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Hematology final outline.docx

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Catherine Newkirk

HEMATOLOGY Dr I Quirt Susan Armstrong and Tara Weir editors Eyal Cohen associate editor LEUKEMIAS26 ANEMIA2 Clinical Approach to Anemia Acute Leukemia AML ALL Bone Marrow Transplantation IRON METABOLISM 3 Myelodysplastic Syndromes Iron Intake Dietary Physiologic Causes of Increased Fe Requirements CHRONIC MYELOPROLIFERATIVE 28 Iron Absorption DISORDERS Iron Transport Common Features Iron Storage Polycythemia Rubra Vera Iron Indices Chronic Granulocytic Myelogenous Leukemia Interpreting Iron Indices Idiopathic Myelofibrosis Laboratory Features Essential Thrombocythemia IRON DEFICIENCY 5 MALIGNANT CLONAL 32 Physiologic Causes PROLIFERATIONS OF B CELLS Pathological Causes Chronic Lymphocytic Leukemia Clinical Presentation Plasma Cell Myeloma Multiple Myeloma Diagnosis Iron Treatment Light Chain Disease Anemia Refractory to Oral Iron Monoclonal Gammopathy of Unknown Significance Macroglobulinemia of Waldenstrom SIDEROBLASTIC ANEMIA 6 MacroglobulinemiaHyperviscosity Syndrome THE ANEMIA OF CHRONIC DISEASE 7 LYMPHOMAS 35 HEMOGLOBIN AND7 Hodgkins Disease and NonHodgkins Lymphoma HEMOGLOBINOPATHIES Staging Thalassemia Hodgkins Disease I Heterozygous Thalassemia Minor NonHodgkins Lymphoma II Homozygous Thalassemia Major III Alpha Thalassemias TUMOUR LYSIS SYNDROME 38 Sickle Cell Anemia WBC DISORDERS 38 Megaloblastic Anemia Neutrophilia B12 Deficiency Pernicious Anemia Leukemoid Reactions Folate Deficiency Neutropenia Hemolytic Anemias Agranulocytosis I Hereditary Hemolytic Anemia BLOOD PRODUCTS AND TRANSFUSIONS40 Structural Abnormalities in Cytoskeleton Enzymatic Abnormalities in RBC Red Cells Hemoglobinopathies Blood Groups II Acquired Hemolytic Anemia Platelets Autoimmune Hemolytic Anemia Coagulation Factors RBC Fragmentation Syndromes Group and Reserve Serum Thrombotic Thrombocytopenic Purpura and Acute Complications of Blood Transfusions Hemolytic Uremic Syndrome Delayed Complications in Transfusions APLASTIC ANEMIA 17 APPROACH TO SPLENOMEGALY 43 HEMOSTASIS18 APPROACH TO BLOOD FILM 43 Three Phases of Hemostasis EXAMINATION Tests of Hemostasis Thrombocytopenia and Other Disorders of Primary MEDICATIONS COMMONLY USED IN 44 Hemostasis HEMATOLOGY Idiopathic Autoimmune Thrombocytopenic Purpura Chronic Adulttype ITP Disorders of Secondary Hemostasis Hereditary Acquired Thrombosis HeparinInduced Thrombocytopenia MCCQE 2000 Review Notes and Lecture Series Hematology 1 Notes ANEMIA CLINICAL APPROACH TO ANEMIATable 1 Approach to Anemia Low or Normal Reticulocytes High Reticulocyteshypochromic microcytic mean red cell volume MCV80treated nutritional deficiency iron deficiency thalassemiasideroblastic anemia lead poisoning chronic diseasenormochromic normocytic 80MCV100hemolytic anemia post hemorrhagic anemiachronic disease liver diseaseuremia endocrine disorders hypohyperthyroid Addisons connective tissue diseasesprimary marrow abnormalities myelodysplasia infiltration leukemia myeloma mets infection myelofibrosisaplasiamacrocyticmegaloblastic MCV100 megaloblasticB12 folate drugs MTX cyclophosphamide nitrous oxide arsenicmacrocytichypothyroidismhypoplastic marrow aplasia liver disease alcohol smoking Historytbleeding tdrugs eg ASA NSAIDs tfamily history and ethnic background tdiet tmalabsorption trecent pregnancy Symptoms tgeneral fatigue malaise weakness tCVS palpitations syncope dyspnea tneurologic headache vertigo tinnitus Signs tCVS tachycardia systolic flow murmur wide pulse pressure CHF tpallor mucous membranes conjunctivae Hb90 skin creases Hb75 tocular bruits Hb55 tsplenomegaly tlymphadenopathy trectal occult blood trare koilonychia spoonshaped nails as in iron deficiency anemia telangiectasia as in hemolytic anemia jaundice as in hemolytic anemia CBC tWBC or platelet count abnormal marrow disease hypersplenism DIC tWBC and platelet count normal focused history physical exam CBC and peripheral blood film PBF Hematology 2 MCCQE 2000 Review Notes and Lecture Series Notes CONTANEMIARDW Red Cell Distribution Width tnormal anemia of chronic disease thalassemia tincreased iron deficiency dual deficiency eg iron and folate myelodysplastic syndrome AIHA liver disease pernicious anemia folate deficiencyIRON METABOLISMIRON INTAKE Dietary taverage Canadian adult diet1020 mg Feday tabsorption510 052 mgday tFe absorption increases with increased erythropoiesis eg pregnancy anemia Fe depletion tmales have a positive Fe balance tmenstruating females have a negative Fe balance PHYSIOLOGIC CAUSES OF INCREASED FE REQUIREMENTS t infancygrowth spurt 2x basal need t pubertygrowth spurt menarche 3x basal need t pregnancymaternal RBC fetus 4x basal need t blood donation 4x basal need 500 mL blood250 mg Fe 4 donationsyear1 g IRON ABSORPTION toccurs in duodenum mainly with iron combining with apoferritin to form ferritin and then absorbed through villiTable 2 Intraluminal Factors in Absorption ofNonHeme Iron Promoters Inhibitors gastric HCl achlorhydria antacids reducing agents oxidants ascorbic acidin Fe3 form in Fe2 form inorganic form organic formsoluble chelators nonabsorbable chelators amino acidsphosphate milk sugarsphytates cereals alcoholoxalate spinach tannin tea MCCQE 2000 Review Notes and Lecture Series Hematology 3
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