Hematology
James Kennedy, Danni Li and Erie Tseng, chapter editors,
Ray Guo and Amold Jacob, associate editors
Shauna-Dae Phillips, EBM editor
Dr. Janey Hsiao, staff editor
Basics of Hematology ...2..... 22022000002
‘Complete Blood Count
Blood Film
Bone Marrow Aspiration and Biopsy
Common Presenting Problems ...... 4
Anemia
Polycytheria
Thrombocytopenia
Thrombocytosis
Pancytopenia
Neutrophitia|
Neutropenia
Lymphocytosis
Lymphocytopenia,
Eosinophilia
Agranulocytosis
Leukemoid Reactions
Approach to Lymphadenopathy ...........10
Approach to Splenomegaly ..............11
Microcytic Anemia ....... suet
Iron Metabolism
Iron Deficiency Anemia
‘Anemia of Chronic Disease
Lead Poisoning
Sideroblastic Anemia
Thalassemia
Normocytic Anemia ..... cee TS
Aplastic Anemia
18
Hemolytic Anemi
Thalassemia
Bota-Thalassemia Minor (Thalassemia Trait)
Beta-Thalassemia Major
Alpha-Thalassemia
Sickie Cell Disease
‘Autoimmune Hemolytic Anemia (AIHA)
Microangiopathic Hemolytic Anemia (MAHA)
Hereditary Spherocytosis
Hereditary Eliptocytosi
GEPD Deficiency
Macrocytic Anemia 2
Vitamin By2 Deficiency
Folate Deficiency
Homostasis ..... cece BB
‘Three Phases of Hemostasis
Disorders of Primary Hemostasis ..........25
Immune Thrombocytopenic Purpure (ITP)
Heparin-Induced Thrambocytopenia (HIT)
Thrombotic Thromboeytopenic Purpura (TTP)
and Hemolytic Uremic Syndrame (HUS)
Von Willebrand's Disease (vWD)
Disorders of Secondary Hemostasis .......28
Hemophilia A (Factor Vill Deficiency)
Hemophilia B (Factor IX Deficiency)
Factor XI Deficiency
Liver Disease
Vitamin K Deficiency
Disseminated Intravascular Coagulation (DIC)
Venous Thrombo: wees 80
Approach to Treatment of Venous Thrombosis
Hypercoagulable Disorders 82
Hematologic Malignancies me)
Myeloid Malignancies .... 33
‘Acute Myeloid Leukemia (ANAL)
Myelodysplastic Syndromes (MDS)
Myeloproliferative Neoplasms ............35
Polycythemia Vera (PV)
Chronic Myeloid Leukernia (CML)
Idiopathic Myelofibrosis (IMF)
Essential Thrombocythemia (ET)
Lymphoid Malignancies... 239
Acute Lymphoblastic Leukernia (ALL)
Lymphomas 40
Hodgkin's Lymphoma
Non-Hedgkin’s Lymphoms
‘Malignant Clonal Proliferations of B Cells . ..43
Chronic Lymphocytic Leukemia (CLL)
Multiple Myeloma (MIM)
Light Chain Disease
Monoclonal Gammopathy of Unknown
Significance (MGUS)
Waldenstronys Macroglobulinemia
Complications of Hematologic Malignancies ..47
Hyperviscosity Syndrome
Tumour Lysis Syndrome
Blood Products and Transfusions ..........47
Blood Products
Red Blood Cells
Platelets
Coagulation Factors
‘Acute Blood Transfusion Reactions
Delayed Blood Transfusion Reactions
‘Common Medications . 81
Antiplatelet Therapy
Anticoagulant Therapy
Chemotherapeutic Agents
Landmark Hematology Trials ........2..-.54
References 55
“Toronto Notes 2010
Hematology HIHo Hematology ‘Basis of Hematology Toronto Notes 2010,
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Figure 1. Hematopoiesis avez wad ea ie oan at
Sites of hematopoiesis in adults: pelvis, sternum, vertebral bodies
+ lifespan of mature blood cells
* exythocytes (120 days); neutrophils (~1 day); platelets (10 days); lymphocytes
(aries - memory cells persist for years)
+ role of lymphoid organs
* spleen: part of reticuloendothelial system, removes aged RBCs, removes antibody-
Coated bacteriaeells site of antibody production
Erect care xg on
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ewrop- os ie + thymus: site of T-cell maturation, involutes with age
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+ Iymph nodes: site of activation of B/T cells (adaptive immune response)
Tabla 1. Common Terms Found on CBC
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“Ga sic d oma as ase“Toronto Notes 200 Basics of Hematology Hematology HS
Approach for Interpreting CBCs
‘L-consider abnormal values in the context of individual's baseline @
Up to tof population without disease may have values outside “normal” range
+ anindividual may display a substantial change from their baseline without violating
normal” reference range
2.is one Hneage allected or are several?
all lines are down’ consider pancytopenia (ase Pancytopeni, HZ)
{RBCs and plateots are down: concider MAHA &
{single lineage affected soe coreespondng section in Common Presenting Problems, Ha
Blood Film Interpretation
nanooo aus Dv
Size Schistesyia Sil et
Iicrocytic (MCV.<80), normocytic (MCV=#0-100), macroeytic (MCV>100)
* anisocytosis: RBCs of variable and abnormal size
iton deficiency anemia thalassemia, myelofibrosis oO Oo
Toardop col Nucleated RBC
Nene bois Spurea!
oye Normal ABC Hypache
Sypomi—tsen n the seth cent pallor normals than one tind | Mam eo
WSs tS) : ‘come
iron deficiency anemia, anemia of chronic disease, hemolytic anemias, sideroblastic e@e
« polychromasia ~ increased reticulocytes (pinkish-blue cells) Sphoroeyto —Blictoyte
increased RBC production by the marrow
Shape (see Figure 2)
* discocyte - normal (biconcave disc)
+ poillocytosis: increased proportion of RBCs of abnormal shape
* iron deficiency anemia, myelofibrosis
+ spherocyte spherical RBC (due to loss of membrane) Tages col Burl
1b Gvalepige the RBC ong axe feeds de eng ofthe short axle
see ees (oe peer
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{due to abnormal membrane lipids)
Se is stn ermin maton
etyun tice
Distribution (see Figure 2)
+ rouleaus formation ~ aggregates of REC resembling sacks of coins
> cause: increased plasna concentration of high molecular weight proteins
+ Senin pregnancy amot common cause; due toa physiological increase in
fibrinogen} inflammatory conditions (due to polyclonal immunoglobulins), plasma
cell dyserasias (de to monoclonal paraprotinemia; eg. multiple myloma,
macroglobutinemia), storage artifact
Inclusions (see Figure 2)
+ hucleus~ present in erythroblasts (immature RBCs)
* hyperplastic erythropoiesis (scen in hypoxia, hemolytic anemia), extramedullary
hematopoiesis (seen with BM infiltration)
‘+ Heinz bodiew denatured and precipitated Nemogiobin
Gap defen
+ Howeltoly bes small nicer remnant eemblingapykotc nucleus tc)
+ petsponciomy hppa, meas mealies
orhiic tipping "deeb panclaton indian seme aggregation