Dr. Prasad's High Yield Heme Review 2024 PDF

Heme Review Chaya Prasad, MD, MBA Anemia Lab Classification based on morphology Microcytic (iron deficiency, thalassemia, ACD) Macrocytic (folate or vitamin B 12 deficiency) Normocytic (hemolytic anemia, sickle cell disease) PNH/G6PD/IHA Know the images of PBS For each disease entity kn...

Heme Review Chaya Prasad, MD, MBA Anemia Lab Classification based on morphology Microcytic (iron deficiency, thalassemia, ACD) Macrocytic (folate or vitamin B 12 deficiency) Normocytic (hemolytic anemia, sickle cell disease) PNH/G6PD/IHA Know the images of PBS For each disease entity know the following: Pertinent pathophysiology - e.g Ab to IF in PA Genetic abnormality - e.g PNH and PIGA Clinical Presentation - e.g gallstones or cutaneous ulcers in SCD Clinical scenarios where they can be encountered - e.g defective heart valve or DIC at risk of developing hemolytic anemia from IV site - e.g ACD and SLE - e.g CLL and ITP or SLE/ITP oozing - e.g SCD and Parvo – Aplastic crisis Abnormal Lab indices - e.g e.g hemolysis and hyperbilirubinemeia, SPECIFIC (diagnostic) lab test - e.g Hb electrophoresis for thalassemias and SCD/SCT Lab(s) that differentiate between 2 diseases - e.g Vit B12 and folate def (urinary MMA and FIGlu test) - e.g Fe def vs ACD (TIBC) Details of the abnormal findings in PBS - e.g hyperseg neuts in macrocytic A - e.g Sickle cells in SCD but not in trait Sequelae of disease - e.g splenic infarcts, crisis with SCD Use algorithms or tables that I have provided Bleeding and Coagulation disorders Know the following topics: PT and aPTT (intrinsic/extrinsic/combined) Factor 8, 9 deficiency vWD D ITP, TTP, HUS, HSP – how to differentiate them Platelet disorders DIC Protein C, S, APS Vit K def Know the following for each entity: Pertinent pathophys - e.g ADAMTS13 def in TTP Specific genetic abnormalities Clinical presentation -e.g Thrombocytopenia and MAHA=TTP -e.g Undercooked beef think HUS - e.g Malabsorption history think vit K def and factor def (2, 7, 9, 10, C/S) - e.g Liver disease – same as above (factor def and PT/PTT abnormal) Clinical scenarios they may be associated with - e.g APS and repeated miscarriages pts - e.g OB events and DIC - e.g CLL and ITP - e.g Heparin and HIT Lab abnormalities Specific (diagnostic) lab test if any - e.g d-Dimer for DIC - e.g ADATS13 for TTP vs HUS Differentiating features - e.g pentad in TTP/HUS but if neuro and fever prominent think TTP rather than HUS Pertinent findings in PBS - e.g giant platelets in PBS (I rarely ask BM images) High Yield – I have mentioned these during my lectures Benign - IM and leukemoid Acute leuk – ALL, AML, AML – know M1, M2, M3 Chronic leuk – CLL/SLL and CML MF and Hairy Cell HD Burkitt’s Adult T-cell lymphomas/leukemias skin lesions Non-Hodgkin's lymphoma - DLBCL, Mantle Cell, Marginal Zone, Follicular W Markers  Leukemia and Lymphoma - Know the following: Most commonly encountered entities. ( I have pointed out what entities are clinically relevant, at the start of each topic) Genetic abnormality Clinical Presentation - e.g teenager with fever cervical adenopathy - IM - e.g African with jaw mass – think Burkitts Clinical scenarios where they can be encountered - e.g MALTOMA in a pt with chronic gastritis due to HP Abnormal Lab indices, markers for immature and mature T-cells and B-cell SPECIFIC (diagnostic) lab test - e.g EBV VCA for IM Lab test (s) that differentiate between 2 diseases - e.g MPO for AML vs ALL Abnormal findings in PBS , know images. - e.g IM, AML, ALL, APML, CLL, CML, HD, Burkitts, etc Sequelae of disease - e.g DIC in APML - e.g HD and subsequent other lymphomas/CA MDS/MPN/immuno proliferative CML Leukemoid PCV ET PMF MM/plasmacytoma Waldenstrom’s  MDS/MPN/Immunoproliferative - Know the following: Most commonly encountered entities. Genetic abnormality -e.g Philadelphia chromosome in CML, 9:22 Clinical Presentation - e.g elderly comes in for routine exam and ha high WBC count - e.g elderly comes in with fullness of abdomen (massive spleno) Clinical scenarios where they can be encountered - e.g Polycythemia and high altitude, renal disease or pul. disease SPECIFIC (diagnostic) lab test - e.g 9:22 for CML (with right clinical findings) - e.g JAK 2 in PCV, PMF - e.g IF for MM Lab test (s) that differentiate between 2 diseases - e.g LAP for CML vs Leukemoid Abnormal findings in PBS , know my images. - e.g Know CML, MM Sequelae of disease - e.g CML can progress to AML - e.g amyloidosis and MM (renal, cardiac, etc) In summary I do not ask about minutia. Look at big picture content Concentrate on the most common diseases in each category. (I mention those as I start the topic and I have provided a trimmed down list today) Diseases that I have trimmed out will not be questioned by me (on Step yes) I do not show BM or solid organ images I do not ask about content form year 1 – no basic physiology I do not ask about treatment modalities. Trimmed down topics is still fair game for other teaching faculty Trimmed down content may show up as distractors, so you need to know them well enough to rule them out. The End