LIVING THE LAB LIFE
A BLOG FOR ASCLS REGION V
You may be wondering, what does SE Asian Refugees have to do with rural South Dakota? It was the same thing that popped into my mind too. But, I learned that Huron, SD has been a receiving site for Karen (pronounced kaRen) refugees (people from the country of Myanmar or Burma) through Lutheran Social Services since 2011. This small ethnic group (approx. 5 million people) have been persecuted by Burmese soldiers for 50 years; they fled to Thailand to seek refuge from death, torture, and forced labor. And now, about 65,000 Karen refugees have relocated to the United States. This has increased the diversity of the 13,000+ person town of Huron significantly. Now about 8% of the town is Asian. And the lab plays a big role in their health on the trip over.
It's a long process from Myanmar to the US, but it begins with a general screening 6 months prior to departure for any inadmissible health-related conditions. Then three weeks before departure refugees are screened for active TB. Then within the 24-48 hour embarkation flight to the US all refugees are screened for lice and treatment of intestinal parasites. Upon arrival and within 30 days, each refugee is to a medical screening by a health care provider. Now its the labs turn to help them out!
Initial Refugee Lab Work includes:
1. CBC: screen for anemia, check eosinophil count
2. CMP- check liver enzymes, screen for diabetes
4. Hep B (very common among refugees) and Hep C
5. Chlamydia, Gonorrhea, HIV, Syphilis
6. Lead-children under 16
7. TB Skin Test-Chest X-ray if positive
8. Preventative Health if indicated--> pap, mammogram, colonscopy
After running these tests the most common diseases found are B-Thalassemia, Malaria, Tuberculosis, Hepatitis B & C.
A recap of some of these diseases just in case you may have forgotten or wouldn't mind a refresher....
-Autosomal recessive, hereditary disorder causes decrease in B globin chains
-protects against malaria; very prevalent in Mediterranean Regions
-3 types: Minor (asymptomatic, normal life expectancy, one normal B globin gene & one thalassemia gene), Intermedia (asymptomatic, 1 or 2 abnormal B globin genes), Major (2 abnormal B globin genes, will die by age 2 without transfusions)
-Anemia caused by abnormal B chain makes RBC die in bone marrow resulting in shorten life span of circulating RBCs. RBC production increases and GI tract absorbs more iron. Thus, many develop iron overload.
-Lab Findings: MCV 55-75 fL, hypochromia, microcytosis, target cells, basophilic stippling, NRBC, HCT <10% (sometimes), poikilocytosis if severe, ferrtitin may be high.
-Treatment: none for Minor --> blood transfusions, splenectomy, iron chelation, bone marrow transplant for Major
-Vector transmitted parasite
-Symptoms: intermittent attacks of fever, chills, and sweating, headache, fatigue, nausea, vomiting, jaundice
-Lab findings: anemia, thrombocytopenia (maybe), Giemsa-stained blood smears, malarial parasite inclusions in RBC on M. Diff.
-Treatment: drug chosen based on strain and geography, if severe, may consider exchange transfusion
-Caused by Mycobacterium Tuberculosis
-One of the world's most wide spread infections-->15 million people have it in the US
-Latent TB--> is alive in the body, but inactive; T cells and macrophages surround bacteria in granulomas; positive PPD (TB skin tes); asymptomatic with normal chest x-ray
-Pulmonary Symptoms: fatigue, weight loss, night seats, fever, cough, blood streaked sputum
-Diagnosis: culture, acid fast bacteria, bronchial washing negative, transbronchial lung biopsy
-TB can affect many parts of the body, not just the lungs