Hematology Flashcards
Low ferritin, normal hemoglobin in female athlete with fatigue. Rx?
100 mg elemental iron daily
Enteric coated prep is not sufficient, nor is 50 mg
Iron absorption sites
Duodenum, proximal jejunum
Chronic ITP: + has had splenectomy. Moderate thrombocytopenia: Mx
Observation
Hematologic side-effect of ganciclovir
Neutropenia
Anticoagulation mx for planned minor opthalmologic or dental procedure such as tooth extraction
Continue anticoagulation
Eg:cataracts, BCC or SCC extraction
Very low platelet count in HIV+ patient: Commonest Cx
ITP
ITP Rx not responsive to glucocorticoids
Splenectomy, rituximab
ESRD: target hemoglobin
10 to 11.5
Newly diagnosed HIV with primary HIV thrombocytopenia: Rx
HAART
if no bleeding
Finding in PHAT not seen in ITP
Splenomegaly
HIV-associated thrombocytopenia (previously referred to as “primary HIV-associated thrombocytopenia” [PHAT]) is the most common cause of low platelet counts encountered in HIV-infected patients. Clinically, this condition is similar to primary immune thrombocytopenia (ITP), except that splenomegaly is more commonly noted in patients with HIV. Platelet counts are often higher in HIV-infected patients, and mild thrombocytopenia occasionally resolves without therapy [12-14]. (See “Immune thrombocytopenia (ITP) in adults: Clinical manifestations and diagnosis”.)
The etiology of thrombocytopenia in patients with HIV infection is complex. Bone marrow examination, as in primary ITP, reveals normal or increased numbers of megakaryocytes in the face of reduced numbers of circulating platelets. This combination suggests the presence of ineffective platelet production and/or increased peripheral destruction. Kinetic studies using radiolabeled autologous platelets from HIV-infected individuals have shown that both factors contribute: there is more than a 50 percent reduction in platelet survival and a 50 percent reduction in platelet production [15].
RCA
- Participant interview, chart review.
- Error identification
- Structured analysis of factors:
- Communication structures
- Human resources and leadership
- Environmental
- Information management
- Create an action plan
Pseudothrombocytopenia: PathMex
antibodies against EDTA
0.1% of population
Schistiocytes, MAHA, LDH up, thrombocytopenia
TTP
Monocytosis: causes
- Primary: Acute monoblastic leukemia, Acute myelonmonocytic leukemia
- Secondary:
- TB, brucellosis, listerosis,
- SLE, vasculitis, Inflammatory bowel disease
- Lymphoma
Myelodysplastic syndrome-Myeloproliferative syndrome partly defined by absolute monocyte count > 1000
Myelomonocytic leukemia
Mechanism by which hydroxyurea works in sickle cell
Increases Hb F
only drug in widespread use for stimulating HbF production in patients with SCD It is generally assumed that most of the beneficial effects of hydroxyurea in patients with SCD are due to this effect [20-22].
Meperidine: why not?
metabolized into a compound (normeperidine) that is relatively toxic, and associated with tremulousness, delirium and seizures.
Accumulation of the metabolite is most likely to occur during repeated administration, and dose escalation, and in renal insufficiency.
Most important way to estimate bleeding risk:
History, family Hx
Normal platelet count, normal clotting studies in patient with personal and family history of mucosal bleeding
von Willebrand’s
ristocetin cofactor analysis
initial screening tests for VWD
- Plasma von Willebrand factor (VWF) antigen (VWF:Ag)
- Plasma VWF activity (ristocetin cofactor activity, VWF:RCo and VWF collagen binding VWF:CB)
- Factor VIII activity (FVIII)
- If there is still a high index of suspicion for VWD in the face of normal initial results, further testing is carried out which first includes repeating the initial tests. If the repeat VWF levels are normal, other causes of bleeding should be investigated. If one of the VWF tests is abnormal, the following specialized assays should be performed to determine the type of VWD (table 2):
●VWF multimer distribution using gel electrophoresis
●Ristocetin-induced platelet aggregation (RIPA)
(ristocetin cofactor activity, VWF:RCo and VWF collagen binding VWF:CB)
●Factor VIII activity (FVIII)
If there is still a high index of suspicion for VWD in the face of normal initial results, further testing is carried out which first includes repeating the initial tests. If the repeat VWF levels are normal, other causes of bleeding should be investigated. If one of the VWF tests is abnormal, the following specialized assays should be performed to determine the type of VWD (table 2):
●VWF multimer distribution using gel electrophoresis
●Ristocetin-induced platelet aggregation (RIPA)
DIC+Auer Rods+t(15;17)
Acute promyelocytic leukemia
Hematopoietic neoplasms involving precursor cells committed to giving rise to granulocytic, monocytic, erythroid, or megakaryocytic elements
AML
