Hematology

Hematology #

Anemia #

Workup #

  • Bleed?
    • GI
    • GU
    • Anyurism (brain)
    • cancer
  • Evidence of hemolysis? (↑ AST, ↑ T-bili)
    • Smear
    • LDH => haptoglobin if needed
    • Causes:
      • Sickle cell/thalassemias
      • Spherocytosis
      • Paroxysmal nocturnal hemoglobinuria
      • Autoimmune
      • direct antiglobulin test (DAT/Coombs test)
      • Cold/warm antibodies
  • Retic count (kinetics)
    • If inappropriate:
      • Microcytic:
        • Iron, ferritin
        • Hb electrophoresis
      • Macrocytic:
        • B12, folate
        • TSH
        • EtOH?
        • LFTs (liver dysfunction)
          • If suspected:
            • Hep B/C
            • Alpha 1 antitrypsin
            • ANA
            • Anitmitocondrial (PBC)
            • serum ceruloplasmin and serum copper => Wilson’s
            • If fasting transferrin >45%, hemochomatosis gene testing
        • Bone marrow bx?
      • Normocytic:
        • All micro and macro anemias start as normocytic
        • CRP => anemia of inflammation
        • CKD?
        • Men: Low T?
        • Serum plasma electrophoresis => plasma cell dyscrasia

Iron Studies #

Total Iron => Total iron
Ferritin => Iron storage (also an acute phase reactant)
TIBC => Amount of “iron carrier”
Saturation => wheather or not body is trying to pick up iron
Transferrin => Iron storage (not an acute phase reactant)

Really only need Total Iron and Ferritin to determine state.

Labs Disease Explanation
↓ Iron, ↓ Ferritin Iron deficiency No iron and none in storage
↓ Iron, ↑ Ferritin Anemia of chronic disease No iron, all squirreled away in storage

Hemolysis #

  • low haptoglobin (usually takes a long time to run)
  • elevated serum LDH
  • elevated (AST) aspartate aminotransferase
  • elevated bilirubin

DIC #

  • Platelets down
  • INR elevated
  • D-dimer elevated
  • Fibrinogen reduced

Leukopenia #

Neutropenia #

Calculator for risk of infection in neutropenic patients.

Thrombocytopenia #

HIT #

Four T’s: (Calculator)

  • Thrombocytopenia
  • Timing
  • Thrombosis
  • oTher causes

Pearls #

  • Pernicious anemia = Vitamin B12 anemia + Anti-intrinsic factor abs
  • Ask about wisdom teeth extraction if fishing for coagulopathy and no family history
    • Fairly bloody proceedure
    • If changing gause 30x/day, might be a good indication to work it up