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MEDICINE
1.4A HEMATOLOGIC MANIFESTATIONS OF SYSTEMIC DISEASE

HEMATOPOIESIS
Formation of the blood

Red blood cells

White blood cells

Platelets
Occurs in the lymphohematopoieic issues

Yolk sac

Liver

Spleen

Bone Marrow

Thymus/Lymph Nodes

ANEMIA
Anemia can be easily associated with a number of disorders.
Presenting signs and symptoms depend on the underlying
disease.
Most often recognized through lab tests

Dyspneic
Dizzy
Tired
Pale

Anemia Priority tests

CBC confirmation
Reticulocyte Index Marrow response
PBS Morphologic correlation

CBC
Hgb 10.0
o
Males: 14 18
o
Females: 12-16
Hct 0.30
WBC 4.2
o
N: 4-10
Plt 200
o
N: 150-300
Retix 5%
Hgb 100

Plt 200

WBC 4.2
Hct 0.30
Retic 5%

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2.1A HEMATOLOGIC MANIFESTATIONS OF SYSTEMIC DISEASE

CORRECTED RETICULOCYTE COUNT

RED BLOOD CELL MORPHOLOGY

Hematocrit - # of erythrocytes
Mean Cell Volume normo, micro, macro-cytic
Mean Cell Hemoglobin normo, hypo hyper-chromic

Hemoglobin / Hematocrit
Mean Cell Hemoglobin concentration increased in hereditary
spherocytosis
Cell Volume Distribution Increased in hemolysis

HYPOCHROMIC MICROCYTIC ANEMIA

Serum Ferritin
ITIM
HgB EP
Iron Deficiency
CRP, ESR
Thalassemia
Marrow Biopsy
Inflammation
Myelodysplasia

NORMOCHROMIC NORMOCYTIC ANEMIA

Creatinine, UTS
KIMI
Serum Ferritin
Kidney Disease
Marrow Biopsy
Iron Deficiency
CRP, ESR
Marrow Defect
Inflammation

MEGALOBLASTIC ANEMIA
Hx Veggie, Serum
BF on DRUGS
Hx meat, Serum
B12 Deficiency
Drug toxicity
Folate Deficiency
Drug Toxicity

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2.1A HEMATOLOGIC MANIFESTATIONS OF SYSTEMIC DISEASE

POLYCYTHEMIA

Headache
Tinnitus
Vertigo
Decrease vision
HTN

THROMBOCYTOPENIA

SLE
Cirrhosis
Scurvy
Ehlers-Danlos

TRAUMA INDUCED BLEEDING

Hemarthosis Factor VIII or IX Deficiency

History and PE
CBC
PT/PTT

PRIORITY TESTS

THROMBOSIS

BLEEDING
A history of bleeding is the most important predictor of bleeding
risk
Easy Bruisability is a complaint that can be seen in patients
with or without primary bleeding disorders
MUCOSAL BLEEDING
PLATELET DISORDERS
Adhesion Von Willebrand Disease
Aggregation Glanzmanns Disease
Secretion Aspirin, Uremia
Coagulant activity Scotts Syndrome

Arterial Thrombosis
o
Atherosclerosis
Venous Thrombosis
o
Hormonal Therapy
o
Obesity
o
Malignancy
o
Immobility / Infection
o
Surgery
There are no screening tests for hereditary causes of
thrombosis
o
Thrombosies in unsual sites
o
Recurrent / Unprovoked episodes
o
Age
o
Family history
Prothrombin G20210A
Factor V Leiden

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Protein C Deficiency
Protein S Deficiency
Elevated FVIII

WBC DISORDERS
Always best to confirm laboratory results
Systemic disorders may affect specific lineages of WBC

NEUTROPENIA
Most common: Latrogenic
Cytotoxic or Immunosuppressive therapy
Antibiotics and infections
B12, Folate deficiency

NEUTROPHILIA
Most common: Infection
Steroids, stress, smoking, marrow proliferation

LYMPHADENOPATHY
Infections
Autoimmune diseases
Malignancy
History and PE
Biopsy

SPLENOMEGALY
Increased demand
o
Thalassemia
o
Myelofibrosis
o
Infections
Abnormal blood flow
o
Cirrhosis
Infiltration
o
Leukemia
o
Amyloidosis
Idiopathic

Nixons
Castels
Barkuns

6th rib
Left Mid-axillary line
Left costal margin

SUMMARY
History and PE are essential
Lab tests must be selected carefully
Know when to refer

2.1A HEMATOLOGIC MANIFESTATIONS OF SYSTEMIC DISEASE

END OF TRANS

What lies behind us and what lies before us are tiny matters compared to
what lies within us. H.Haskins

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