خامسة جديد🤺😎

هلا وغلا

حللتم أهلًا وسهلًا
رحلة سعيدة يا سناير إن شاء الله.

#Snapshots_in_Haematology (1)
🔳Hemolytic anaemia
+ Pancytopenia
+ Thrombosis
= #Paroxysmal_nocturnal_Heamoglobinuria
▶️Dark urine in morning is clue.
▶️Initial screening test is Hams test
▶️Gold standard investigation is Flow cytometry
which detect low levels of CD59, CD55.

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🔳Venous/ arterial thrombosis
+ recurrent fetal loss
+ livedo reticularis
+ low platelets
+ prolonged APTT
( fails to correct with addition of normal plasma )
+ History of SLE
+ lupus anticoagulant + anticardiolipin antibodies
= #Antiphospholipid_syndrome
#Treatment
➡️Venous thrombosis = Warfarin with INR 2-3
for 6 months.
➡️Recurrent venous thrombosis = lifelong warfarin
#if occurred while taking warfarin
then increase INR to 3-4.
➡️Arterial thrombosis = lifelong warfarin
target INR 2-3.

🔳Treatment of Antiphospholipid syndrome in
#pregnancy = Aspirin + LMWH.

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🔳Causes of Extravascular haemolysis are :
➡️warm Autoimmune HA
➡️hereditary spherocytosis
➡️Heamoglobinopathies
i.e. Sickle cell anaemia , thalassemia
➡️Haemolytic disease of new born

🔳Warm autoimmune haemolytic anaemia has = #IgG
🔳Cold Autoimmune haemolytic anaemia has = #IgM

🔳Causes of #warm_autoimmune haemolytic anemia:
➡️Autoimmune disease = SLE
➡️Neoplasia : Lymphoma, CLL
➡️Drugs: Methyldopa, penicillin, cephalosporin,
levodopa , NSAIDS , Quindine
#treated by stopping drugs
+ oral Prednisolone

🔳Causes of #Cold_autoimmune haemolytic anaemia:
➡️Neoplasia: Lymphoma
➡️Infections : Mycoplasma , EBV , legionella ,
malaria

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🔳Anemia
+ jaundice
+ splenomegaly
+ retic count > 3
= Haemolytic anaemia

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🔳Features of intravascular haemolytic anaemia are :
➡️Heamoglobinuria
➡️Low hepatoglobin
➡️Haemosiduria
➡️High LDH

🔳Direct Combs test is diagnostic for haemolytic
anaemia.

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🔳50 -60 years
+ fatigue
+ massive splenomegaly
+ weight loss , night sweats
+ tear drops poikilocytes
+ high WBC
+ high Platelets (initial)
+ dry tap
+ high LDH + Jak2 + large abnormal platelet
+ portal Hypertension
= #Myelofibrosis
🔳Treatment of Myelofibrosis is :
➡️First line : hydroxycarbamide
➡️interferon A and Bone marrow transplantation

🔳Diagnostic test for Myelofibrosis
= Trephine bone marrow biopsy

-د.محمود لبيب.