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 

Treatment

1.嚴重- Bone marrow transplant(<40 y/o) or ATG + cyclosporin + steroid

2.中, 輕微- Steroid

3.支持療法- 輸血

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↑