PACES Approaches Ep9:
An in-depth discussion on various types of anemia, including macrocytic, normocytic, and microcytic, along with their etiologies such as B12/folate deficiency, chronic diseases, hemolytic anemia, and more. The presentation also covers hemolytic anemia, immune vs. non-immune causes, and marrow dysfunction. Additionally, it delves into easy bruisability, hypercoagulable states, and thrombocytopenia related to viral infections, inflammatory conditions, malignancy, and primary hematological disorders.
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Presentation Transcript
PACES Approaches Ep9: Haematology Approaches
Approaches Anemia Easy Bruisability Hypercoagulable State and Young Stroke Epistaxis Polycythemia
Anemia Macrocytic: B12/folate, Hypothyroidism, CLD, Ethanol, reticulocytosis Normocytic Acute blood loss Anemia of Chronic Disease: CKD, inflammatory disorders Haemolytic Anemia: Immune vs Non-Immune Marrow Dysfunction: Primary vs Secondary Microcytic: IDA, thalassemia, sideroblastic anemia, lead poisoning
Etiologies Hemolytic Anemia Immune: Transfusion, CTDs (SLE/Sjogren s), drugs (penicillins, cephalosporins), haematological malignancy, infections (mycoplasma, EBV, CMV) Non-Immune: Mechanical heart valve, HUS/TTP, malaria, congenital (sickle cell, G6PD, wilson s disease), HTN TMA Marrow Dysfunction Primary: Congenital aplasias, haematological malignancy, MDS Secondary: Drugs, infection, infiltrative disorders Pernicious anemia A/w other autoimmune disorders (check thyroid, vitiligo) Check neurology Sideroblastic anemia: Congenital vs acquired (drugs like isoniazid/linezolid, alcohol, copper def) Lead poisoning: Gasoline, paint/pigments, batteries, cosmetics
Easy Bruisability/Coagulopathy Connective Tissue Congenital: Marfan s, Ehlers Danlos, HHT Acquired: Cushing s, HSP, Vasculitis Platelet Dysfunction: Antiplatelet, uremia, vWD Thrombocytopenia Refer to subsequent slide Coagulation PT prolongation: Warfarin, Vit K deficiency, early liver disease APTT prolongation Factor deficiency: Haemophilia (VIII, IX), vWD inhibitors: APS abs, acquired inhibitors (idiopathic, autoimmune, malignancy), heparin/Xa inhibitors Both prolonged: DIC (sepsis, polytrauma, APML), advanced liver disease Normal Plt and Coag Screen: Factor XIII def, platelet dysfunction, CTD
Thrombocytopenia Infection: Viral infections (dengue, HIV), HUS/TTP, Hep C Inflammatory: SLE, Sjogren s, APS Malignancy: Haematological malignancies, mets with marrow involvement Drugs: Heparin, chemotherapy, AEDs (valproate), antibiotics (bactrim) Primary haematological disorders: Myelodysplasia, vWD, ITP (Can be 2 HIV, Hep C, SLE) Sequestration: Splenomegaly Consumption: DIVC (infection, malignancy, trauma, intravascular hemolysis)
Hypercoagulable State Thrombophilia: APS, factor V leiden mutation, protein C/S deficiency, anti-thrombin III deficiency Malignancy: Solid organ, hyperviscosity syndrome Nephrotic Syndrome Iatrogenic: OCP, surgery Vasculitis Hyperlipidemia/cholesterolemia Stasis: AF, immobility
Young Stroke Hypercoagulable states Cardiac (Echo, telemetry): Atrial Fibrillation, paradoxical emboli, intracardiac thrombus, infective endocarditis Vascular (Vessel imaging): Moya Moya, Fibromuscular Dysplasia, Arterial Dissection (Marfan s, Ehler s Danlos) Metabolic: CADASIL, Fabry s Disease, MELAS
Epistaxis Coagulopathy, NPC PACES specific: HHT, Wegener s
Polycythemia Primary: PRV, congenital methemoglobinemia Secondary: Hypoxia related (Chronic pulmonary disease, R>L shunts, OA/OHS, high altitude, CO poisoning, smoking) Autonomous EPO Production: RCC, HCC, Pheochromocytoma
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