"Thalassemia" case for my Professional Exam. I'm finally a doctor !

Hey guys. I’m sorry for the very long hiatus. It has been several months and finally I’m back to blogging. I was busy with the professional exams and I took some weeks off after that to recuperate. The medical professional exam was really exhausting as I had almost two months of study weeks which were full of anxiety, late night thoughts, wondering whether are you going to pass or not, pondering whether are you worthy enough to become a doctor and etc. Fret not, I’ve managed to pass the professional exams and now I’m officially a medical doctor!! Yeay me.

Before this, I was too focused on writing articles which were related to health, specifically medicine because my intention was to share whatever things which I have studied. For now onwards, probably I’m going to stray away from medically-related topics because I need to get my head off from medicine for at least let’s say… a couple of months? I do have lots of interest in other fields in science which you guys will see in the upcoming posts. Again, sorry for the long absence and I hope that you guys will enjoy and appreciate the upcoming contents from me.
I would like to share about the long case examination which I’ve gotten during my exams. There are several parts of the professional medical exams, and I was required to pass all the components in order to graduate. The components are long case, short case, theory exams, and unmanned OSCE. Just a brief description of each:

1. Long case is the biggest deal of all. You are required to take history, do some physical examinations, and perform some bedside investigations. After that you should present your case to a selected panel of examiners which are specialists and then the Q&A session. The total timespan is about 1.5 hours. The most nerve wrecking one and a half hours of my life.
2. There are four short case stations. You are told to perform physical examinations on real patients for about 10 minutes each.
3. Theory exams, as the name implies, will test your theoretical medical knowledge. Comprises of one best answer questions, extended matching items and key features questions from all the departments in the hospital
4. The last one but not least is the unmanned OSCE . There was 20 stations which you are only allowed to spend about 5 minutes each station. Honestly, this is the most difficult one as you have to make very fast decision and our questions were really hard.

Alright, I’ll concentrate more about the long case. I have examined a 32 year old Malay gentlemen with underlying Beta Thalassemia with its complications. I’ve explained about how he was diagnosed and then how was the blood transfusion started. What is his pre-transfusion hemoglobin level and what is his post-transfusion hemoglobin level. I’ve mentioned about most of the complications of blood transfusion which includes the risk of infection, iron overload and the complications of the treatment of iron overload. The iron overload level is measured via the serum Ferritin. Iron overload is the most common complication of thalassemia as the breakdown of the abnormal red blood cells causes iron build up in the person. Iron sediments can be deposited anywhere in the body and if it affects some of the vital organs, the result can be quite devastating. He was started on iron chelation therapy via subcutaneous Desferioxamine so the body will excrete more iron. The picture shows how Thalassemia is inherited, which is Autosomal Recessive. Usually, both parents are Thalassemia carriers.

The most common blood-borne infection transmitted via blood transfusions are HIV, Hepatitis B, and Hepatitis C. Hence it is important for the patient to do annual screening for these infections. Yeah it’s true that most of the blood products are screened beforehand but the screening accuracy is not perfect, hence there is still chances of transmission.
As for the iron overload, the iron can be deposited in the pancreas. The pancreas is an endorcrine organ that secretes insulin, glucagon and digestive enzymes. The iron deposition can damage the pancreas and might cause damage to the Beta islets cells of the pancreas which results in Diabetes Mellitus due to reduce insulin secretion. Another lethal complication of iron overload is cardiomyopathy due to iron deposition on the heart. It can cause symptoms of heart failure and the mortality rate is very high especially if the patient is not compliant to the iron chelation/iron removal therapy.

One interesting fact is that the examiner asked me why the patient’s face is very smooth, as in free from pimples. It was actually the fault of iron overload which deposits in the pituitary gland. The pituitary gland is important in handling all sorts of endocrinal function of the whole body but in this case, probably the sex hormones are affected. Reduction in sex hormones causes less pimple formation. Sweet eh? Haha.

Apart from that, the iron chelation therapy itself can cause damage to the ears and eyes. Hence regular follow up to the ENTs and Ophthalmologists are essential. Due to the extensive breakdown of blood in the spleen, the patient’s spleen was enlarged and was remove surgically. This is a normal physical finding of Thalassemia and it is essential to remove the spleen as it can cause more blood transfusion requirements. Post-splenectomy, the person is required to take penicillin for life as they are prone to get infections namely the OPSIs (Overwhelming Post-Splenectomy) infections. Have a read about it.

Alright, that’s all for my sharing today. I hope I will be able to come out with good quality articles in the future. No more medical content for me, at least for a short while. Haha. Thanks for the time :)

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Disclaimer: Some pictures are owned by me, those without names. No reference are included because it is all from my experience.