype. The first form is characterized by poorly differentiated monoblasts (immature monocytes) with lacy-appearing genetic material. The second, differentiated form is characterized by a large population of monoblasts, promonocytes, and monocytes. The proportion of monocytes in the bloodstream may be higher than that in the bone marrow. M5 leukemia may infiltrate the skin and gums, and it has a worse prognosis than other subtypes.
erythroleukemia (M6) - This form of leukemia is characterized by abnormal red blood cell-forming cells, which make up over half of the nucleated cells in the bone marrow.
megakaryoblastic leukemia (M7) - The blast cells in this form of leukemia look like immature megakaryocytes (giant cells of the bone marrow) or lymphoblasts (lymphocyte-forming cells). M7 leukemia may be distinguished by extensive fibrous tissue deposits (fibrosis) in the bone marrow.
In addition, patients sometimes develop isolated tumors of the myeloblasts (early granulocytes). An example of this is isolated granulocytic sarcoma, or chloroma - a malignant tumor of the connective tissue. Individuals with chloroma frequently develop AML, so they usually are treated with an aggressive, AML-specific chemotherapy program.

Chronic Myelogenous Leukemia (CML) Chronic myelogenous leukemia (CML) is known as a myeloproliferative disorder - that is, it is a disease in which bone marrow cells proliferate (multiply) outside of the bone marrow tissue.
CML is easy to diagnose, since it has a genetic peculiarity, or marker, that is readily identifiable under a microscope. About 95% of CML patients have a genetic translocation between chromosomes 9 and 22 in their leukemic cells. This abnormality, which is known as the Philadelphia chromosome (Ph1), is named after the city in which it was discovered. The Philadelphia chromosome causes uncontrolled reproduction and proliferation of all types of white blood cells and platelets (blood clotting factors). Sadly, CML is not yet curable by standard methods of chemotherapy or immunotherapy.
CML tends to occur in middle- and retirement-aged people (the median age is 67 years). It occasionally affects people in their 20s, but it is rare in the very young; only 2% to 3% of childhood leukemias are CML. Early disease often is without symptoms (asymptomatic) and is discovered accidentally. Individuals with more advanced cases of CML may appear sickly and experience fevers, easy bruising, and bone pain. Laboratory and physical findings include enlarged spleen (splenomegaly), a high white blood cell count, and absent or low amounts of the white blood cell enzyme alkaline phosphatase.
Like other forms of leukemia, CML is not "staged". Rather, this unstable disease is categorized according to the three phases of its development: chronic, accelerated, and blast.
Chronic phase - Patients in this initial phase have fewer than 5% blast cells and promyelocytes (immature granulocytes) in their blood and bone marrow. This phase is marked by increasing overproduction of granulocytes. Individuals generally experience only mild symptoms, and they respond well to conventional treatment.
Accelerated phase - Patients in this progressive phase have more than 5%, but fewer than 30% blast cells. Their leukemic cells exhibit more chromosomal abnormalities besides the Philadelphia chromosome, and so more abnormal cells are produced. Noticeable symptoms such as fever, poor appetite, weight loss occur, and patients may not respond as well to therapy.
Blast phase (acute phase, blast crisis) - Patients in this final phase have more than 30% blast cells in their blood and bone marrow samples. The blast cells frequently invade other tissues and organs outside of the bone marrow. During this phase, the disease transforms into an aggressive, acute leukemia (70% acute myelogenous leukemia, 30% acute lymphocytic leukemia). If untreated, CML is fatal in roughly 20% of all patients each year.
Acute Lymphocytic Leukemia (ALL) Acute lymphocytic leukemia (ALL) - also known as acute lymphoblastic leukemia - is a malignant disease caused by the abnormal growth and development of early nongranular white blood cells, or lymphocytes. The leukemia originates in the blast cells of the bone marrow (B-cells), thymus (T-cells), and lymph nodes. ALL occurs predominantly in children, peaking at 4 years of age. ALL is seen more frequently in industrialized nations, and it is slightly more common among white children and boys.
ALL often is diagnosed after a patient experiences a 4- to 6-week period of illness. Initial symptoms may include a nonspecific infection (e.g., respiratory infection) that persists or recurs despite antibiotic therapy. During this period, the person may start to experience aching bone pain in the back, limbs, and/or joints. Walking difficulties may be seen in some children who have extreme swelling of the large joints. But the symptoms that most often suggest referral for a blood count (measure of the number of blood cells within the blood) are a purplish-brown rash or the onset of excessive bruising.
If ALL is T-cell in type, the thymus is involved. Leukemia-related enlargement of the thymus may lead to coughing, shortness of breath, or compression of the superior vena cava (SVC), the large vein that carries blood from the head and arms back to the heart). Such venous blockage may induce head and arm swelling and may cause a life-threatening condition known as SVC syndrome.
Both children and adults with ALL are at risk of developing complications due to central nervous system (CNS) involvement. CNS invasion is especially likely among patients with the L3 subtype of ALL. When leukemic cells infiltrate the CNS, they can cause increased pressure within the skull and paralysis of cranial nerves that connect the brain with other organs, muscles, etc.
Age is an important prognostic factor in ALL. Studies have suggested that patients who are younger than 35 years of age fare better than older patients; however, this observation may be related to the higher incidence of the Philadelphia chromosome (Ph1) among older ALL patients - a subgroup that has a poorer chance of survival. Fortunately, though, 60% to 80% of children and adults with ALL will achieve complete remission of the disease after completing appropriate therapy.
There is no standard staging system for ALL. Rather, ALL is categorized according to a system known as the French-American-British (FAB) Morphological Classification Scheme for ALL:
L1 - Mature-appearing lymphoblasts (T-cells or pre-B-cells). Cells are small with uniform genetic material, regular nuclear shape, nonvisible nucleoli (round bodies within the nucleus, the site of RNA synthesis), and little cytoplasm (substance of a cell, excluding the nucleus).
L2 - Immature and pleomorphic (variously shaped) lymphoblasts (T-cells or pre-B-cells). Cells are large and variable in size, with variable genetic material, irregular nuclear shape, one or more large nucleoli, and variable cytoplasm.
L3 - Lymphoblasts (B-cells; Burkitt's cells) are large and uniform; genetic material is finely stippled and uniform; nuclear shape is regular (oval to round); there are one or more prominent nucleoli; and cytoplasm is moderately abundant.
Chronic Lymphocytic Leukemia (CLL) Chronic lymphocytic leukemia is the most common leukemia in North America and in Europe. It is a disease of older adults and is very rare among people who are younger than 50 years of age. Men with CLL outnumber women by a 2-to-1 average. The disease usually is detected accidentally during a doctor's examination for an unrelated complaint.
CLL is thought to result from the gradual accumulation of mature, long-lived lymphocytes. Therefore, this cancer is caused not so much by overgrowth as it is by the extreme longevity and build-up of malignant cells. Although the rate of accumulation varies among individuals, the extensive tumor burden eventually causes complications in all CLL patients.
CLL is classified by one of two staging systems, although these systems are based on cytology (the study of cell characteristics) and are different from the staging used to evaluate other, nonleukemic cancers. The first system - known as Rai Classification - is used more often in the United States; the other system - known as Binet Staging - is more popular in Europe. Both methods are correlated with prognosis.

The process of becoming a Bone Marrow Donor is very simple through the Anthony Nolan Trust
1) You need to make sure you meet the following General Criteria:
- age 18 - 40 : health and circumstances permitting, you remain on the Register until your 60th birthday, so don't be put off joining if you are close to 40
- in general good health
- weight over 51kg / 8 stone
- women must not be pregnant
- women with children under the age of 12 months cannot join the register or donate marrow during that time
In addition you will need to check that you not excluded through the Medical Criteria (set out below)
Although it costs up to £70 to recruit each donor, tissue-type each sample, and maintain the donor's records there is no cost or charge for you and you can ‘sign up’ from anywhere in United Kingdom, so long as you are a UK resident.
2) Completing the Paperwork
You can obtain an information pack and medical questionnaire in four ways:
- calling Anthony Nolan hotline number - 0901 88 22 234 : calls are charged at 25p per minute and a proportion of the call charge comes to the Trust
- writing to: The Anthony Nolan Trust, Units 2 - 3, Heathgate Place, 75 - 87 Agincourt Road, London, NW3 2NU
- attending a donor recruitment clinic near you
- email: newdonor@anthonynolan.org.uk
3) Giving a Blood Sample
A blood testing kit can be sent to you by the Anthony Nolan Trust, so that you can take this to your local GP or health clinic, where a small sample of your blood will be taken - about 4ml. Needless to say, on no account should you attempt to take the sample yourself.
The sample will be forwarded to the Anthony Nolan laboratories, where it is tested to establish your tissue type. The results are stored on their database, which is, of course, confidential.
As a new member of the Register you will receive confirmation of your status as a potential life saver.
You may be found to be a match for a patient almost immediately; other people wait many years before being asked to donate - and some never are.
Every single person on our Register is still making a wonderful commitment – to make themselves available to support another person in need of a life saving transplant.

Find out more at www.anthonynolan.com

Medical Criteria
For a variety of reasons which can relate to the outcome of a transplant, or to your own welfare as a donor, certain conditions prevent you from joining the Register.
The application you complete before giving a blood sample covers all of the following medical conditions.

ALCOHOL
Sometimes Acceptable
No - if you are alcoholic or regularly consumer more than 40 units a week as a man or 30 units a week as a woman; or if you are on antabuse.
Exception - if you have recovered from alcoholism, and it has been two years or longer since recovery

ALLERGY : drug-induced
Generally Not Acceptable
Exception - if environmentally produced

ANAEMIA
Generally Acceptable
No - especially if there is a history of persistent anaemia or if someone is regularly anaemic i.e. more than three times a year.
Exception - you are only temporarily or rarely anaemic, you are not taking medication and you haemoglobin count is within the accepted range

ANKYLOSING SPONDYLITIS
Definitely not acceptable

ANGINA
Definitely not acceptable

ASTHMA
Generally not acceptable
No - if you are on continuous high dose medication (more than 8 inhalations /puffs per day) as people suffering from asthma are more likely to have post-operative complications.
Exception - if medication is taken rarely, less than 8 inhalations/puffs per day or if the asthma is brought on by an allergy

BACK PROBLEMS
Generally Not Acceptable
No - if upper back / neck problems, chronic lumbar vertebrae problems, such as slipped discs or sciatica, chronic lower back problems, or any injury which means that you are have to avoid certain sports, heavy lifting, prolonged seating
Exception - minor muscular problems or minor problems in the cervical or thoracic areas of the spine

BRAIN SURGERY
Generally Not Acceptable
Exception - if the brain surgery was performed after September 1992

CANCER
Definitely Not Acceptable
No - if any form of cancer including skin cancer even if you have been given the all clear by your treating physician.

CHRISTMAS DISEASE
Definitely Not Acceptable

CIRRHOSIS
Definitely Not Acceptable
No - there is a risk with general anaesthetic and bleeding.

COAGULATION DISORDERS
Definitely Not Acceptable
No - if you have a history of DVT, PE, Leiden factor, Von Willebrands.

CELIAC DISEASE
Definitely Not Acceptable
No - intolerance to gluten may relate to the auto-immune system

CROHN'S DISEASE
Definitely Not Acceptable
No - auto-immune

CYSTIC FIBROSIS
Definitely Not Acceptable
No - medical risks associated with general anaesthetic

DEPRESSION
Generally Acceptable
No - if endogenous, manic or severe.
Acceptance criteria - mild, short-term reactive depression with short term medication
N.B. individual assessment is obligatory

DIABETES
Generally Not Acceptable
No - insulin or tablet dependent diabetes can be associated with auto-immune disease which could be passed on to the patient.
Exception - non insulin-dependent diabetes, well controlled by diet

DERMATITIS HERPETIFORMIS
Definitely Not Acceptable
No - as often associated with coeliac disease.

DOWNS SYNDROME
Definitely Not Acceptable

ECZEMA
Generally Acceptable
No - if atopic (since childhood and severe) or if auto-immune related
Exception - mild and irregular

ENDOMETRIOSIS
Generally Acceptable
Acceptance Criteria - if well controlled.

EPILEPSY
Generally Not Acceptable
No - if on medication, due to risks associated with general anaesthetic
Exception - if you have not had a seizure for a minimum of 3 years and have not taken medication during that time. Donors must be aware that there is a small risk of fitting when awakening from the anaesthetic but this can be well-controlled

GALL STONES
Generally Not Acceptable
Exception - If you have undergone surgery and have no current problems.

GASTRO-INTESTINAL SYMPTOMS such as ulcers, general gastritis
Generally Acceptable
Exception - If the condition is well-controlled, with no internal bleeding or other complications.

GLANDULAR FEVER
Generally Acceptable
No - if a current condition or if you are still suffering from after effects
Acceptance criteria - if in the past and mild.

GRAVES DISEASE
Definitely Not Acceptable
No - auto-immune

HEART CONDITIONS
Generally Not Acceptable
No - angina, cardiomegeneral anaestheticity, cardiomyopathy, past history of heart attacks, heart arrhythmia, pacemaker, or a congenital condition such as thickened valve, hole in heart, heart murmur or any other condition which requires individuals to take antibiotic cover at any time, as all are considered a risk under general anaesthesia
Exception - if you have a congenital heart condition but do not have to take any prophylactic antibiotic cover at any time and are in good health

HEPATITIS A
Generally Acceptable
Acceptance criteria - if you have been clear for longer than 12 months and you are currently asymptomatic.

HEPATITIS B OR C
Definitely Not Acceptable
No - these viruses are found in body fluids, including blood and bone marrow.

HIGH BLOOD PRESSURE
Generally Not Acceptable
Exception - if the condition is well-controlled by medication and the most recent blood pressure reading is below: 150/95

HIP REPLACEMENT
Generally Acceptable
Acceptance Criteria - as long as no current problems at all but you must be aware that some short-term back pain could arise if you donate

HIV EXPOSURE
Definitely Not Acceptable
No - if you have been knowingly exposed to HIV you are considered a high risk category

HUMAN PITUITARY EXTRACT TREATMENT
Generally Not Acceptable
No - if treated with growth hormones or gonadotrophins
Exception - if treatment started after 1987

HYPOTHYROIDISM (MYXOEDEMA)
Generally Not Acceptable
Exception - if the cause is not auto-immune related

HYSTERECTOMY
Generally Acceptable
Acceptance Criteria - if the operation was over 6 months ago and there were no malignancies

ITP
Definately Not Acceptable
No - auto-immune

JAUNDICE
Generally Not Acceptable
Exception - the jaundiced was experienced as a baby or at a young age.

LUPUS (SLE)
Definitely Not Acceptable
No - auto-immune

MAJOR SURGERY OR OPERATION
Generally Not Acceptable
Exception - if at least six months must have elapsed since the operation and you are clear of all post operative symptoms.

MALARIA
Generally Not Acceptable
No - especially if within the last 12 months
Exception - if you have taken a full course of anti-malarial tablets, the timespan was longer than 12 months ago, and no symptoms are being experienced

ME / POST VIRAL SYNDROME
Generally Acceptable
Acceptance Criteria - only one episode over 12 months ago and no relapses have occurred

MIGRAINE
Generally Acceptable
Acceptance Criteria - if mild or infrequent (less than every 2 months

MS
Definitely Not Acceptable
No - auto-immune

MYASTHENIA GRAVIS
Not Acceptable
No - Autoimmune

OCD (OBSESSIVE COMPULSIVE DISORDER)
Generally Not Acceptable
No - especially if severe
Exception - depends on severity/ treatment - individual assessment necessary

OSTEO-ARTHRITIS
Generally Acceptable
No - especially if severe
Acceptance Criteria - if the treatment is mild, you are not on steroids and the hip and spine areas are unaffected

OSTEOGENESIS IMPERFECTA
Definitely Not Acceptable
No - there is a risk of fracture

OSTEOPOROSIS
Definitely Not Acceptable
No - a risk of bone damage

PANCREATITIS
Generally Not Acceptable
No - especially if chronic and with diarrhoea.
Exception - if there has been just one episode and you are fully recovered

PARAPLEGIC / TETRAPLEGIC
Not Acceptable

PERICARDITIS
Generally Not Acceptable
Exception - if fully recovered and no antibiotic cover needed

PERNICIOUS ANAEMIA
Definitely Not Acceptable
No - auto-immune

PITUITARY TUMOUR
Generally Not Acceptable
Exception - if benign, with no post-operative complications

PLEURISY
Generally Not Acceptable
Exception - if just a single incident with no recurrence

POLIO
Generally Not Acceptable
No - with serious physical disabilities which could be aggravated by donating marrow
Exception - if mild and no serious physical disabilities

POLYCYSTIC KIDNEY
Not Acceptable

PRE-CANCEROUS CELLS
Generally Not Acceptable
Exception - if your last two smear tests have been clear

PREGNANCY
Generally Not Acceptable
Exception - you can only join after your baby is 12 months old

PROCTITIS
Generally Not Acceptable
No - If autoimmune

PSORIASIS
Generally Not Acceptable
Exception - if very mild

PSORIATIC ARTHRITIS
Definitely Not Acceptable
No - auto-immune

PULMONARY EMBOLISM
Definitely Not Acceptable

PUPURA
Definitely Not Acceptable
No - could be auto-immune

RAYNAUD'S SYNDROME
Generally Not Acceptable
No - if associated with SLE

ROSACEA
Generally Not Acceptable
Exception - if localised, e.g. on the face.

RHEUMATIC FEVER
Definitely Not Acceptable

RHEUMATOID ARTHRITIS
Definitely Not Acceptable
No - auto-immune disease

SARCOIDOSIS
Definitely Not Acceptable
No - the cause is unknown, can affect any system, heart, lungs bone

SCIATICA
Generally Not Acceptable
Exception - the condition is mild and does not interfere with your normal lifestyle

SCHEUERMANNS DISEASE
Generally Not Acceptable
Exception - no current problems

SCHIZOPHRENIA
Definitely Not Acceptable
No - medication given is usually a contra-indication to general anaesthetic

SCOLIOSIS
Generally Not Acceptable
Exception - if you have no current back problems or rods inserted

SICKLE CELL DISEASE
Generally Not Acceptable
Exception - as trait only

SLEEP APNOEA
Definitely Not Acceptable
No - there is a risk with airway post general anaesthetic

SLE
See Lupus

SPINA BIFIDA OCCULTA
Generally Not Acceptable
Exception - if you are free from problems or mobility problems

TACHYCARDIA
Generally Not Acceptable
Exception - if mild and you are not on medication

TATTOOS / BODY PIERCING (Recent)
Generally Not Acceptable
Exception - if 12 months since tattoo or piercing

TAY SACHS DISEASE
Generally Not Acceptable
Exception - as trait only

TESTOSTERONE INJECTIONS
Generally Not Acceptable
Exception - synthetic injection

THALASSAEMIA
Generally Not Acceptable
Exception - as trait only

THROMBOCYTOPENIA
Definitely Not Acceptable

THYROID
Generally Acceptable
No - if you have Graves disease or Hashimoto's disease, due to auto-immune association
Acceptance Criteria - if you are on thyroxine. If you are on other drugs individual assessment is necessary

TB
Generally Not Acceptable
Exception - if you have been clear for more than 24 months and are not on medication

TURNERS SYNDROME
Generally Not Acceptable
Exception - if the donor has no heart problems

ULCERATIVE COLITIS
Definitely Not Acceptable
No - auto-immune.

URTICARIA
Generally Not Acceptable
Exception - if the condition is mild. Individual assessment is necessary

VITILIGO
Definitely Not Acceptable
No - can be associated with auto-immune disorders.

The following medical conditions do not preclude donating, but should be noted on your registration to join our bone marrow register :
- Gilberts' syndrome
- Hormone replacement therapy
- Irritable bowel syndrome
- PID (Pelvic Inflammatory Disease)
- peritonitis
- polycystic ovary
- renal colic (kidney stone)
- shingles
- termination of pregnancy
- Toxoplasmosis

Indications - Allogeneic

I.


Histocompatibility - All potential allogeneic transplant recipients must have a five of six HLA antigen matched related or unrelated donor. The recipient and donor must be HLA-DR identical. Also, all unrelated donor/recipients must be HLA-DR Beta 1 identical by DNA analysis.

II. Type of Transplant by Disease Category

A. Related, Matched (myeloablative and non-myeloablative)
1. Acute Non-lymphocytic Leukemia in 1st, 2nd or greater remission
2. Refractory Acute Non-lymphocytic Leukemia (Considered on a case by case basis)
3. Acute Non-lymphocytic Leukemia in early relapse (<30 blasts)
4. Acute Lymphocytic Leukemia in 1st, 2nd or greater remission (adult) and Acute Lymphocytic Leukemia in 2nd or greater remission (children)
5. Chronic Myelogenous Leukemia in chronic or accelerated phase
6. Chronic Myelogenous Leukemia in 2nd chronic phase (after blast crisis)
7. Chronic Lymphocytic Leukemia - symptomatic advanced Stage III and IV
8. Juvenile Chronic Myelogenous Leukemia
9. Myelodysplasia
10. Hodgkin's Disease or Non-Hodgkin's Lymphoma
11. Aplastic Anemia
12. Multiple Myeloma
B. Unrelated, Matched
1. Acute Non-lymphocytic Leukemia in 1st, 2nd or greater remission (adult) and Acute Non-lymphocytic Leukemia in 2nd or greater remission (children)
2. Acute Non-lymphocytic Leukemia in early relapse (<30% blasts)
3. Acute Lymphocytic Leukemia in 2nd or greater remission
4. Chronic Myelogenous Leukemia in chronic or accelerated phase
5. Myelodysplasia (Refractory Anemia with Excess Blasts)
III. Source of progenitor cells
A. Bone Marrow
B. Peripheral blood stem cells
C. Cord blood


Indications - Autologous

I.


Disease Status - All patients must demonstrate chemotherapy responsive disease prior to autologous transplantation and evidence of normal cellular, malignancy - free bone marrow on marrow aspirate and biopsy. Peripheral blood stem cells will be the primary source of progenitor cells for autologous transplantation.
II. Diagnoses (Adults and Children)
A. Advanced Stage, Recurrent Hodgkin's Disease; non-purged
B. Advanced Stage, Recurrent Intermediate and/or High Grade, Non-Hodgkin's Lymphoma; non-purged
C. Low Grade Non-Hodgkin's Lymphoma, non-purged (adult)
D. Acute Nonlymphocytic Leukemia in 1st, 2nd or greater remission; non-purged (adults only)
E. Acute Nonlymphocytic Leukemia in 1st remission; purged (children only)
F. Neuroblastoma; purged and non-purged (adult and children)
G. Multiple Myeloma
H. Selected Solid Tumors
III. Source of Progenitor cells
A. Peripheral blood stem cells
B. Bone marrow with or without peripheral blood stem cells


Contraindications

I. Relative
A. Age
B. Cardiopulmonary Disease
C. Renal Disease
D. Liver Disease
E. Active Infection
F. Psychosocial dysfunction
II. Absolute
A. HIV seropositivity
B. Chronic Active Hepatitis
C. Any active soft tissue infection
D. Inability to give informed consent


Allogeneic and Autologous Eligibility Criteria

Adults and Adolescents (Allogeneic)

Patients must be >12 years but < 60 years of age for related donor transplants, and >12 years but < 60 years of age for non-related donor transplants, and < 75 years for non myeloablative, related donor transplant.

Patients must have an ECOG Performance Status of 2 or less.

Patients must have no evidence of active infection at the time of transplantation.

Patients must be HIV nonreactive.

Patients must have a multi-organ assessment prior to transplantation with the following outcome:

A resting ejection fraction of 50% or greater which increases with exercise as demonstrated by Resting/Exercise MUGA

A diffusion capacity of 50% or greater of predicted, a FEV1 of 60% or greater, and PO2 of 80 mm Hg as demonstrated on pulmonary functions testing

A serum creatinine of less than or equal to 2.0 mg/dL and a creatinine clearance of 50 ml/min or greater on 24 hr. urine collection

A total bilirubin of <2.5 mg/dL and/or a AST <2 times the upper limit of normal.

Patients who have had any complication that makes the risk of death during transplantation from non-malignant causes greater than the risk of relapse are ineligible.

Patients who have any active infection such as a soft tissue infection, sinus infection, dental infections, fungal infections or hepatitis including chronic active hepatitis are ineligible; if the infection is successfully treated, the patient may be reconsidered for transplantation at a later date.

Patients who have diabetes mellitus will be considered on a case-by-case basis. However, patients with diabetes who are not controlled by medical management will be ineligible.

Psychosocial assessment by the bone marrow transplant team may identify individuals for whom this form of therapy may be contraindicated. These decisions will be based upon estimated adequacy of patient support systems and prediction of patient's compliance with medications, required diagnostic procedures and/or follow-up care.

Patients or their guardians must give written informed consent in accordance with institutional and federal regulations.

Patients or their guardians must demonstrate proof-of-payment.

Small Children and Infants (Allogeneic)

Patients must be <12 years of age for related donor transplants, and >1year but <12 years of age for non-related donor transplants.

Patients must have an ECOG Performance Status of 2 or less, or appropriate for age.

Patients must have no evidence of active infection at the time of transplantation.

Patients must be HIV non-reactive.

Patients must have a multi-organ assessment before transplantation with the following outcome:

A normal echocardiogram

O2 saturation >95% by pulse oximetry

A serum creatinine within normal limits for age

Patients who have had any complication that makes the risk of death during transplantation from non-malignant causes greater than the risk of relapse are ineligible.

Patients who have any active infection such as a soft tissue infection, sinus infection, dental infections, fungal infections or hepatitis including chronic active hepatitis are ineligible; if the infection is successfully treated, the patient may be reconsidered for transplantation at a later date.

Patients who have diabetes mellitus will be considered on a case-by-case basis. However, patients with diabetes who are not controlled by medical management will be ineligible.

Guardian must give written informed consent in accordance with institutional and federal regulations.

Guardian must demonstrate proof-of-payment.

Adults and Adolescents (Autologous)

Patients must be ≥12 years but ≤ 70 years of age.

Patients must have a life expectancy without therapy of >4 weeks.

Patients must have an ECOG Performance Status of 2 or less, or appropriate for age.

Patients must have no evidence of active infection at the time of transplantation.

Patients must be HIV non-reactive.

Patients who have had any complication that makes the risk of death during transplantation from non-malignant causes greater that the risk of relapse are ineligible.

Patients must have a multi-organ assessment before to transplantation with the following outcome:

A resting ejection fraction of 45% or greater which increases with exercise as demonstrated by Resting/Exercise MUGA with no documented coronary artery disease, history of congestive heart failure, or uncontrolled cardiac dysrhythmia.

A PO2 greater than 60% on room air, O2 saturation of greater than 90% on room air, a FEV1 of greater than 50% and diffusion capacity greater than 40% of predicted.

A serum creatinine of less than 2.0 mg/dL and a creatinine clearance of 50 ml/min or greater on 24 hr. urine collection.

A total bilirubin <2.5 mg/dL, AST<3 times normal.

Patients who have diabetes mellitus will be considered on a case-by-case basis. However, patients with diabetes who are not controlled by medical management will be ineligible.

Psychosocial assessment by the bone marrow transplant team may identify individuals for whom this form of therapy may be contraindicated. These decisions will be based upon estimated adequacy of patient support systems and prediction of patient's compliance with medications, required diagnostic procedures and/or follow-up care.

Patients or their guardians must give written informed consent in accordance with institutional and federal regulations.

Patients or their guardians must demonstrate proof-of-payment.

Small Children and Infants (Autologous)

Patients must be > 3 months but < 18 years of age at time of diagnosis.

Patients must have no evidence of active infection at the time of transplantation.

Patients must be HIV non-reactive.

Patients must have a multi-organ assessment before transplantation with the following outcome:

A normal echocardiogram

O2 saturation >95% by pulse oximetry

A serum creatinine within normal limits for age

Patients who have had any complication that makes the risk of death during transplantation from non-malignant causes greater than the risk of relapse are ineligible.

Patients who have any active infection such as a soft tissue infection, dental infections, fungal infections or hepatitis including chronic active hepatitis are ineligible; if the infection is successfully treated, the patient may be reconsidered for transplantation at a later date.

Patients who have diabetes mellitus will be considered on a case-by-case basis. However, patients with diabetes who are not controlled by medical management will be ineligible.

Guardian must give written informed consent in accordance with institutional and federal regulations.

Guardian must demonstrate proof-of-payment.

Indications and Contraindications for Retransplantation

Allogeneic

Related Donor - Patients who have a related donor are eligible for a second allogeneic bone marrow transplant if they do not demonstrate evidence of engraftment or if graft failure occurs due to rejection or graft versus host disease. Patients must not have evidence of overwhelming infection or end-stage organ dysfunction.

Unrelated Donor - Patients who have an unrelated donor transplant are eligible for a second unrelated donor transplant if they do not demonstrate evidence of engraftment or if graft failure occurs. However, our Bone Marrow Transplant Program must abide by the retransplantation policy and procedures of the National Marrow Donor Program. Those patients who experience a recurrence of their disease following allogeneic bone marrow transplantation will be eligible for a second transplant if they are greater than six months from the first transplant, (first transplant which included ablative chemotherapy alone or in combination with radiotherapy), and if the status of their disease (malignancy only) is minimal or a remission has been achieved with salvage therapy. In addition, patients must have no evidence of major organ dysfunction and/or evidence of active infection. Each patient will be considered by the transplant team on a case-by-case basis.

Autologous

It is not our policy to perform second autologous transplants for patients with recurrent disease.

At this time, we do not perform tandem transplants, however, we do participate in an ECOG study that investigates the efficacy of tandem transplants for patients with testicular cancer.

Evaluation

Patient

A transplant physician in the outpatient clinic evaluates all patients considered for bone marrow transplantation. This evaluation consists of a review of medical records, pathology slides and x-ray films to determine medical history, diagnosis, stage (if applicable) and current disease status. Prior to transplantation, a multi-organ assessment is performed to demonstrate there are no contraindications to transplantation. Appropriate consultations are obtained when indicated. In addition, all transplant candidates and family members are interviewed by the transplant coordinator, primary outpatient nurse and social worker.

Donor

Potential donors are HLA-A, B and DR typed in addition to ABO typing. State- of-the-art, molecular, DR typing is also performed. All HLA testing must be performed at UWHC. Prior to transplantation, the potential donor must have an evaluation which includes: 1) complete history and physical; 2) CBC with differential and platelet count; 3) prothrombin time (PT) and partial thromboplastin time (PTT); 4) chemistry panel that includes glucose, electrolytes, and liver and renal function tests; 5) antibody screen for Hepatitis B and C; 6) antibody screen for toxoplasmosis, Epstein-Barr virus, RPR, HTLV I/II, cytomegalovirus and HIV antigen and antibody; 7) urinalysis. Other tests may be ordered when necessary, such as chest x-ray, electrocardiogram, and pregnancy test.

Also, adult donors may donate one unit of blood for autologous transfusion if it is planned that more than 500 ml of bone marrow will be collected. Donors who are minors will be evaluated on an individual basis regarding the necessity of transfusion following the marrow collection and/or the feasibility of their donating blood for autologous transfusion.

A detailed list of tests performed during the evaluation follows the Summary Statistics.

Acceptance

Patients are accepted/rejected as transplant candidates after the transplant team, which is comprised of transplant physicians, nurses, coordinators and social worker, reviews the initial evaluation. Patients who are accepted for transplantation must satisfy UWHC's financial requirements through written confirmation of insurance coverage or alternative financial arrangements.

When patients are not accepted for transplantation, either because they do not meet the indications or have a condition, which is contraindicated, the transplant physician informs them. When necessary, support from a social worker is available. In addition, we communicate information regarding non-acceptance to the appropriate referring or primary physician to whom the patient is referred back for continuing medical care.