Transcript General Hematology Slide Review

General Hematology Slide
Review
• 15 month old with
pallor and hemoglobin
2.5g/dl, MCV 62fl and
retic 4%
• Drinks 48 oz of whole
milk/day
• What is this child’s
problem?
Iron Deficiency Anemia
• Family lives on a farm
and brings in their 2yo
for you to examine…
• Child is pale and an
HPD reveals a
hemoglobin 4g/dl,
MCV 102fl
• You diagnose a
macrocytic anemia
secondary to what?
Folate deficiency
Unpasteurized Goat’s Milk
• 7 yo boy with:
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fever x 1 week
Hemoglobin 9g/dl
WBC 1,200
Plt 32K
Ferritin 6000
What’s his diagnosis?
Hemophagocytic syndrome
Hemophagocytic Syndrome
• Non-malignant disorder of
antigen-presenting
macrophages
• Caused by:
– Uncontrolled
hemophagocytosis
– Defective NK cell function
– Cytokine upregulation
• Familial and sporadic forms
• Appears in association with:
– Bacterial, parasitic or viral
(EBV) infections
– Malignancy
– Drugs
– Connective tissue disorders
(SLE, Kawasaki’s)
• Diagnosis:
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Fever, splenomegaly
Cytopenias (>2 cell lines)
Elevated ferritin, triglyceride
Hemophagocytosis in marrow,
spleen, lymph nodes
• Prompt diagnosis/treatment
essential
What is this?
• 14 month old AfricanAmerican child
presents with mild
anemia – HPD
obtained and when
reviewed showed
these cells.
• What are they?
Elliptocytes
Hereditary Elliptocytosis
• 5 yo African-American
boy recently
presented with fever.
Prescribed Bactrim
for presumed otitis
media. Brought back
in by mom due to
increased fatigue and
this peripheral
smear…
What is the cause of this
peripheral smear?
Glucose 6-Phosphate
dehydrogenase (G6PD) deficiency
G6PD Deficiency
• Jaundice in first 24
hours of life
(pathologic jaundice)
• G6PD gene located
on X chromosome –
females can be
affected
• Common in certain
ethnic groups
• Newborn in your
practice – healthy, no
prenatal
complications
• His newborn screen
results comment on a
“fast” band seen on
hemoglobin
separation
What’s his diagnosis?
Hemoglobin H disease
Hemoglobin H Disease
• Caused by 3-gene
deletion a thal
• Excess b chains
• Tetramers precipitate
forming red cell
inclusions
• High O2 affinity
leading to reduced O2
carrying capacity
• 2 yo AAM presents
with pain in lower
extremities x 2 days
• Peripheral smear and
hemoglobin
separation reveal
this…
• What’s the diagnosis?
Homozygous sickle cell
anemia
• Same patient
presents with h/o
fever and marked
pallor
• Hemoglobin 2.5g/dl
• Retic 0.1%
• What’s your
diagnosis?
Aplastic Crisis
Parvovirus B19 infection
What does this child have?
Chédiak-Higashi
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Autosomal recessive
Absence of pigment in eyes, skin and hair
Giant granules in leukocytes
Increased susceptibility to infections
– Defective movement
– Decreased granulation
– Decreased microbicidal activity
• Frantic doctor refers a
child to your practice
with a platelet count
of 20K.
• Child has no bleeding
problems and is
completely healthy.
• What’s your
diagnosis?
Pseudothrombocytopenia
EDTA
• Another child
presents with
epistaxis, “wet”
purpura in mouth and
bruises/petechiae
over trunk and
extremities
• Platelet count 2K with
remainder of counts
normal
What’s the diagnosis?
Immune Thrombocytopenic
Purpura