| ☉RPI |
RPI= Ret(%)* Hct(%)/45 *1/MI (MI=1/1.5/2, HCt:45/35/25) (Range=1-1.5) |
| ☉IDA/ ACD: |
TIBC(<420)↑↑/Ferritin(>20) ↑↑(A B CDEF), Iron(>50)↓↓
|
| ☉Folic acid, B12(only): |
all from meat |
| ☉Aplastic anemia |
Tx: Steroid, Cyclosporin A, Antithymocyte globulin(ATG), BMT
|
| ☉Hemolytic anemia |
→Hereditary: Coombs' test (-)
1.Spherocytosis
2.G6PD→Acquired: Coombs' test (+): direct (Ab on RBC)/ indirect (Ab in plasma)
1.Autoimmune(AIHA)
(a)warm type: IgG: lymphoma, CLL, SLE, Drug
(b)cold type: IgM: cold agglutinine dz, lymphoma, mycoplasma（發冷）」
2.Microangiopathic HA
→Acquired: Coombs' test (-), Sugar water test
PNH: Pig-A gene mutation, GPI protein def, sensitive to Complement
|
| ☉Hemolytic transfusion reaction |
Stop transfusion as soon as reaction is suspected.
Replace blood with saline.
Begin aggressive fluid resuscitation in order to maximize renal cortical
perfusion.
★Furosemide may be administered to increase renal blood flow.
Low-dose dopamine may be considered to improve renal blood flow.
Make efforts to maintain urine output at 30-100 mL/h.
|
| ☉Thalassemia |
HbA1(a2b2): normal
HbF(a2r2): fetal
HbA2> 4%: beta: chr. 11
HbA2< 4%: alpha: chr. 16 |
| ☉Thiamine(Vit B1) Deficiency |
1.Dry beriberi: peripheral neurologic changes
2.Cerebral beriberi (Wernicke-Korsakoff syndrome)
→Mental confusion, aphonia, confabulation, Wernicke's
encephalopathy(nystagmus, total ophthalmoplegia, coma)
3.Cardiovascular (wet) beriberi
4.Infantile beriberi
|
| ☉後天性出血疾病： |
甘(hepatic)地(DIC產生血栓)K(Vit.K)敗(Sepsis)腎(Uremia) |
| ☉血小板疾病： |
Infeciton: HIV, Hanta, Dengue
Immune: ITP, TTP, Hypersplenism→→Plt<10K再治療
Tumor: leukemia
Drug: aspirin, ticlipidine
Other: HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelet) |
| ☉ITP D/D: |
Anaphylactoid purpura (Henoch-Schoenlein Purpura)
→→symmetric, all under buttock, knee pain, CBC normal
|
| ☉Coagulative factors |
Vit K : 2,7,9,10
PT(extrinsic) : 7
PTT(intrinsic): 12,11,9,8: Hemophilia （「交」(膠)了「內」力深「厚」的朋「友」）
(common) : 10,5,2,1 |
| ☉Anticoagulants |
1.Warfarin(Coumadin): check PT(Vit K: VII)（兩畫）
2.Heparin: check aPTT（三畫） ,activate anti-thrombin III |
| ☉vWF: |
most commmon, BT, aPTT prolong, protect 8, treated with DDAVP |
| ☉Cryoprecipitate: |
8, vWF, 13, fibronectin |
| ☉intron 22 inversion |
found in about 50% of severe hemophilia A
|
| ☉HMB-45: |
melanoma specific antibody |
| ☉leudocyte alkaline phosphatase(LAP) score |
→LAP is usually higher-than-normal with:
Polycythemia vera
Myelofibrosis
→LAP may be normal or higher-than-normal with:
Leukemoid reaction to infection
Women on oral contraceptives
→LAP is usually lower-than-normal with chronic granulocytic leukemia.
→LAP may be lower-than-normal with decreased bone marrow activity:
Pernicious anemia
Aplastic anemia
Primary thrombocythemia is an additional condition under which the test
may be performed.
|
| ☉Multiple myeloma |
→plasma cell, M-protein(Urine B-J protein)
→A: anemia, B: bone pain(Punch-out lesion), C: Ca↑,Cre↑
→Elders
→Bone scan not necessary: because osteoclastic↑,not osteoblastic
→Cause of death: infection |
| ☉C/T |
A: alkylating→→cyclophosphamid→→pul.fibrosis, hemorrhagic cystitis,
secondary malignancy
A: antimetabolite→→MTX/5FU/6MP/Ara-C→→hepatic toxicity
A: antibiotics→→bleomycin
T: tubulin poisons→→taxol(Paclitaxel)（紫衫醇）/vincristine→→/ileus,SIADH
T: topoisomerase
inhibitor→→doxorubicin(Anthracyclin)/etoposide（拓樸）/idarubicin→→cardiotoxicity/（傷心小紅莓）
T: (tamoxifen)
P: platinum→→cisplatin→→（腎耳神經毒）
P: (prednisolone)
|
| ☉C/T: preparation |
Normal saline: cisplatin, doxorubicin
D5W: oxaliplatin
Ringer sol: high dose Ara-C |
| ☉Tx for leukemia/lymphoma |
→Lymphoma: CHOP (Cyclophosphamide, Doxorubicin(adriamycin),
Vincristine(Oncovin), Prednisolone)
→ALL: HOP
→AML: I3A7(Idarubicin+ ara-C)
→APL(AM3L): "ATRA" 砒霜, ATRA syndrome→→t(15,17) good, t(9,22) bad
→Stem cell Tx: 40-5 y/o, ALL, after consolidatio |
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