lymphoadenopathy.pdfVIP

1Common Hematology disorders 血液腫瘤科 滕傑林 Anemia Anemia: Hb12 g/dL in women and 14 g/dL in man PE findings that aid in diagnosis include lymphoadenopathy, hepatic or splenic enlargement, jaundice, tenderness, neurological symptoms, and blood in feces Anemia Lab evaluation Hb and Hct: Hb might be normal in acute blood loss because not having enough time to restore plasma volume Reticulocyte count: reflex the BM response to anemia MCV Peripheral blood smear Additional testing: such as G6PD…. Anemias associated with decreased RBC production Iron-deficiency anemia (IDA) Etiology: blood loss (menstration, feces, occult GI tract malignancy, consumption of clay….) Lab results MCV: usually normal in early IDA Hct30%- hypochromatic microcytic Serum Ferretin level: 10 ng/ml in women; 20 ng/ml in men Serum iron: 50 ug/dL; TIBC: 420 ug/dL Bone marrow biopsy: absent staining for iron is the definitive test for iron deficiency Anemias associated with decreased RBC production Therapy Oral ferrous sulfate, 325 mg PO TID, taken between meals Parental iron therapy Most patients require 1000-2000 mg iron to correct the deficit 2Anemias associated with decreased RBC production Thlassemias Alpha-thalassemia Normally, 4 a-globin genes Def. 3 genes: HbH Def. 4 genes: hydrops fetalis Beta-thalassemia Normally, 2 b-globin genes Def. 1 gene: Thlassemia minor (trait) Def. 2 genes: Thalassemia intermedia Def. 2 genes severely: Thalassemia major (Cooley’s anemia) Anemias associated with decreased RBC production Treatment Transfusion Splenectomy Not performed for patient younger than 6 y/o Immunization against Pneumococcus, H.I, and Neisseria meningitis Iron chelating therapy: Deferoxamine 50- 100mg/Kg/D BMT Anemias associated with decreased RBC production MDS Refractory anemia Refractory anemia with ringed sideroblast Refractory anemia with excess blasts Refractory anemia with excess blasts in transformation CMMoL Anemias associated with decreased RBC production Megal