HEMATOLOGY Flashcards
FATIGUE JAUNDICE BACK PAIN DARK URINE
ACUTE HEPATITIS
ACUTE HEMOLISIS
HEMOLYTIC ANAEMIA
G6PD DEFICIENCY
HEREDITARY RED BLOOD CELL MEMBRANE DEFICIENCY WITH ASSOCIATED INFECTION
CHOLANGITIS TO RETAINED STONES IN THE COMMON BILE DUCT
IWU:
CBC PERIPHERAL SMEAR PT AND PTT LFT UA US ABDOMEN
IM:
U FOR HEMOSIDERINE AND HEMOGLOBIN
HAPTOGLOBINA
G6PD LEVEL REPEAT AFTER HEMOLISIS IS OVER
COOMB TEST
CRYSTAL VIOLET STAIN OF PERIPHERAL SMEAR HEINZ BODIES
FM:
SUPPORTIVE CARE
HYDRATION
SUPPORT TRANSFUSION IF NEEDED
FU:
G6PD LEVEL RE CHECK
NOSE BLEED
THROMBOCYTOPENIA
VWD
ITP*
ACUTE LEUKEMIA
DRUG RELATED
DXZ
ISOLATED PLATELET
SLE
HIV
LLC
PATH:
IgG C3-5 SPLENIC DESTRUCTION
100-50 NOTHING
-50 STEROID IT
-10 IVIG IT ——–
AVOID PLAT TRANSF
IWU:
CBC*
PT
PTT
Fb
FM:
BMBx ANA HIV ANTI PLATELETS Abs* AUS
FU:
STEROID 4-6 wk
IVIG* IF THREATENING BLEEDING
SPLENECTOMY*
CITOTOXIC LIKE VINCRISTINE
THROMBOPOYETICS* NOT ONLY DESTRUCTION BUT MEDULLA
ROMIPLOSTIN
ELTROMBOPAG
SOB + JOINT BACK PAIN
ACS*
P INFARCTION OR PNA
IWU:
CBC PERIPHERAL SMEAR BILI UA ABG CXR
IM:
SPUTUM CYTOLOGY URINE CYTOLOGY Hb ELECTROPHORESIS AGGRESSIVE PAIN MGMT W/NARCOTICS HYDRATION OXYGEN THERAPY EMPIRIC ABx CETRIAXONE or CEFOTAXIME EXCHANGE TRANSFUSION* IF HYPOXIA DOES NOT CORRECT WITH SUPPLEMENTAL MEASURES HYDROXYUREA FUTURE CRISIS
FU:
PNEUMOCOCCAL VACCINE
FOLATE CHRONICALLY
BLEEDING
HOSPITALIZED PNA BROAD SPECTRUM ABx*
COFFEE GROUND EMESIS
PT 16 RV <14
PTT 45 RV <35
PLAT 250
ALGORITHM DX:
PT - PTT OR BOTH*?
MIXING CORRECT?
FACTOR INHIBITOR AUTOIMMUNE DZ OR HEMOPHILIA MULTIPLE DOSES OF CRYOPRECIPITATE DEVELOP IMMUNITY
FACTOR DEFICIENCY
DIC
LIVER DISEASE
VITAMIN K DEFICIENCY*
IWU:
ASAT ALAT Fb LDH PAL BIL
IM:
TRIAL OF S/C VIT K*
FFP
SHOCK/BLEEDING
POST TRANSFUSION STATE
IWU:
CBC PT PTT Fb UA BUN /Crea
IM:
FREE Hb IN PLASMA U Hb HAPTOGLOBIN COOMBS LDH BLOOD RE* TYPE PT & DONOR FM: DIC= FFP + SUPPORT MEASURES RENAL FAILURE = FOROSEMIDE AND MANITOL
FU:
BUN / Crea IF RAISES = DYALISIS
HYPOTENSION = IVF + DOBUTAMINE
EPISTAXIS AND BRUISING
MENINGOCOCCEMIA
DIC*
LEUKEMIA WITH RESULTANT INFECTION AND THROMBOCITOPENIA
LIVER FAILURE COAGULOPATHY
SEPSIS WITH ASSOCIATED THROMBOCITOPENIA
Pg -> PlASMIN Fg -> FIBRINA FIBRIN SPLITS PRODUCTS & D DIMER
IWU:
CBC
PT
PTT
LFT
IM:
Fb FIBRIN SPLIT PRODUCTS ABX TO CONTROL INFECTION FFP REPLACEMENT HEPARIN IS NOT INDICATED
FM:
TREAT THE CAUSE EX ABRUPTIO PLACENTAE
ROUTINE OFFICE VISIT
TINGLING IN HANDS AND FEET
DZ X
MGUS*
SPIKE < 3g OTHER POLICLONAL GG TENDS TO BE NORMAL PLASMA CELL BMBx < 10 %
MM Ca BUN/Cr MONOCLONAL SPIKE IgG IgA
HIV
SENSORY NEUROPATHY SECONDARY TO DRUGS EX ALCOHOL
VITAMIN B 12 DEFICIENCY
*SENSORY MOTOR NEUROPATHY
IWU:
CBC TOTAL PROTEIN* > 9.5G/L ALB 3.5 G/L ELECTROPHORESIS OF PROTEIN* MONOCLONAL SPIKE IN THE GAMMAGLOBULIN SITE OF 2.5 G VITAMIN B12 LEVEL LUMBAR PUNCTURE IM: SKELETAL SURVEY URINE FOR BENCE JONES BONE MARROW EXAMINATION
FU:
PROGRESSION TO PLASMA CELL DYSCRASIA RATE 10 Y 5 - 22%
MELPHALAN PREDNISONE BORTEZOMIB LEFLUNOMIDE OR CHT AGENTS HAS NOT PROVEN BE OF BENEFIT.
FATIGUE UPPER RECURRENT RESPIRATORY INFECTIONS AND EASY BRUISABILITY
APLASTIC ANEMIA MYELODYSPLASIA VITAMIN B 12 OR FOLATE PNH DRUG OR TOXIN INDUCED BM FAILURE MYELOFIBROSIS HYPERSPLENISM HAIRY CELL LEUKEMIA SLE
IWU:
CBC: WBC 1.2 Hb 7.8 PLAT 30 PERIPHERAL SMEAR ABSOLUTE NEUTHROPHILE* COUNT IF < 500 WORRISOME - ABx IT HIV CXR BONE MARROW
IM:
URINE FOR HEMOSIDERIN
CYTOGENETICS
VITAMIN B 12 LEVEL
FM:
REMOVAL OF OFFENDING TOXIN IF PRESENT
BONE MARROW TRANSPLANTATION IN THOSE YOUNGER THAN 50 YO WITH A MATCHED DONOR
TRIAL OF INMUNOSUPRESSIVE THERAPY WITH ANTHYMOCYTE GLOBULIN AND CYCLOSPORIN IF TRANSPLANT IS NOT AN OPTION
FATIGUE DEPRESSION AND ATAXIA
VIT B12 SYPHILIS TERTIARY CEREBRO VASCULAR DISEASE THYROID HYPO* OFTEN CO EXIST CHRONIC ALCOHOLISM DEPRESSION
IWU:
CBC - MCV 102 THYROID: ANTI PER-OXIDASE / THYROGLOBULIN TSH, FREE T4 LP CT SCAN BUN/Crea
IM:
SERUM B12 / MMA / FOLATE
SERUM GASTRIN
SCHILLING TEST*
BLUNTED 2ND PHASE = ACHLORIDIA OR INTESTINAL INJURY DUE TO MEGALOBLASTOSIS
FM:
ANTI PARIETAL LOW SPECIFICITY
ANTI INTRINSIC FACTOR F NEG LOW SENSITIVITY ONLY 74%
FU:
VIT B12 REPLACEMENT
CBC
ROUTINE OFFICE VISIT
IWU:
IM:
FM:
FU:
FATIGUE
DZ X
IRON DEFICIENCY* FOLATE DEFICIENCY VITAMIN B 12 THALASEMIA SIDEROBLASTIC LEAD ALCOHOL SULFA INDUCED BONE MARROW SUPPRESSION
HEMOLITIC ANEMIA DUE TO DRUGS OR SLE
EX: 82-92/ COOMB + /RETIC >
MYELODYSPLASIA
SYND THALASEMIC TARGET CELL NORMAL IRON STUDIES INCREASED HFETAL Y A2 >RBC NUMBER /MICRO/NORMAL RDW 2 GENES DELETED= NORMAL ELECTROPHORESIS WHEN 3 OF 4 GENES ARE DELETED HEMOGLOBIN H B4 TETRAMER IN 3/4 GENES DELETED
IWU:
CBC
MCV* 72 MICRO
IM:
SMEAR
PRUSSIAN BLUE SIDEROBLASTIC
RETICULOCYTES
FM:
FERRITIN NORMAL IN SIDEROBLASTIC
TIBC
SERUM IRON HIGH IN SIDEROBLASTIC
TX:
PO FERROUS SULFATE
SOME B6 RESPONSE IN SIDEROBLASTIC
VIT C
FU:
CONSTIPATION
RETICULOCYTES COUNT
I WANT TO BE CHECKED OUT FOR CANCER
PAP
SIGMOIDOSCOPY
COLONOSCOPY
FOBT
Yly X 3 YRS THEN e/3 Yr e/3-5 Yrs e/ 10 Yrs e/Yr Yrly
JAUNDICE
IWU:
IM:
FM:
FU:
BROAD SPECTRUM CLINIC CASE PRESENTATION
CUSHING OR ECTOPIC ACTH OAT CELL DIABETES DEPRESSION AUTOIMMUNE JOINT COMPLAINTS RHEUMATOID ARTHRITIS DEGENERATIVE ARTHRITIS LIVER DISEASE RENAL FAILURE PAN HYPO PITUITARY /HYPOGONADISM GRANULOMATOUS DISEASE ALCOHOLISM SUPRA VENTRICULAR TACHYCARDIA
PHLEBOTOMY OCCASIONAL CHELATION
INFERTILITY LOSS OF LIBIDO AND MALAISE
MISSENSE CYS 286
1/220 COMMON
STAPH AUREUS, YERSINIA, LISTERIA INFECTIONS IRON CONSUMER ORGANISM
30% HEPATOMA
SECONDARY IRON OVERLOAD CHRONIC TRANSFUSIONS EX: MAJOR THALASEMIA
IWU:
CBC BMP OGT ASAT ALAT EKG / ECHO 2D
FSH LH TESTOSTERONE SERUM IRON TIBC FERRITIN SATURATION TRANSFERIN
IM:
CYTOGENETIC HFE GEN
FM:
LIVER BIOPSY SPARED BY CYTOGENETIC
DETECTION OF HFE GEN IRON CONTENT PER WT LIVER BIOPSY CUTOFF 2000 x gr
PT CARDIAC Sx DEFEROXAMINE CHELATION
CAREFUL MONITORING FOR THE DEVELOPING OF CIRRHOSIS OR HEPATOMA
INTENSIVE PHLEBOTOMY
MAINTENANCE PHLEBOTOMY
POSTRANSFUSIONAL REACTIONS
MAJOR: ABO*
MINOR: LEWIS Kf Jk
DIC= FFP + SUPPORT MEASURES
IgA DEFICIENCY= EPI + STEROID NO IV HEMOLISIS WASHED RBC or IGA DEF PLASMA TRANSF
FEBRIL NON HEMOLITIC: RIGOR AND FEVER NO IV HEMOLISIS LEUCOCYTE REDUCED FILTERED RBC
WORK UP TRANSFUSION REACTION :
HAPTOGLOBIN COOMB FREE Px Hb UA-U Hb LDH BP MONITORING HYPOTENSION* BUN/Crea MONITORING ATN* BILI SMEAR SCHISTOCYTES D DMIMER Fb LOW DDIMER
