hematology Flashcards
things to ask on Hx for anemia
- HPI
- effect - pallor, tired etc
- diet - cow milk, goat milk, pica
- ROS
- PMHx - birth, jaundice
- Meds - septra, pens, phenytoin
- allergies
8 Fam Hx
things to look for on Phx
- epistaxis
- rings or blue hue
- nodes
- thyroid
- tachy
- murmurs
- HSM
3 most important investigations
- CBC - WBC, Hb, MVC, Plts
- Retic count
- smear
what are two outcomes for retics
high - RBC loss- hemolysis
low - poor production
2 problems for high retics
- intrinsic to RBC
- membranopathy
- Hbopathys
- enzymopathy - extrinsic to RBC
- non-immune hemolysis - coombs neg
- immmune hemolysis - coombs pos
3 problems with low retics
- microcytic - TAILS
- normocytic
- chronic disease
- renal failure
- malignant
- trnasient - macrocytic
- folate or B12 def
- marrow failure
4 causes of Fe def. anemia
- poor stores at birth
- poor diet
- blood loss
- malabsorption
workup for FE def.
- CBC
- smear
- retics
- ferrtin, transferritin, serum Fe
mgmt of Fe def. anemia
give Fe
- follow up CBC in 2 weeks
2 types of hemolysis and what is seen on tests
- intravasc.
- high LDH, bili, low haptoglobin
- film show shistocytes and frags - extravasc.
- spherocytes
3 causes of intravasc.
- membrane defects
- hereditary spherocytosis
- need splenectomy - enxyme defects
- G6PD
- x-linked recessive
- triggered by drugs, fava beans, infections - hemoglobinopathies
- sickle and thal
-
2 main types of extrinsic defects and how to tell apart
- immune related
- non-immune related
coombs test - identify antibodies/complement on surface of RBC or in serum
3 main types of immune
- drug related
- alloimmune
- hemolytic transfusion
- hemolytic disease of newborn - autoimmune
- Warm- IgG/complement
- Cold IgM - keep the blood warm
3 main causes of non-immune
- TTP
- emergency
- hyaline microthrombi
- supportive and plasmaphersis - hemolytic uermic syndrome
- like TTP but restricted to kidneys
- mainly in children
- may need dyalisis - DIC
3 main types of sickle cell
- SS disease
- SC disease
- S-Bthal
what is special about infections in sickle
functionally asplenic, so at risk from encapsulated organisms
invest for SC
- part of new born screen
- sickledex
- protein electrophoresis for def. Dx
- high retics
SCD infection prophylaxis
- antimicrobials between 2mos-5yrs
- Pen V, or amox
- regular immunizations, PLUS S.pneumo and n. meningiditis
stroke prophylaxis for SCD
screen with transcranial doppler
- abnormal results indicate art. narrowing and increased stroke risk
- from 2-16 years for average and until 18 for high
4 main SCD prophylaxis
- infection
- stroke
- hydroxyurea
- transfusions
what is use of hydroxyurea
- reduces crises by increasing HbF
- for all HbSS or thal >9mos or more than 3 crises per year
- expect drop in WBC and platelets and increase in MCV
- not for preg or breastfeeding
2 main types of transfusions in SCD
- top up to Hb 100
2. exchange - HbS of 30%
4 indications for transfusions
- anemia exacerbation
- peri-op
- SCD complications
- prevention of complications
complicaitons of transfusions
- delayed hemolytic
- hyperhemolysis
- hyperviscosity
- iron overload
general approach to SCD crises
- pain
- avoid extreme temp
- hydroxyurea
- good analgesics
- rehydration
8 crises of SCD and their Tx - see P142 for their casues
- vaso-occlusive - most common
- analgesics - aplastic
- RBCs
- isolation - splenic sequestration
- IV resus
- splenectomy - acute chest
- IV cephalosporin, macrolide
- O2
- possible RBC - fever/sepsis
- empiric Abx - stroke
- urgent CT head
- exchange transfusion - priapsim
- hydration and analgesia - gallstones
- watchful waiting
what is def. of thrombocytopenia
platelets of less than 150
3 broad differential for thrombopenia
- decreased production
- increased destruction
- immune - ITP, SLE, evans
- non-immune - DIC, HUS, thrombosis - sequestration
def. of ITP
autoimmune dis. char. by immune destruction of normal platelets
- peak age 2-6
Tx of ITP
observe if >10 platelets if under 10 - pred - IVIG - anti-D
