Thrombocytosis and thrombocytopenia

Thrombocytosis Etiology- GI bleeding, IDA, JAK2 先測試JAK2, MPL, CALR, 不是gene問題後→ Hydroxyurea, aspirin Thrombocytopenia Etiology 1.Splenomegaly→ Normal BM(liver cirrhosis), abnormal BM(Leukemia, lymphoma) 2.Normal spleen→ Normal BM(ITP, TTP, DIC, HIT, APS, HUS, pregnancy, Kasabach-Merritt syndrome, HIV, malignancy, trisomy 13,18, methylmalonic acidemia, Bernard-Soulier, WAS, burns, hypothermia), abnormal BM(aplastic anemia, PNH)

Aplastic anemia

前言– 3 peaks→ 2~5y/o, 20~25y/o, 55~60y/o Etiology- Fanconi anemia(咖啡牛奶, 性腺功能低下, 小頭症), Dyskeratosis congenita(neutropenia, nail dystrophy, leukoplakia, pigmented skin), Shwachman-Diamond(neutropenia, pancreatic exocrine dysfunction, short stature), chemotherapy, parvovirus B19, HIV, EBV, SLE, gold, NSAID, 抗癲癇, sulfonamide, benzene, pregnancy, thymoma, PNH Diagnosis 1.取2- ANC<500, Ret<1%, PLT<20000 2.取1- Bone marrow cellularity< 25%, Bone marrow cellularity< 50% with <30% hematopoietic  […]

Iron deficiency anemia (IDA)

Presentation- Angular cheilosis, atrophic glossitis, pica, koilonychia Lab- Ferritin<15(Normal: 50~300)→ TIBC>360, SI<50→ MCV<80, Hg↓, Fe/TIBC<18, MCV/RBC>13, reticulocyte↓, RDW↑, sideroblast↓ Treatment- Oral ferrous iron Fe2+, IV Ferric iron Fe3+ *Protoporphyrin- Combined with iron to form heme → Iron↓ make protoporphyrin↑