Some tips to remember concepts in Hematology

Vitamins Needed
Methyl Malonic Acid—–>B12—–>Succinyl CoA
Homocysteine—–>B12
Folate
Pyridoxine
—–>Methionine

From above table, we can understand that Both Methyl Malonic acid and Homocysteine will go up in B12 deficiency.

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Here are some differences to help in the differential diagnosis:

B12 DeficiencyMDS
Smooth & bald tongue, cheilosis, hyperpigmentation
Intramedullary destruction, SACD
Elderly patient with low Blood cells [RBC, WBC and or Platelets]
Oval Macrocytes Oval Macrocytes
MegaloblastsMegakaryocytes
Hypersegmented PMN Hyposegmented PMN
Hypercellular MarrowHypercellular Marrow

Megakaryocytes are also seen Aplastic anemia [Hypocellular marrow], ITP, Essential thrombocytosis, Marrow fibrosis [Dysmorphic megakaryocytes]

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Thrombotic Thrombocytopenic Purpura [TTP]. Tip to remember the Pentad: Neuro Renal FAT

  1. Neurological Symptoms

2. Renal issues

3. Fever

4. Anemia by hemolysis

5. Thrombocytopenia

-Adamts 13 protein deficiency

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Schistocytes =Fragmented RBCs

These are seen in

HUS

HELPP

TTP

DIC

Tip to remember: [Who’s helping that dick?] =HUS HELLP TTP DIC.

HUS->AKI after bloody diarrhea after eating meat with EColi O157:H7, It is atypical HUS if it happens without Diarrhea.

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Vaccines that should be given prior to Splenectomy:

Tip to remember: PIMP hem before Splenectomy

PCV13

Influenza

Meningococcal

Pneumovax 23

Hemophilus Influenza Type B

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Itching after shower is seen in:

Polycythemia vera

NHL

Myelofibrosis

.

Patient feeling better with shower:

Marijuana abuser

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