Hematology & Oncology
Anemia with low MCV
- Iron deficiency- blood loss, pregnancy, dietary deficiency, PUD, HHT
- Malignancy- gastric and colonic carcinoma
- GIT- IBD, diverticulitis
- Malabsorption- celiac disease, IBD
- Thalassaemia- alpha & beta thalassaemia
- Sideroblastic anemia
- Anemia of chronic disease
- Bleeding & hemolysis ( high reticulocyte count)
Anemia with high MCV
- Folate deficiency- dietary deficiency, malabsorption, celiac, surgery, pregnancy, hemolysis, OCP, phenytoin MTX
- B12 deficiency- dietary, gastrectomy, pernicious, SIBO, Crohn’s, fish tapeworm
- Alcohol
- Hypothyroid
- Myelodysplasia
- Hypercholesterolemia
- Bleeding and hemolysis
Lymphadenopathy
- Infective- bacterial, viral, protozoal, fungal
- Neoplastic- primary- lymphoma, leukemia; secondary- lung, breast, thyroid, stomach, melanoma
- CTD- RA, SLE
- Sarcoidosis, amyloidosis, AOSD, Phenytoin
Splenomegaly
- Hematological- megaloblastic anemia, hemoglobinopathies (thalassemia), hereditary spherocytosis; AIHA; MPD- CML, MF, PRV, ET; Leukaemia, lymphoma
- Congestive- Liver- CLD with portal HTN, portal vein thrombosis, hepatic vein occlusion; cardiac-chronic CCF, constrictive pericarditis
- Infective- TB, salmonella, brucella, infective endocarditis, viral- hepatitis, CMV, EBV; malaria, kala-azar, histoplasmosis, trypanosomiasis, melioidosis
- Inflammatory- felty’s in RA, sarcoidosis, SLE
- Others- metastatic cancer, lysosomal storage disease- Gaucher’s, Niemann-pick; splenic cyst, amyloid, thyrotoxicosis
Thrombocytopenia
- Decreased production
Marrow hypoplasia- congenital- fanconi’s anemia, aplastic anemia, drugs- cytotoxics,
antimetabolites, transfusion-associated GVHD
Marrow infiltration- leukaemia, myeloma, carcinoma, myelofibrosis, storage disease
B12 or folate deficiency
Familial thrombocytopathies – abnormal platelets, Bernard-soulier, wiskott-aldrich syndrome
- Increased consumption
- Immune- ITP(CTD, SLE, HIV, B cell malignancy, pregnancy, drugs) , post transfusion, drugs-quinine, vancomycin, heparin
- Coagulation activation- DIC
- Mechanical pooling- hypersplenism
- Thrombotic microangiopathies- HUS, TTP, liver disease, pre-eclampsia
- Others- gestationa, type2b VWD
Venous thrombosis
- Patient factors- age, immobility, obesity, varicose vein, previous DVT, positive family history, pregnancy, puerperium, OCP, long-distance travel >4hrs, IVDU
- Surgical conditions- major surgery, abdominal or pelvic surgery, lower limb orthopedic surgery
- Medical conditions- ( head to toe) – stroke, GBS, paraplegia, MI, heart failure, pneumonia, COPD, IBD, nephrotic syndrome, malignancy in tummy or pelvis
- Hematological conditions- PNH, PRV, essential thrombocythaemia, protein C protein S deficiency, factor V leiden mutation, myelofibrosis
- APS
Oncological consideration in etiology
- Weight loss- occult malignancy ( GIT, Lung)
- Back pain- metastasis to vertebra from primary ( PUBLIK-T) ( prostate, urinary bladder, bronchus, breast, liver, intestine, kidney, thyroid)? multiple myeloma
- Dyspnea- superior vena cava obstruction due to malignancy? lymphoma, SCLC
- Spinal cord compression- paraplegia with urine retention
- Hypercalcemia- metastasis, multiple myeloma
- Fever- neutropenic fever
- Acute renal impairment- tumor lysis syndrome
Aplastic anemia
- Primary idiopathic aplastic anemia
- Secondary-
- Viral hepatitis
- Pregnancy
- Radiation therapy
- Paroxysmal nocturnal hemoglobinuria
- Chemicals- benzene, toluene solvent, insecticides, DDT, OPC, carbamates
- Drugs- cytotoxic drugs, antibiotics- chloramphenicol, sulphonamides, indomethacin, gold, penicillamine, phenylbutazone, carbimazole, propylthiouracil, anticonvulsants, phenytoin
- Fanconi’s syndrome
