Hepatomegaly, splenomegaly, stigmata of liver disease Liver disease as a cause of hypersplenism/sequestration Infectious causes Rashes Associated with hematologic malignancies, autoimmune and infectious diseases related to drug reactions, rheumatologic disorders, infections, and malignancies
Oral lesions Thrush suggests immune compromise Oral ulcers may be seen in SLE, Crohns Initial Evaluation CBC with diff Peripheral smear Reticulocyte count (absolute < 20,000 suggests hypoproliferation)
PT/INR, aPTT CMP, LDH, uric acid Type & screen Bone Marrow Biopsy Helpful Acute Not leukemias Aplastic anemia
Multiple myeloma helpful Medication-induced Recent use of hematopoietic growth factors Peripheral destruction, sequestration Pancytopenic Emergencies ANC < 1000, newly-diagnosed or with evidence of infection
Symptomatic anemia (e.g. myocardial ischemia, hypotension) Thrombocytopenia < 10,000 (or < 50,000 with active bleeding) DIC, TTP, HUS, or other MAHA with schistocytes and elevated LDH Acute leukemia (e.g. with DIC or tumor lysis syndrome) Associated metabolic abnormalities
Delirium, dehydration, abdominal pain: hypercalcemia (multiple myeloma, adult T-cell leukemia/lymphoma) Acute renal failure (e.g. with elevated uric acid in tumor lysis syndrome If none of the above are present, CBC is stable and near normal, and the patient is asymptomatic, referral is non-urgent Autoimmune Causes RA, Feltys syndrome SLE
Suppression from alcohol or viral infections Myelodysplastic syndrome Certain malignancies Hairy cell leukemia T-cell large granular lymphocyte leukemia Neoplastic Causes Acute leukemias
Myelodysplastic syndrome Often see circulating blasts Often see dysplastic leukocytes Myelofibrosis Tear drop cells (dacrocytes), nucleated RBCs, early WBCs Overview and Treatment of Myelodysplastic Syndromes Description A group of hematopoietic stem cell disorders
characterized by Ineffective, dysplastic hematopoiesis Risk of transformation to acute leukemia Quantitative and qualitative defects in production of red blood cells, platelets, and granulocytes Develops like other cancers, from stepwise acquisition of oncogenic mutations Epidemiology 10,000-30,0000 cases per year in the United States
Most common in older adults, median age at diagnosis 65 years or older Associated with certain exposures: benzene, radiation, tobacco, chemotherapy drugs Certain connective tissue disorders associated Behets, Sjgrens, IBD, polymyalgia rheumatica, relapsing polychondritis No causal link established
Presentation Hepatomegaly, splenomegaly, lymphadenopathy uncommon Infection Usually bacterial, often skin infections Non-infectious cutaneous manifestations Sweet syndrome (acute febrile neutrophilic dermatosis: uncommon, but much greater frequency than in general population)
Myeloid sarcoma (extra-medullary AML) Pancytopenia with inappropriately low reticulocyte response Peripheral Smear Findings RBCs Normocytic or macrocytic Ovalomacrocytes most common, can also see dacrocytes, stomatocytes, or acanthocytes
Basophilic stippling, Howell-Jolly bodies, and megaloblastoid nucleated red cells Peripheral Smear Findings (cont.) WBCs: most commonly seen finding are the pseudoPelger-Huet abnormality and reduced granulation Pre-treatment Evaluation: Scoring Treatment Modalities High-intensity Allogeneic hematopoietic cell transplant
Combination chemotherapy, such as daunorubicin and cytarabine Low-intensity (improves symptoms, not curative) Hematopoietic growth factors (epoetin alfa, eltrombopag, GM-CSF) Azacitidine/decitabine (hypomethylating agents) Immunosuppresive therapy Lenalidomide Supportive care
Antibiotics PRN RBC and platelet transfusions PRN Prognosis Highly dependent on underlying cytogenetics Intermediate-, high-, or very high-risk patients can receive high-intensity therapy, which can be curative With older age, other medical comorbidities, often supportive care is the best option
High- to very-high risk groups have survival measured in months with supportive care End
Isabel CastroPiedras1, Leah Quisenberry2, James Hutson2, Reid Norman3, John McGlone4, Daniel Hardy2, Joaquin Lado-Abeal1,2. 1Internal Medicine 2Cell Biology and Biochemistry 3Pharmacology and Neurosciences 4Animal Sciences, Texas Tech University Health Sciences Center, Lubbock, Texas, United States, 79430. Methods. Conclusions. References. Abstract
The Physician-Pharmaceutical Industry Relationship The CAGE Questionnaire for Drug Company Dependence Have you ever prescribed CelebrexTM? Do you get Annoyed by people who complain about drug lunches and free gifts?
55, avenue Laurier Est. Ottawa ON K1N 6N5. Telfer School of Management. University of Ottawa. 55 Laurier Avenue East. Ottawa ON K1N 6N5 . telfer.uOttawa.ca. Telfer.uOttawa. Telfer_uOttawa. tlfr.ca/ linkedin. Telfer_uOttawa (EN) Telfer_UdO (FR)
är det bra att använda rekursion? Hmm… när det passar naturligt som lösning. Var passar det? När man kan hitta svaret genom rekursiv/induktiv problemlösning. Exempel frågeställning: Kan jag lösa basfall av problemet? Kan jag lösa alla andra fallom jag antar...
Smooth Manifold Case. Let ? be a smooth manifold embedded in ?? Theorem [Niyogi, Smale, Weinberger] Let ?⊂? be such that ???, ?≤?. If 2?≤?≤35??, there is a deformation retraction from ?? to ?. Corollary A. Under the conditions above,...
The project partner was Penal Reform International (led by Baroness Vivienne Stern). A Federal Law on Alternatives to Imprisonment was enacted at the end of December 2004, and the numbers serving Community Service Orders grew from 17,400 in 2005, to...
Gross Anatomy of Muscles. Anterior and Posterior Trunk Muscles. Arm and Shoulder Muscles. 207-209. Table 6.3 Superficial Anterior Muscles of the Body (See Figure 6.22) (2 of 3). Figure 6.17a Muscles of the anterior trunk, shoulder, and arm. Clavicle. Deltoid.
Ready to download the document? Go ahead and hit continue!