Hematology and Oncology

• Purpuric rash + abdominal pain + glomerulonephritis in a child/young patient: HENOCH-SCHONLEIN PURPURA (HSP):

mnemonic: AGAR

Abdominal pain

Glomerulonephritis

Arthralgia

Rash

• Purpura (livedo reticularis) after a coronary angiogram: think CHOLESTEROL ATHEROEMBOLIC DISEASE

• Purpura (livedo reticularis) + hepatitis B + abdominal pain after meals + footdrop + HTN: think POLYARTERITIS NODOSA

• THROMBOTIC THROMBOCYTOPENIC PURPURA (TTP): mnemonic: FAT RN

Pentad: 1. Fever

2. Anemia, microangiopathic hemolytic (+) schistocytes

3. Thrombocytopenia

4. Renal abnormalities

5. Neurologic abnormalities (confusion, aphasia, headache, coma, seizures)

• HEMOLYTIC UREMIC SYNDROME (HUS): mnemonic: RAT

Renal failure

Anemia, microangiopathic hemolytic Thrombocytopenia

(1) Normal coagulation tests (normal PT/PTT)

(2) Elevated LDH

• HUS is similar to TTP, except that it only affects the RENAL system

• Patients with chronic low-grade lymphoproliferative disorders for years who develop new lymphadenopathy: consider transformation to a high-grade lymphoma

• Patients with ACUTE LEUKEMIAS usually present with low to normal WBC, whereas patients with CHRONIC LEUKEMIAS may present with splenomegaly and high WBC

MORE COMMON PERIPHERAL SMEARS AND GENETIC MARKERS:

• Smudge cells (mature lymphocytes): chronic lymphocytic leukemia

• Auer rods: acute myelogenous leukemia/promyelocytic leukemia

• Reed-Sternberg cells: Hodgkin's disease

• Spur cells: liver disease, DIC

• Reactive lymphocytes: infectious mononucleosis

• "Fried egg" appearance of cells that are TRAP (+): hairy cell leukemia

• Target cells: liver disease, iron deficiency, thalassemia

• Helmet cells: traumatic hemolysis, DIC

• Polychromasia and spherocytosis: implies autoimmune hemolytic anemia

• Young patients with unexplained pancytopenia: consider paroxysmal nocturnal hemoglobinuria

• Philadelphia chromosome t(9,22)/bcr-abl gene: chronic myelogenous leukemia

• Bite cells/Heinz bodies: Think glucose-6-phosphate dehydrogenase (G6PD) deficiency

IRON-DEFICIENCY

ANEMIA OF

ANEMIA

vs. CHRONIC DISEASE

IRON

Decreased

Decreased

FERRITIN

Decreased

Increased

TIBC

Increased

Decreased

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