Hematology

Question 1

Megaloblastic anemia findings

Answer 1

Smear - hypersegmented neutrophils and oval cells

Often high ldh and bili with b12 bc rbc precursors get destroyed as they leave the marrow
Low retic

MMA up in b12, not folate

If b12, antipar cell and antiIF ig confirm pernicious anemia

Question 2

Sickle cell anemia workup

Answer 2

Blood cx, ua, retic, cbc, cxr

If fever, start ctx, Levo or moxi empirically

Question 3

Cold vs warm agglutinins

Answer 3

Hemolysis

Warm is autoimmune, Coombs pos, IgG, responds to ivig and splenectomy

Cold is coombs neg, complement pos, IgM mediated, tx ritux

Question 4

HUS vs TTP

Answer 4

Hus- ecoli, autoimmune hemolysis, renal failure, thrombocytopenia (art)

TTP- drugs, above sx plus fever and neuro (fat rn)

Adamts13 decreased in both

DO NOT GIVE PLTS

Eculizumab stops rbc destruction

Question 5

PNH dx

Answer 5

Cd55 and cd59 antibody

Question 6

Methemoglobinemia - cause and tx

Answer 6

Cause is nitro drugs, dapsone, anesthetics ending in -caine

Tx methylene blue

Question 7

DIC workup

Answer 7

Platelets, coags, fibrinogen, ddimer

Question 8

Transfusion reactions and rbc treatments

Answer 8

Immediate - anaphylaxis
Then acute hemolytic (eg mismatch)
Then febrile nonhemolytic, taco, trali, urticaria
Then delayed hemolytic days out

Treatments:
-irradiated for immunocomp
-leukoreduced if chronically transfused, at risk of cmv, have had febrile nonhemolytic reaction prior
-washed if iga deficiency, cold agg, allergic rxns despite antihist (washing removes plasma)

Question 9

ITP vs TTP

Answer 9

ITP less severe, often after virus, plts morphologically normal, mucocut bleeding and petech, normal rbc and wbc, tx is nothing unless plt<30, then steroids. Ivig only if hemorrhage

TTP more severe, plt and rbc, hemolytic anemia with schistocytes, end organ damage, tx plex

Question 10

Dic vs ttp

Answer 10

Both have maha and thrombocytopenia but ttp has normal coag times