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Hematology (Multiple Myeloma (CRAB :red_flag: (HyperCa,Renal involve…
Hematology
Multiple Myeloma
CRAB :red_flag:
HyperCa,Renal involve,Anemia,Bone lytic lesion(Punched out lesion)
Monoclonal plasma cell :warning:Fried egg appearance ,สร้าง IgG55%/IgA25%
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DDx Waldenstrom macroglobulinemia มี IgM, hyperviscosity(Blurr ,Raynald phenomenon) ,No CRAB
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Physiology
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Hb development
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Fetal : HbF(a2g2), Adult : HbA1(a2b2)
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Coagulation
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Vit K dependent factor
Factor 2 7 9 10 ,Protein C S
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Pathology
RBC
Acanthocyte(Spur cell)
Abetalipoproteinemia, Liver ds
Basophilic strippling
Lead poison,Sidero anemia,MDS
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Bite cell , Heinz bodies,Eccentrocyte
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Schistocyte/Helmet cell
MAHA(DIC,TTP,HUS,HELLP),heart valve prosthesis
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Target cell
Thalassemia, Liver disease, Asplenia
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Leukopenias
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Lymphapenia
HIV, DiGeorge syndrome, SCID, SLE, corticosteroids
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Coag disorder
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VWD
:arrow_up:BT intrinsic defect :arrow_down:vWF :arrow_up:PTT defect Plt plug formation , AD Tx : Desmopressin
DIC
:arrow_up:PT/PTT/BT :arrow_down:Plt clotting factor defect, schitocytes :arrow_up:D-dimers
cause : Gr.neg sepsis, truama,obstetic comp, pancreatitis, Malignancy, Nephrotic ,transfusion
Plt disorder
LAB :arrow_up: BT อาการmicrohemorrhage เช่น mucosal bleeding,epistaxis
Bernard-Soulier syndrome
defect plt plug formation, :arrow_down:GpIb(pt to vWF)
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HUS
:arrow_down:Plt,MAHA,ARF มักพบในเด็กมาด้้วยท้องเสียจากEHEC adultจะคล้ายTTP tx : plasmapheresis
ITP
:arrow_down:plt, AntiGp2b3a Ab, Splenic macrophage, Megakaryocytes Tx : steroid,IVIG,splenectomy
cause : idiopathic, viral infection,AI,CA
TTP
:arrow_down:plt , :arrow_up:LDH ,defect ADAMTS13 เกิด Plt agg,thrombosis Tx : plasmaparesis,steroid
Symptoms : Pentad of neurologic,renal,fever,thrompocytopenia,MAHA
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Anemia
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Macrocytic anemia
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Folate def
NO neuro symptoms,มักมาจากmalnu/alcoholics/ยา เช่น MTX,TMX,phynytoin
Cobalamin def
Veganism,Crohn disease,Gastrectomy,Diphyllobothrium latum
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Leukemia
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Lymphoid neoplasms
ALL
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PBS : Lymphoblast++ , CD10+
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Myeloid neoplasms
AML
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Myeloperoxidase+,PBS : myeloblasts++
CML
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Philadelphia chromosome t[9;22],BCR-ABL
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Lymphoma(LN tumor)
Hodgkin
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CC; B symptoms ,Localized LN(contiguous spread)
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มักเกี่ยวกับ EBV, bimodal(young adult,>55)
Non-Hodgkin
CC : B symptoms, multiple LN involved
เด็กและผู้ใหญ่ AI,immunodef
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