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5 High Yield Hematology Pearls for Clinical Practice and the ABIM Board Exam

Hematology is a topic that comes up every day in clinical practice, and it is very interesting to ABIM Internal medicine board exam. Evaluation of anemia, as well as other hematologic disorders, is very important for the internist. I will try to provide five evidence-based pearls in this post to help physicians understand some important concepts and avoid common pitfalls in their diagnosis and treatment. hematological disease.

Pearl #1: Guaiac tests are NOT good for patients on iron supplements.

• In vitro studies show that ferric iron (Fe³⁺) gives a good guaiac reaction with ferrous iron (Fe²⁺) does not exist
• Iron is absorbed in the ferrous form and transported to the blood in the ferric form
• Patients on iron supplements and good guaiac should be examined to identify the source of the bleeding.
• Yellow (Fe²⁺) iron does not produce positive guaiac tests in vivo

Pearl #2: The pentad of Thrombotic Thrombocytopenic Purpura (TTP) is not always present.

• The pentad is: microangiopathic hemolytic anemia (MAHA), thrombocytopenia, cardiac arrest, neurologic abnormalities, and fever.
• Less than 50% of patients have the entire pentad
• Measurement of ADAMTS13 activity is not required for diagnosis; the diagnosis is clinical
• The gold standard treatment is plasma transfusion and if that is not available you can use fresh frozen plasma as an alternative treatment.

Pearl #3: Primary hemostasis disorders are platelet aggregation and secondary hemostasis disorders are bleeding disorders.

• Primary hemostasis disorders:
  • It is a product of platelet function
  • Immediately
  • Patients may have petechiae and purpura
  • Increased bleeding time (platelets not working) and normal PT/PTT (no problems with bleeding issues)
• Secondary hemostasis disorders:
  
  • It is a product of blood thinners
  • Slows bleeding (helps strengthen clots by forming fibrin)
  • Patients suffer from hematomas and hemarthroses
  • All are affected by blood pressure (platelet function) and variable PT (external pathway) and PTT (internal pathway).

Pearl #4: Acute myelogenous leukemia (AML) type M3 is well characterized.

• AML is the most common form of acute lung cancer in adults

• Usually M2 – M5 types have a positive myeloperoxidase stain (Note that PTU and micropolyangitis are also positive)

• Auer rods are pathognomonic for AML

• Type M3 (promyelocytic) leukemia has t(15,17)

• The treatment is all-trans retinoic acid (ATRA).

• The most important prognostic factor in AML is cytogenetics: t(15;17) has a 70% 5-year survival rate and a 33% recurrence rate.

Pearl #5: Anemia is the most common blood disorder, so know it as a cold.

• Iron deficiency anemia is the most common cause of anemia
• Iron deficiency anemia:
  1. Low iron, transaminases, and ferritin
  2. High TIBC
  3. Transferrin Receptor Index = transferrin receptor / Log Ferritin is the most sensitive for iron deficiency anemia (>2.0 = Iron Deficiency Anemia; <1.0 = Anemia of Chronic Disease)
  4. Treatment is PO iron → if no improvement after 6 weeks consider IV iron
  5. The first lab to check after starting iron replacement is the reticulocyte count (It starts to rise in 5 to 7 days)
  6. The addition of Ascorbic acid (vitamin C) increases the absorption of iron
  7. Most of the iron is absorbed in the duodenum
  8. Celiac sprue can cause iron deficiency anemia: The best test is tissue transglutaminase antibody or antiendomysial antibody; Tx is a gluten-free diet; Dermatitis herpetiformis is often associated with this entity

As I said in my big fruit pearls to pass the boards: “Most of the common” is focused on the ABIM curriculum, so it’s good to know these disease processes. In addition, the diseases that are on the rise, they have a high risk and the consequences are also high. Anemia (the most common hematologic malignancy), AML (the most common vaccine-associated malignancy in adults), and Thrombotic Thrombocytopenic Purpura (the most common malignancy) are 3 of the hematology pearls covered in this column. . Good luck as you prepare for yours ABIM board examand hopefully these pearls will help you get your other questions right.

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