Hematology Mksap

Front 1

Differentiate Anemia of Chronic Disease vs. Anemia from Iron Deficiency.

Back 1

ACD: TIBC is low/normal, Serum iron is low, Ferritin can be higher than normal since acute phase protein.
A of Iron Def:. Serum iron is low, TIBC is high, ferritin is usually low.

Front 2

Dx. Pancytopenia, low reticulocyte, and hypoplastic bone marrow

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Aplastic Anemia. Need to rule out thymoma, and take out any kind of drugs that could be causing it.

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Dx. and Tx: Bite cells on peripheral smear, a hemolytic anemia caused by taking in bactrim. High Retic, Indirect billirubinemia.

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G6PD deficiency. Is essential in producing NADPH, found on the X chromosome, and hemolysis can be precipitated by drugs, infection. Also jaundice, and dark urine.

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Dx. target cells with microcytic anemia

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Thalassemia minor.

Front 5

Differentiating B12 def. from a Folate deficiency.

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First, B12 is cobalamin, and deficiency will cause neurologic symptoms. Folate does not. Both cause a macrocytic anemia. To dx cobalamin def., you need to check methymalonic acid and homocystein levels. They will be elevated in B12 def. before B12 def. becomes grossly apparent.

Front 6

Macrocytic anemia, with elevated levels of homocysteine, but normal levels of methymalonic acid. No neurologic symptoms.

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Folate Def.

Front 7

Dx. Schistocytes

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MAHA. This can be found in TTP, HUS, or DIC, or w mechanical destruction due to prosthetic heart valves.

Front 8

Findings in AIHA

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microspherocytes, increased reticulocytes, NO schistocytes

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Smear showing Microcytosis, hypochromia, anisocytosis, and poikilocytosis

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Iron Def. Anemia. The poikilocytosis is classic of iron def. anemia.

Front 10

Positive Coombs Test, indirect bilirubinemia

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AIHA. No schistocytes on smear!
Can be caused as a result of drugs, chemo, malignancies.

Front 11

Dx. Prolonged PT, PTT, bleeding time. Negative D Dimer

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Severe liver dysfunction.

Front 12

Dx. prolonged, PT, PTT, high D dimer, and reduced fibrinogen, reduced platelet, and MAHA

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DIC. Fragmented erythrocytes seen on smear.

Front 13

Dx. Thrombocytopenia, MAHA, neurologic deficits, renal impairment, fever

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TTP, affects older people. No elevation of PT or PTT, D dimer depression.

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Dx .thrombocytopenia, MAHA, Renal dysfunction.

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HUS. usually no fevers, usually no neurologic deficits. Normal PT and PTT, and D dimer is normal.

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characteristics of ITP

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only associated w thrombocytopenia.

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Dx. Personal hx and family hx of bleeding, prolonged bleeding a time, and elevated PTT, low factor VIII levels.

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vWD. X linked. Only way to differentiate from Hemophilia A is the bleeding time (which isnt affected in A).

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Vit K dependent Co Factors

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II, VII, IX, X, protein S, protein C, protein Z. Only factors not made in the liver is VIII, vWF.

Front 18

Dx. Sever weakness and dyspnea in a sickle cell patient, no retics on smear, and only significant for tachycardia to 148.

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Aplastic Crisis, common in patients w chronic anemia. Most common cause is parvovirus B19.

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Fixed splitting of S1 and S2, large a and v waves, vetricular heave, systolic murmur that increases w respiration

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Pulmonary hypertension. Found as a comorbidity of patients w sickle cell diseae.

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Tx of Sickle Cell patient w right sided pleuritic chest pain, non productive cough and pain in leg and pelvis.

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Acute Chest Syndrome, it is managed RBC exchange transfusion. Increases hemoglobin A levels, preventing the sickling. BC they are not volume down, you need to actively remove bad blood and put good blood in, thus a nl transfusion is not indicated.

Front 21

Dx. Sickle Cell pt. w left groin pain, diff. walking, no trauma, limp on walking, restricted flexion and internal rotation.

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Avascular necrosis (osteonecrosis). Common in pt. w trauma, sickle cell, alc. abuse, steroids, gout. Xray may show increaed density. MRI is study of choice.

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Tx. of HIT

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DC heparin, start argatroban (direct thrombin inhibitor). Do not use Warfarin, as you have not been able to bridge, and you can induce a warfarin induced necrosis picture.

Front 23

Dx. ADAMTS12

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Usually seen in patients with TTP. Remember the Pentad: Thombocytopenia, fever, renal, hemolytic anemia, CNS symptoms

Front 24

Dx. AIHA with immune thrombocytopenic purpura

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Evans syndrome. Will have microspherocytes, and NO schitocytes.

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Dx. Thrombocytopenia w large platelty

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This is usually seen in ITP, first line treatment is corticosteroids. This should be done in acute episodes or if platelets are less than 15k.

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Mgmt of thrombophillic screening

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Should be done after completion of antithrombotic therapy.

Front 27

Tx length of anticoagulation for patients diagnosed w antiphospholipid antibody syndrome and one episode of DVT

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Anticoagulation indefinitely. If they havent had a DVT yet. Their risk of recurrence is high if they were ever to stop anticoagulation.

Front 28

Dx. Hypercoagulable state associated with fetal loss

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antiphospholipid antibody syndrome

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Dx. 70 yo F w anorexia and malaise for 1 week, decreased anion gap, proteinuria, hypercalcemia, and renal failure

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Multiple Myeloma. AKI is the initial presentation in 50% of patients. A low anion gap indicates a low albumin or an unmeasured cation (a light chain for example in MM).

Front 30

Dx. hypercalcemia, osteopenia, rouleaux formation erythrocytes. Biopsy shows cluster of plasma cells, which have perinuclear halo.

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Multiple myeloma. Many of these patients have a hx of encapsulated organism-related pneumonia.

Front 31

Dx serum monoclonal protein level less than 3. g/dl wo features of myeloma and less than 10% plasma cells in bone marrow.

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MGUS. M protein, serum monoclonal protein. No therapy is indicated.

Front 32

Dx Mature appearing leukocytosis w CD5, CD20, and CD23 cells.

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CLL. Occurs commonly in patients after age 40. Also large number of smudge cells.

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Dx Explosive increase in T or B cell precursors, rapidly rising levels of blasts in the marrow. Bulkly lympadenopathy. Young age of onset!

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ALL.

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Dx. Sever pancytopenia and circulating myeloid blasts, infections.

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AML. Lots of circulating leukemic blasts. Auer Bodies! Happens when youre 50 or older.

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Dx. BCR/ABL, philadelphia chromosome. Granulocytes w a marked left shift, and hypercellular bone marrow w marked myeloid proliferation.

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CML