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Hematology Part 2
DR. ALABASTRO
3rd Shifting/2/2/09
“SMV ”
1. Detailed History
- Hemorrhage: site, severity, duration, onset
(spontaneous, after trauma)
- Thrombosis/emboli: family history
2. Complete Physical Examination
Plasma thromboplastin time: intrinsic pathway, common pathway - Muscles, mucocutaneous, joints
Coagulation time: intrinsic pathway, common pathway 3. Complete Blood Count
Prothrombin tim: extrinsic pathway, common pathway - Platelet count
4. Coagulation Tests
MARY YVETTE ALLAIN TINA RALPH SHERYL BART HONEY PIPOY TLE JAM CECILLE DENESSE VINCE HOOPS CES XTIAN LAINEY RIZ KIX EZRA GOLDIE BUFF MONA AM MAAN ADI KC PENG
KARLA ALPHE AARON KYTH ANNE EISA KRING CANDY ISAY MARCO JOSHUA FARS RAIN JASSIE MIKA SHAR ERIKA MAQUI VIKI JOAN PREI KATE BAM AMS HANNAH MEMAY PAU RACHE
ESTHER JOEL GLENN TONI
Shar, Maqui & Viki
Hematolgy Part 2
BLEEDING DISORDERS
Clinical
Study Purpose
Significance Vascular Factors
Prolonged in: 1. Trauma or other physical cause
ITP, 2. Infectious diseases
thrombocytopat 3. Drugs, chemicals, toxins
Measures
hy, von 4. Scurvy
platelets and
Bleeding time Willebrand’s, 5. Allergic or anaphylactoid purpura
vascular
aspirin 6. Irradiation
function
ingestion, 7. Metabolic: Cushing syndrome
anticoagulant, 8. Hereditary telangiectasia
uremia 9. Ehlers-Danlos syndrome
Decrease in:
ITP, bone Intravascular Factors
marrow 1. Thrombocytopenia
Assesses malignancies, - ITP, secondary (infections, drugs, toxins,
Platelet count platelet drugs irradiation, neoplasm, etc.)
concentration Elevated in: 2. Qualitative Platelet Disorder
early - Characterized by easy bruising, epistaxis,
myeloproliferativ oozing after dental extraction, spontaneous
e disorders petechiae, Glanzmann thrombasthenia
Poor in: 3. Inherited Deficiencies of Coagulation
Assesses thrombocytopeni - Hemophilias, deficiency of other factors
platelet a and 4. Acquired Clotting Factor Deficiencies
Clot retraction - DIC, Vitamin K deficiency, liver disease,
adequacy to polycythemia;
form fibrin clot lysis of clot in uremia, congenital heart disease
fibrinolysis
Prolonged in: IDIOPATHIC THROMBOCYTOPENIC PURPURA
Lee-White Assesses severe
clotting time coagulation deficiencies of - Due to autoantibodies, drug-dependent antibodies
(coagulation) mechanism coagulation or alloantibodies
factors - Characterized by: thrombocytopenia, shortened
Prolonged in: platelet survival, presence of antiplatelet antibody
deficiencies of in the plasma, increased megakaryocytes in the
Measures Factors VII and X bone marrow
Prothrombin
extrinsic and and fibrinogen, - May be acute (returns to normal within 6 months),
common excess chronic (beyond 6 months), recurrent
time (PT)
coagulation dicumarol, - Incidence: between 1 and 8 years, both sexes
pathways severe liver - Predisposing factors: infection within preceding 1-4
disease and vit.K weeks
deficiency - Signs and symptoms:
Prolonged in: o Ecchymoses or purpura: anterior surface of
deficiencies of lower extremities and bony prominences
Measures
Factors VIII to XII
Activated partial intrinsic and
and fibrinogen,
o Petechiae: subconjunctivae, buccal mucosa,
thromboplastin common soft palate, skin
anticoagulant
time (aPTT) coagulation o Bleeding: nose, gums, mucus membranes,
therapy, liver
pathways
disease, DIC, GIT or kidneys
vit.K deficiency o PE not significant: pallor, splenomegaly,
Prolonged in: cervical lymphadenopathy rare
low fibrinogen - Laboratory:
Measures levels, DIC, liver o Platelet count: <100,000/mm3
Thrombin time
fibrinogen to disease,
(TT) o Blood smear: normal, mild eosinophilia,
fibrin formation anticoagulant
therapy, anemia
dysproteinemias o Bone marrow: ↑ megakaryocytes, ↑
Thromboplastin Measures ability Prolonged in: eosinophils
generation time to form thrombocytopeni
Shar, Maqui & Viki
Hematolgy Part 2
Inactive Active
Preservation of Proteolysis of
fibrin fibrin ONCOLOGY
LEUKEMIA
Organ Hemorrhagic
damage diathesis
• ETIOLOGY: Radiation, chemicals, drugs, genetic
Component Vitamin K Liver DIC
disease
• SYMPTOMS: fever, bleeding, bone pain,
RBC normal target Fr, Burr, lymphadenopathy, splenomegaly,
schista hepatosplenomegaly
PTT prolong prolong prolong • SIGNS: anemia, neutopenia, thrombocytopenia
PT prolong prolong prolong • DIAGNOSIS:
Fib. Spl Normal Normal or Marked inc 1. CBC: Hgb ( mod-marked ↓); WBC (low, normal
inc or ↑); ↓platelets
Platelets Normal Normal Decrease 2. BLOOD SMEAR: normocytic, normochromic,
Decrease II, VII, IX, X I, II, V, VII, I, II, V, VII, anemia; blasts; occ. Eosionophilia
factors IX, X VIII 3. BONE MARROW: blasts; absent megakaryocyte
4. CXR : mediastinal mass
JAUNDICE 5. COAGULATION PROFILE: ↓factors in AML
6. CSF: CNS leukemia
- Unconjugated: Hemolytic • DIFFERENTIAL DIAGNOSIS:
o Hemolytic disease of the newborn 1. Idiopathic thrombocytopenic purpura
o Erythrocyte membrane abnormality 2. Aplastic anemia
o Erythrocyte enzyme deficiency 3. Mononucleosis
o Alpha thalassemia 4. Juvenile rheumatoid arthritis
o Sickle cell anemia 5. Leukemoid reaction
o Vitamin K overdose 6. Malignant diseases that invade bone marrow
o Oxytocin induction • TREATMENT
- Unconjugated: Polycythemia 1. INDUCTION: (4-6wks)
o Placental hypertransfusion: twin- vincristine (IV/wk)
twin; maternal-fetal; delayed cord asparaginase (IM, biweekly)
clamping prednisone (PO/day)
o Placental insufficiency: SGA; 2. INTRATHECAL: (wkly x 6; q 8 wks x 2 years)
postmaturity; toxemias; previa MTX
o Endocrine: CAH; thyrotoxicosis; Hydrocortisone
maternal diabetes cytarabine
o Miscellaneous: Down syndrome; 3. CONTINUATION: (2-3yrs)
hyperplastic visceromegaly 6-MP (PO/day)
- Unconjugated: Other causes MTX (PO, IV, IM/wk)
Prednisone/ vincristine
o Hematoma: cephalhematoma, etc.
o Conjugation defects: Crigler-Najjar; NEUROBLASTOMA
Gilbert’s disease
o Metabolic: hypothyroidism; DM; • Most common solid tumor outside CNS
galactosemia • Diagnosed before age 5
o Gut obstruction: pyloric stenosis; • Any site of SNS: abdomen (adrenal,
duodenal atresia retroperitoneal)
• SX: hard, fixed, abdominal mass, nerve root
compression, bone pain, “dancing eye, dancing
feet” syndrome (ataxia & opsomyoclonus)
Hemoglob
in • DIAGNOSIS:
1. XRAY, CT, MRI : mass with calcification/
hemorrhage
High Normal Low 2. HVA & VMA : elevated
3. BIOPSY
4. BONE MARROW: neuroblast
Polycythem Conjugation Examine infant
ia defects
Metabolic
defects
Gut obstruction
Shar, Maqui & Viki
Hematolgy Part 2
WILMS TUMOR
RETINOBLASTOMA