Mnemonics – Hematology – Flashcards
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Anisocytosis
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rbcs - varying sizes
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Poikilocytosis
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rbcs - varying shapes
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Order of WBC differential in healthy individual
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"Neutrophils Like Making Everything Better"
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Hypersegmented polys
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B12 or Folate deficiency
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Causes of eosinophilia ("NAACP")
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Neoplasia Asthma Allergy Connective tissue dx Parasites (only invasive types)
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Receptors found on dendritic cells
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MHC class II and Fc receptor (req. for antigen presentation)
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Factor V Leiden
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Factor V resistant to inhibition by activated Protein C (activated by thrombin-thrombomodulin complex on endothelial cells)
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MOA: heparin
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Enhances activity of antithrombin (targets activated factors)
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Platelet factors (2)
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Ca2+ = coagulation cascade ADP = induces gpIIb/IIIa expression and finding of fibrinogen
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MOA: aspirin
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inhibits COX → ↓TXA2 synthesis
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MOA: Ticlopidine and clopidogrel
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inhibit ADP induced expression of gpIIb/IIIa
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MOA: Abciximab
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direct inhibitor of gpIIb/IIIa
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MOA: Ristocetin
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activates vWF → binds gpIb (diagnose von willebrand dx)
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Glanzmann thrombasthenia
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deficiency of gpIIb/IIIa
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Bernard-Soullier syndrome
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deficiency of gpIb
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Basophillic stippling
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"basically, acid alcohol is lethal" Anemia of Chronic Dx Alcohol abuse Lead poisoning Thalassemias
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Bite cells
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G6PD deficiency
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Acanthocyte (spur cells)
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Liver disease or abetalipoproteinemia
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Ringed Sideroblast
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Defect in heme synthesis (ALA synthase, Myelodysplasia, ↑ETOH, ↑Lead, ↓B6, ↓Copper, isoniazid) *excess iron in mitochondria (bone marrow)
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Schistocyte (helmet cells)
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mechanical trauma, DIC, TTP/HUS
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"'HALT' said the hunter to his target"
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Target cells HbC disease Asplenia Liver disease Thalassemia
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Heinz bodies
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(denatured Hg precipitation) G6PD alpha-thalassemias
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Howell-Jolly bodies
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(nuclear remnants) asplenia
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Plummer-Vinson syndrome
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iron deficiency anemia, esophageal webs, athrophic glossitis
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"LEAD" poisoning symptoms
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Lead lines on gingivae and metaphyses of long bones Encephalopathy and Erythrocyte basophilic stippling Abdominal colic and sideroblastic anemia Drops - wrist and foot
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Lead poisoning treatment
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Kids ("it sucks to be a kid who eats lead") = Succimer Adults = Dimercaprol or EDTA
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Child with megaloblastic anemia that cannot be cured by folate/B12
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Orotic aciduria: treat with UMP
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Nonmegaloblastic macrocytic anemia
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(DNA synthesis is unimpaired) Liver Dx ETOH reticulocytosis drugs (5-FU, zidovudine, hydroxyurea)
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Normocytic anemia: decreased haptoglobin
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intravascular hemolysis (paroxysmal nocturnal hemoglobinuria, mechanical, microangiopathic)
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Normocytic anemia: with jaundice (↑ unconjugated bilirubin)
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extravascular hemolysis (hereditary spherocytosis)
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osmotic fragility test +
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Hereditary Spherocytosis (↑MCHC, ↑RDW)
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Back pain and hemoglobinuria following antimalarial Rx
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G6PD (↓ glutathione)
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Hemolytic anemia in a newborn
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Pyruvate kinase deficiency (↓ATP → rigid rbcs)
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Coombs negative hemolytic anemia, pancytopenia, and venous thrombosis
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Paroxysmal nocturnal hemoglobinuria (complment-mediated RBC lysis d/t defect in anchoring decay-accelerating facor via CD 55/59) *increased incidence for acute leukemias
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Eculizumab Rx
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Paroxysmal nocturnal hemoglobinuria (complement inhibitor)
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Factors which precipitate sickling in SCD
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low O2 dehydration acidosis
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Complications of SCD
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Aplastic crisis (parvo) Autosplenectomy Salmonella osteomyelitis Painful crises (dactylitis, acute chest syndrome--cause of death in adults, necrosis, stroke) Renal papillary necrosis
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Cold agglutinins
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IgM Mycoplasma pneumonia, CLL, mono
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Warm agglutinins
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IgG SLE, CLL, alpha-methyldopa
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↓ iron ↑ TIBC ↓ Ferritin ↓↓ TIBC saturation
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Iron deficiency
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↓ iron ↓ TIBC ↑ Ferritin nl TIBC saturation
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Anemia of Chronic dx
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nl iron ↑ TIBC nl Ferritin ↓ TIBC saturation
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Pregnancy, OCP use
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↑ iron ↓ TIBC ↑ Ferritin ↑↑ TIBC saturation
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Hemochromatosis
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Neutrophilia, lymphopenia, and eosinopenia
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Corticosteroid use or Cushing Sx
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"The 5 P's"
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Acute Intermittent Porphyria Painful abdomen Port-wine stain Polyneuropathy Psychological disturbances Precipitated by drugs, ETOH, and starvation
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Rx for Acute Intermittent Porphyria
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Glucose and Heme (inhibit ALA synthase)
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Porphobilinogen deaminase
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Acute Intermittent Porphyria
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Uroporphyrinogen decarboxylase
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Porphyria cutanea tarda
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ALA synthase
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Sideroblastic anemia
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ALA dehydrogenase, Ferrochelatase
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Lead Poisoning
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Hemarthroses
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Hemophilia (A or B)
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↑ PTT ↔ PT
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Hemophilia A (VIII) or B (IX)
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↑ PTT ↑ PT
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Vit K deficiency
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↑ BT ↓ PC (3 diseases)
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* Bernard Soulier (↓ gpIb, platelet adhesion to vWF) * ITP (anti-gpIIb/IIIa antibodies) * TTP (defect ADAMTS 13, a vEF metalloprotease)
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↑ BT ↔ PC
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Glanzmann Thrombasthenia (↓ gpIIb/IIIa, no platelet clumping)
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"Nasty Fever Torched His Kidneys"
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TTP symptoms (Like HUS but with Neuro and fever symptoms) Neuro Fever Thrombocytopenia Hemolysis Kidneys (renal insufficiency)
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↑ BT *Other lab work normal
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von Willebrand disease (Autosomal dominant) ** possible ↑ PTT, depending on severity, because vWF protects factor VIII
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Rx for von Willebrand disease
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DDAVP (releases stored vWF from endothelium)
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"STOP Making New Thrombi"
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Causes of DIC Sepsis Trauma Obstetric complications Pancreatitis Malignancy Nephrotic syndrome Transfusion
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Most common inherited hypercoagulability in whites
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Factor V Leiden
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Mutation ↑ prothrombin
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Mutation in 3' untranslated region of gene --> venous clots
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Heparin is ineffective
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Antithrombin deficiency (genetic or nephrotic syndrome)
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Subcutaneous tissue necrosis after warfarin administration
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Protein C deficiency
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↑ WBC, ↑ neutrophils, and ↑ Leukocyte ALP
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Leukemoid reaction (vs CML, with ↓ ALP)
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50% of cases associated with EBV
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Hodgkin Lymphoma
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Cancer of B-cells, non-contiguous spread, few "B" symptoms
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Non-Hodgkin Lymphoma
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B-cell tumors (CD15 and CD30 +)
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Reed-Sternberg cells of Hodgkin lymphoma
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"Starry sky" histology (sheets of lymphocytes with interspersed macrophages)
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Burkitt Lymphoma (associated with EBV)
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t(8;14)
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Burkitt lymphoma 8 = c-myc 14 = heavy-chain Ig
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Most common non-Hodgkin lymphoma in adults
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Diffuse Large B-cell lymphoma
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t(14;18)
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Diffuse B-cell lymphoma and Follicular lymphoma 14 = heavy-chain Ig 18 = bcl-2
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t(11;14)
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Mantle cell lymphoma (older males) 11 = Cyclin D1 14 = heavy-chain Ig
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Painless waxing and waning lymphadenopathy
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Follicular lymphoma
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HTLV-1
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Adult T-cell lymphoma
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Cutaneous plaques/tumors, CD4+ cells
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Mycosis fungiodes (or Sezary syndrome if circulating cells) *A t-cell lymphoma
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Monoclonal M Protein spike (IgG or IgA) (think "CRAB")
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Signs and symptoms of multiple myeloma hyperCalcemia Renal insufficiency Anemia Bone lytic lesions/Back pain
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Monoclonal M Protein spike (IgM) and hyperviscous blood
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Waldenstrom Macroglobulinemia (no bone lesions)
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Pseudo-Pelger-Huet anomaly
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Seen after chemo. neutrophil with bilobded nuclei connected by thin filament
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Stem-cell defect → ineffective maturation of non-lymphoid lineages
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myelodysplastic syndrome risk → AML
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mediastinal mass < 15 years old Down syndrome association
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T-cell ALL
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TdT+ (pre-T and pre-B cells) CD10+ (pre-B cells)
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ALL
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smudge cells
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Small lymphocytic lymphoma (AKA: CLL, which has ↑ blood lymphocytosis)
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> 60 years CD20+, CD5+ B-cell neoplasm autoimmune hemolytic anemia
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Small lymphocytic lymphoma (AKA: CLL, which has ↑ blood lymphocytosis)
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Adults Mature B-cell neoplasm TRAP+ Dry tap on bone marrow aspiration
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Hairy cell leukemia
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MOA: cladribine
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ADA inhibitor Rx: hairy cell leukemia
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t(15;17) Auer rods
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M3 type of AML
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Rx: M3 type of AML
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all-trans retinoic acid *risk of DIC during treatment
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t(9;22)
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CML ("Philadelphia CreaML cheese) bcr-abl hybrid
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MOA: imatinib
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inhibitor of bcr-abl tyrosine kinase Rx: CML
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Child with recurrent otitis media or skin rash, and lytic bone lesions S100+ and Birbeck granules ("tennis rackets")
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Langerhans cell histiocytosis (cells do not stimulate T-lymphocytes)
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Intense itching after a hot shower
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Polycythemia vera (hct >55%)
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ectopic EPO
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Renal cell carcinoma hepatocellular carcinoma Wilms tumor hydronephrosis
