Hematology

Review
Dr. Baher Krayem
IMC- EMEK MEDICAL CENTER
Classification of Anemia
 Anemia
– Clinical Manifestation
• Weakness
• Fatigue
• Dizziness
• Exertional dyspnea
• Chest pain
– Diagnosis
• Check Hb, MCV
• Reticulocytes count
– Treatment
• According to etiology
– Blood transfusion
• Indications:
– Active bleeding
– Hb level less than 7
Iron metabolism
Iron Deficiency Anemia
 IDA Blood Smear
• Microcytosis = small RBC
• Hypochromia = No Hb in RBC
• Poikilocytosis = Different RBC shapes
• Anisocytosis = Different RBC sizes
Iron Deficiency Anemia
Vs
Anemia of Inflammation
Question
B12 Anemia
 B12 Anemia

– Pancytopenia
– Increased LDH
– Blood smear
Treatment of B12 Anemia
Folate Deficiency Anemia
Hemolytic Anemias Classification
Lab of Hemolytic Anemia
Features of HA
G6PD
 AIHA

– Etiology
– Clinical
• Back pain
• Symptoms of anemia
• Jaundice
• Splenomegaly
– Diagnosis
• Lab diagnosis
• Positive Coombs
– Treatment
• Supportive treatment
• Steroids
 PNH = Paroxysmal Nocturnal
Hemoglobinuria

– Triad
• Hemolytic anemia
• Thrombocytopenia
• VTE = DVT, PE, Portal Vein thrombosis
– Diagnosis
• Flow cytometry CD55 CD59
– Treatment
• Supportive
• Ecolizumab

– When to suspect PNH?

Bone marrow cells
 AML
– Etiology: HRED
• Hereditary
• Radiation
• Exposure to toxic substances
• Drugs like chemotherapy
– Blood smear
• Myeloblasts with Auer rods
– Presentation
• Anemia = Symptoms of anemia
• Thrombocytopenia = bleeding symptoms
• Leukopenia = infections
– Diagnosis
• Blood smear
• Bone marrow aspiration
• Bone marrow biopsy
– Treatment
• HSCT= Hematopoietic stem cell transplant
Acute Promyelocytic Leukemia

– Subtype of AML
• Translocation 15,17
– Bleeding symptoms
– Better prognosis
– ATRA [Vitamin A derivative] proved to be useful
– Also Arsenic acid is useful
 Chronic Myeloid Leukemia

– Translocation 9,22
– Symptoms:
• Usually asymptomatic
– Diagnosis
• Incidentally usually
• Leukocytosis
• Elevated neutrophils
– Treatment
• TKIs = Tyrosine kinase inhibitors like Imatinib
 CLL

– Blood Smear
• Lymphocytosis
– Clinical:
• Lymphocytosis
• Adenopathy
• Splenomegaly
• Anemia and Thrombocytopenia
– Diagnosis
• Blood smear
• BM biopsy and aspiration
– Flow cytometry
– Treatment
• Most cases watch and wait
 Multiple Myeloma
– Plasma cell disorders
– Clinical:
• Bone pain
• Infections
• Hypercalcemia
• CKD
• Anemia
– Diagnosis
• BM biopsy
– Urine stick
• High protein without albumin
– Treatment
• Prednisone
• Bortezomib = Proteasome inhibitors
• Thalidomide \ Lenalidomide
 Hodgkin’s Lymphoma
– Age distribution
• Early 20s
• Second peak 70-80
– Clinical manifestation:
• Lymph node enlargement
• Mediastinal mass
– Types
• Nodular sclerosing
• Lymphocyte rich
• Lymphocyte depleted
• Mixed cellularity
– Diagnosis
– BM biopsy = Owl’s eyes = Reed Steinberg cells
– Treatment
• Aggressive chemotherapy
• Radiation if Bulky disease = more than 7 cm
• Complications of radiation?
Platelets Disorders
ITP = Idiopathic thrombocytopenic
Purpura
HIT = Heparin Induced thrombocytopenia

– Definition
• 50% drop in thrombocytes 5 days after administration of heparin/Clexane
– Timing
• 5-14 days after imitation of therapy
– Manifestation
• Thrombosis mainly
– 4Ts for diagnosis
– Diagnosis
• Clinical diagnosis
• Test for heparin-PF4
– Treatment
• Stop heparin
• Start fondaparinux
 HUS TTP
– High prevalence in SLE patients
– HUS  associated with E.Coli
– TTP  ADAMTS-13 deficiency

Microangiopathic hemolytic anemia

HUS TTP
Hemolytic anemia Hemolytic anemia
Thrombocytopenia Thrombocytopenia
Acute renal failure Acute renal failure
Fever
Neurologic symptoms
 TTP HUS Treatment
– HUS:
• Mainly suppurative therapy
• Eculizumab = anti complement agent
– TTP:
• Plasmapheresis
• If due to a drug [like cyclosporin]  stop the drug
 Warfarin
– Mechanism of action
• Vitamin K antagonist: factors 2 7 9 10
– Complications of warfarin:
• Asymptomatic increased INR:
– Thorough medical history and physical examination
» INR 3.5 – 10 = stop the drug until INR reaches 2-3
» INR 10+ = give PO vitamin K 2.5-5 mg
• Bleeding:
– Give IV vitamin K 5-10 mg
– Give Fresh frozen plasma
– Give Prothrombin complex concnetrate
 Clotting Factors
– I II V VII VIII IX X XI XII XIII
• Vitamin K related = 2 7 9 10
– Liver Related = all but 8
– Endothelium Related = 8
– Coagulation Cascade
• Intrinsic pathway
• Extrinsic pathway
 DIC = Disseminated Intravascular
Coagulation
– Etiology:
– Diagnosis:
• PT PTT increased
• Fibrinogen low
– TTP: PT PTT are normal
– Treatment:
• Treat the cause
• Suppurative treatment
» Fresh frozen plasma
» PCC
» Cryoprecipitate
» Vitamin K