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Hem/Onc
RBC Pathology
Image Pathology What it is Causes Heinz Body Also, Bite cells Oxidized hemoglobin G6PD Howell-Jolly Body Nuclear remnant Asplenia Sickle Cell Disease Ringed Sideroblast Mitochondria Sideroblastic anemia MDS Basophilic stippling Ribosomes All microcytic anemias Lead poisoning Alcohol Target cell Thalassemia Asplenia HbC disease Liver disease Acanthocyte Spur cell Abetalipoproteinemia...
Read moreBlood Transfusion
Adverse Reactions Allergic Etiology Anaphylactic Within seconds Anti-IgA antibodies in recipient Urticarial IgE antibodies in recipient Mast cell activation Presentation Urticaria Flushing Angioedema Pruritus Anaphylaxis Treatment Severe (Anaphylactic) STOP transfusion Epinephrin Mild/Moderate (Urticarial) DON’T stop transfusion ? Antihistamine Febrile Etiology Cytokines during storage Presentation 1-6h after Fever Chills Rigors...
Read moreImmune Coagulation Disorders
ITP Etiology Anti-PLT IgG Presentation PLT-type bleeding ↓PLT Normal size spleen Acute → Children after viral illness Chronic → Young adults, F>M Diagnosis Diagnosis of exclusion Anti-PLT Ab → Not specific U/S, CT → Exclude hypersplenism ↑ Megakaryocytes ⇒ ↑ Mean PLT volume Normal RBC morphology Treatment PLT >30k, No bleeding → No treatment...
Read moreAnticoagulants
Coagulation Cascade Heparins → Antidote → Protamine sulfate Heparin → ↑PTT LMWH → No change in PTT Enoxaparin Dalteparin Contraindicated in Renal Failure Warfarin → Toxicity → FFP, Vit K, Protrombin complex concentrate ↑PT ↓ liver synthesis of K-dependent factors 2, 7, 9, 10 C, S → Shorter half-life ⇒ Paradoxical hypergoagulability Factor Xa inhibitors Direct RiveroXaban (Xarelto) →...
Read morePorphyrias
Etiology Heme production abnormality ⇒ Porphyrin accumulation Porphyria Cutanea Tarda HCV Hemochromatosis Acute Intermittent Porphyria Erythropoietic Porphyria Lead Poisoning → Porphyria-like disorder Presentation General Photodermatitis Erythema Blisters Neuropsychiatric Psychosis Polyneuropathy Areflexia Visceral Abdominal pain Seizure Hemolytic anemia Pink/brown urine → Telltale sign Tachycardia Disease specific Porphyria Cutanea Tarda Most common...
Read moreAplastic Anemia
Etiology BM invasion Infection Cancer Myelofibrosis Myelophthisic anemia Etiology BM fibrosis Extramedullary hematopoiesis Spleen Liver Presentation Pancytopenia symptoms Diagnosis Pancytopenia Blood smear Tear-drop cells Nucleated RBC Treatment TNF inhibitors Thalidomide Lenalidomide <50y → BM transplant Ruxolitinib → JAK2 inhibitor → Suppress myelofibrosis Disease SLE PNH B12/Folate deficiency Renal failure (↓EPO) Thymic...
Read moreHemolytic Anemia
Seen in all hemolytic anemias Sudden ↓HCT ↑LDH ↑Indirect bilirubin → Bilirubin gallstones (in chronic hemolysis) ↑Retic → ↑MCV ↓Haptoglobin ↑K ↓Folate Sickle Cell Disease Etiology AR Beta globin chain 6th position → Point mutation → Valine replaces Glutamic acid Presentation African American First presentation → Dactylitis in children Acute crisis Billirubin gallstones...
Read moreMacrocytic Anemia
Etiology ↓B12 Pernicious anemia Parietal cell atrophy → No intrinsic factor ↑ Risk of gastric cancer Pancreatic insufficiency → B12 not freed from R-protein Dietary (vegan) Terminal illeum Crohn Celiac → Also causes Iron deficiency Tropical sprue Radiation Blind loop syndrome Diphyllobotrium latum HIV Alcoholism ↓Folate Dietary (goat milk) Alcoholism...
Read moreMicrocytic Anemia
MCV <80 fL Etiology Iron deficiency Blood loss Menstruation GI bleeding Iron need Normal → 1-2 mg/day Menstruating → 2-3 mg/day Pregnancy → 5-6 mg/day Duodenum absorption → 4 mg/day Chronic disease Iron locked in cells, macrophages and ferritin Renal failure → ↓Erythropoietin ⬆︎Hepcidin Sideroblastic Iron cannot incorporate into heme Alcohol Lead poisoning Isoniazid...
Read moreHypercoagulable States
Factor V Leiden mutation Etiology Factor 5 resistant to inactivation by protein C Presentation Young caucasian with family history of thrombosis DVT PE MI Stroke Treatment First event → Heparin to Warfarin until INR 2-3 for 6m Second event → Heparin to Warfarin until INR 2-3 for 12m Third event...
Read moreBleeding Disorders
Hemophilia Etiology XR Factor 8 → A (80%) Factor 9 → B Factor 11 → C Presentation Male child with delayed joint/muscle bleeding Normal BT Normal PT ↑aPTT Diagnosis Best initial → Mixing study → Corrects aPTT Most accurate → Factor assays for 7, 8, 9, 11, 12 Treatment...
Read morePlasma Cell Disorders
Multiple Myeloma Etiology Plasma cell monoclonal proliferation Osteoclast activating factor (OAF) ⇒ Lytic lesions Presentation CRAB C → ↑Ca R → Renal failure A → Anemia B → Bone pain Most common → Bone pain → Pathologic fracture ↑Ca Infection ↑ Uric acid → Nuclear material turnover Anemia Renal failure Immunoglobulin accumulation...
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