Hematology
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| Schilling test | 2-step test using radiolabeled B12 to test for pernicious anemia
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| Schistocytes; MAHA; high LDH; low platelets; ADAMTS13-auto antibodies; neg Coombs = | TTP
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| TTP labs | Normal PT, PTT, fibrinogen. Platelets <20,000. High LDH. MAHA (schistocytes, helmet cells, NRBCs). ADAMTS13-auto antibodies. Neg Coombs
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| Glanzmann labs | normal ristocetin (von W or B-S abnormal); abnl ADP, collagen, thrombin (opp von W or B-S)
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| DIC labs | +D dimer, +FSP; low fibrinogen; PTT prolonged more often than PT, but PT goes out 1st (FVII short half life)
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| Fe def anemia labs | low H&H/MCV, aniso & poikilocytosis, TIBC increases; ferritin <30, serum Fe <30, transferrin saturation <15%; high plts in severe
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| thalassemia labs | Hgb H: lower Hct. Hgb H & beta thal: increased retic (alpha: normal); Normal Fe/ferritin. Basophilic stippling & NRBCs
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| thalassemia: blood smears | alpha: target/acanth; Hgb H: target/poik; beta: target, poik (NRBCs in major)
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| sideroblastic anemia labs | Hct 20-30, high serum Fe, low MCV, hypochromic; BM eval to est dx (sideroblasts); HSM; baso stippling in Pb tox
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| N/N anemia labs | nml-high BM iron stores/ serum Fe/ferritin, nml-low TIBC
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| macro anemia 2/2 folate def: labs | serum folate <150 ng/mL (daily diet req 50-100 mg/dL); macro-ovalocytes, H-J bodies, nml B12
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| macro anemia 2/2 B12 def: labs | high MCV, aniso, poik, macro-ovalocytes, hypersegs; high LDH & indirect bili; low B12, low retic, high methylmalonic acid
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| G6PD def | inc retic & ind bili; bite cells & Heinz bodies
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| CRAG = | cryptococcal Ag assay
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| Hemolytic anemia lab findings | Low haptoglobin; high LDH (microangiopathic hemolysis), high indirect bili (not >4-5mg/dL unless underlying liver dz); high retic with low-normal H&H; hemoglobinuria; stable or falling Hgb
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| Absolute Neutrophil count formula | WBC x (% segs + % bands) = ANC
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| Neg Coombs | hereditary spherocytosis
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| Pos Coombs | AIHA, cold agglutinin
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| HIT labs | Plt drop 4-10 d post heparin; 50% of plt baseline; coags normal; confirm w/Serotonin Release Assay
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| PT measures: | extrinsic (FVII) & common pathways (Factor 1,2,5,10) (exogenous TF is added to initiate clotting)
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| aPTT measures: | intrinsic (factors 12,11,9,8) & common pathways (1,2,5,10)
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| Cause of prolonged PT: | Def. in FVII and Common Pathway Factors (FX, FV, FII, Fibrinogen); Liver Dz; Warfarin tx; Vit K Def; Inhibitor to FVIIa (rare)
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| Common pathway deficiencies will prolong: | PT & aPTT
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| von W Disease usually presents with PT and aPTT that are: | Normal
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| Anti-Phospholipid Syndrome: Labs | prolonged aPTT (b/c in vitro fx of the Ab on aPTT); mixing study fails to normalize; confirmatory tests required to make the diagnosis
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| Confirm HIT with: | Serotonin Release Assay
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| Unlike PTT, PT tests for | factor 7
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| PT monitors: | Coumadin; common pathway (1,2, 5, 10); F7
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| PT/PTT ref ranges | PT = 11-13; PTT = 26-36
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| PTT monitors: | Heparin; intrinsic (12, 11, 9, 8); common pathway (1,2, 5, 10)
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| Formula: corrected retic | % retic x HCT/45% = absolute % retics
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| Hallmark of Waldenstrom: | Monoclonal IgM spike in SPEP
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| Waldenstrom is differentiated from MGUS by: | Presence of bone marrow infiltration
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| Pancytopenia seen in: | ALL, AML, hairy cell
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| Giant plts & teardrop poik | Myelofibrosis
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| Dohle bodies | blue patch near edge; PMN; infxn
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| Toxic gran | purple/blue-black; PMN; severe infxn/toxic
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| Hyperseg: | 6 or more; PMN; megaloblastic anemia, B12-folate def
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| Causes of prolonged aPTT: | Def of intrinsic (FXI, FVIII, FIX ) & common pathway factors; Heparin & DTI tx; Inhibitors to coag factors
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| Prolonged aPTT; doesn't correct w/mixing study | FVIII inhibitor
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| PT is sensitive to (1) & normal range is (2) | (1) FVII ; (2) 9.5-13.1
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| aPTT measures: | intrinsic (factors 12,11,9,8) & common pathways (1,2,5,10)
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| aPTT normal range | 24.1-32.3 sec (uses neg charged particles to initiate)
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| Very rare causes of prolonged PT | FVII def; FVIIa inhib
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| DIC labs: | 1st PT prolonged 1st (2/2 short FVII half-life), then long aPTT. Low factor II, V, VII, VIII, IX, X) & fibrinogen & AT & platelets. Anemia High D-Dimer (more specific than FSP). Schistocytes; likely toxic granulation.
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| Normal bleeding time is | < 8 min
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| Single best indication of functional platelet deficiency | Bleeding time
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| When is bleeding time is prolonged? | Platelets <100,000. Abnormal platelet function. Drugs (eg, clopidogrel)
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| Heparin tx PTT range | 50-70 seconds
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| Negative Coombs | hereditary spherocytosis
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| Positive Coombs | AIHA, cold agglutinin
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| Heinz bodies | Hemolytic anemias (G6PD)
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| Low retic is found in: | hypoproliferative anemia; B12; PRCA; aplastic anemia
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| Defintion of neutropenia | PMN <1500 (AA may have 1200 normal)
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| Absolute Neutrophil count formula | WBC x (% segs + % bands) = ANC
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| Reticulocytosis may reflect: | Hemolytic anemias. Elevated retic indicates increased RBC production
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| PNH labs | Flow cytometry: absence of CD59 Ab. Normocytic; hemoglobinuria
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| Sickle cell labs | Very low Hgb (7-10). sickled cells: 5-50% of RBCs. Reticulocytosis. NRBCs. Leukocytosis, thrombocytosis, high indirect bilirubin
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| H&H normal ranges | RBC: M 4.4-5.9, F 3.8-5.2. Hgb: M 13.3-17.7, F 11.7-15.7. Hct: M 40-52%, F 35-47%
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| Gold standard test to measure Hct | RBC mass: nuclear med test measuring mL RBCs per kg body wt (usually reserved to evaluate polycythemia
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| Normal retic range | 0.5-1.5%
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| Lead poisoning labs | Micro/hypo, basophilic stippling. ringed sideroblasts. Increased Fe, normal TIBC, increased transferring & ferritin. Lead lines in xrays of long bones. Blood lead level >10 in kids
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| Pernicious anemia labs | Serum IF (intrinsic factor) antibodies, parietal cell antibodies, high serum gastrin levels, high MMA and homocysteine. pos Schilling test
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| Anemia of chronic disease labs | N/N (possibly mildly micro/hypo). Normal-high ferritin. Low Fe and TIBC.
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| Transferrin saturation calculation | Serum iron / TIBC
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| ITP labs | Isolated thrombocytopenia +/- megakaryocytes in BM. Acute form <20,000. Chronic form 30,000-80,000. Coags normal. Platelet clumping on smear suggests pseudothrombocytopenia
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| Hemophilia A & B labs | Decreased level of FVIII or FIX. Increased PTT; normal PT, bleeding time, & fibrinogen.
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| Hemophilia A & B: mixing study results | Mixing normal plasma with Hemophilia pt plasma -> normal PTT
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| von Willebrand labs | BT >8 min. Low factor VIII level. High PTT. Platelet aggregation abnormal with ristocetin. Low vW antigen (VWF:Ag); Low levels of vW Activity (VWF:RCo). Multimers are decreased
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| Liver dz coagulopathy labs | Prolonged PT>PTT. Long PTT in advanced dz. Mixing study corrects. No response to Vitamin K. low fibrinogen. Target cells & macrocytes on PBS.
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| Lupus anticoagulant labs | Immunoglobulin in pts with / without SLE. Increases risk of VTE & spontaneous abortion. High PTT. Mixing study does not completely correct.
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| Beta thalassemia labs | Beta major: Hgb A2 and Hgb F. Beta minor: Hgb A2
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Created by:
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