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Headaches Blurry vision Red skin on the face, hands, and feet Fatigue High blood pressure Dizziness Abdominal pain Periods of cognitive confusion Gout (inflammation of the joints) Itchy skin Abnormal bleeding and bruising

However, severe cases with very low platelet counts may require more aggressive treatment

Representative mutations are those that interfere with contact points between the and subunits (e.g., Hb Philly [ 35TyrPhe ]), alter the helical segments (e.g., Hb Genova [ 28LeuPro ]), or disrupt interactions of the hydrophobic pockets of the globin subunits with heme (e.g., Hb Kln [ 98ValMet ]) (Table 127-3)

## The difference between a properly reconstituted vial and a mishandled one can mean the difference between full potency and wasted medication