Hematology Flashcards
Mentzer Index
MCV/RBC
< 13 = thalassemia
> 13 = IDA
How should infants of Rh -ve mothers be monitored?
If RhD antibody titer >/= 1:16 –> monitor fetal anemia with doppler US of middle cerebral artery (increased velocity of blood flow correlates with severity of anemia) and percutaneous umbilical cord sampling if indicated (if doppler suggestive of moderate to severe anemia)
Heinz Bodies
G6PD - oxidative stress
Pencil cells
IDA
CBC features of HS
MCHC >35.4 g/dL combined with a red cell distribution width (RDW) <14% has been suggested as a screening test for HS.
Hemolytic anemia!
Normal or slightly low MCV
Testing for HS
- osmotic fragility
- EMA fluorescence test
- Genetics (AD)
Hemoglobinopathy newborn screen
Testing for bleeding disorders
Hemophilia = prolonged PTT (mixing normal unless inhibitor present)
Interpretation of a Mixing Study
- corrects = factor deficiency
- does not correct/partial = inhibitor to a factor
- not corrected and no bleeding = lupus anticoagulant
Severity classification of Hemophilia
<1% = severe
1-5% = moderate
>5% = mild
Indications for DDAVP in bleeding disorders
- responder in VWD Type 1
- Hemophilia A (VIII) if mild
ECG findings in PE
Lab findings in DIC
- low fibrinogen
- low platelets
- low Factor II, III, V
- elevated PTT
- elevated INR
- elevated TT
- schistocytes on smear
Vaccines in hyposplenism
Indications for lymph node biopsy
Biopsy should be considered for the following reasons:
- suspicion of malignancy
- if the patient does not have resolution of lymphadenopathy over 4 to 6 weeks
- lymphadenopathy that steadily increases in size over 2 to 3 weeks
- lymphadenopathy greater than 2.0 cm
- multiple lymph nodes that have concerning features on ultrasonography or CT.
Vitamin K Prophylaxis in Newborns
Vitamin K IM for all newborns within 6 hours of life
- 0.5mg if <1500g
- 1.0mg if > 1500g
- 0.2 - 0.5mg IM for preterms
Vitamin K PO if declined
- 2.0mg PO with first feeding, repeat at 2, 4 and 6 weeks of age
Counsel parents on risk of Hemorrhagic Disease if declining
- PO Vitamin K is less effective
- Infant MUST receive ALL doses
- There is still a risk of late VKDB - potentially with ICH
Hydroxyurea is preventative for…
- acute chest
- VOE
- transfusions
- hospitalizations
- mortality
Low risk criteria for SCD and Fever
Acute Management of SCD Complications
Indications for transfusion in SCD
- acute stroke (exchange)
- chronic stroke prevention
- aplastic crisis
- acute chest syndrome
- splenic sequestration
- Hgb 20 below baseline or < 60 with unknown baseline
VOE is not an indication for transfusion
