Screening
There are several groups where screening for PNH should be undertaken. These include patients with unexplained thrombosis who
are young, have thrombosis in an unusual site (e.g. intra-abdominal veins, cerebral veins, dermal veins), have any evidence of hemolysis (e.g. a raised LDH), or have a low red blood cell, white blood cell, or platelet count. Those who have a diagnosis of aplastic anemia should be screened annually. Treatment
Acute attacks
There is disagreement as to whether steroids (such as prednisolone) can decrease the severity of hemolytic crises. Transfusion therapy may be needed; in addition to correcting significant anemia, this suppresses the production of PNH cells by the bone marrow, and indirectly the severity of the hemolysis. Iron deficiency develops with time, due to losses in urine, and may have to be treated if present. Iron therapy can result in more hemolysis as more PNH cells are produced. Long-term
PNH is a chronic condition. In patients with only a small clone and few problems, monitoring of the flow cytometry every six months gives information on the severity and risk of potential complications. Given the high risk of thrombosis in PNH, preventive treatment with warfarin decreases the risk of thrombosis in those with a large clone (50% of white blood cells type III).Episodes of thrombosis are treated as they would in other patients, but, given that PNH is a persisting underlying cause, it is likely that treatment with warfarin or similar drugs needs to be continued long-term after an episode of thrombosis.
Cuboid syndrome or cuboid subluxation describes a condition that results from subtle injury to the calcaneocuboid joint and ligaments in the vicinity of the cuboid bone, one of seven tarsal bones of the human foot. This condition often manifests in the form of lateral (little toe side) foot pain and sometimes general foot weakness. Cuboid syndrome, which is relatively common but not well defined or recognized, is known by many other names, including lateral plantar neuritis, cuboid fault syndrome, peroneal cuboid syndrome, dropped cuboid, locked cuboid and subluxed cuboid. Signs and symptoms
A patient with cuboid syndrome usually seeks medical advice and attention complaining of pain, discomfort, or weakness along the lateral aspect of the foot between the fourth and fifth metatarsals and the calcaneocuboid joint. The pain may radiate throughout the foot. Tenderness may be elicited over the tendon of the peroneus longus muscle and an antalgic gait may be observed. The pain may be observed in a controlled environment by standing on the toes or rolling the arches of the foot, as these motions tend to exercise the foots calcaneocuboid joint and ligament, which are characteristically strained in a patient suffering from cuboid syndrome. Also, the pain may come on suddenly or it may develop gradually and persist over time. Sometimes the pain is intermittent, subsiding partially or completely for a period of time before returning again. Causes
A patient may develop Cuboid syndrome through either a single traumatic event (e.g., ankle sprain) or insidiously with repetitive strain over time.