General Hematology Slide Review

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General Hematology Slide Review
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• 15 month old with pallor and hemoglobin 2.5g/dl,
  MCV 62fl and retic 4
• Drinks 48 oz of whole milk/day
• What is this childs problem?

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Iron Deficiency Anemia
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• Family lives on a farm and brings in their 2yo
  for you to examine
• Child is pale and an HPD reveals a hemoglobin
  4g/dl, MCV 102fl
• You diagnose a macrocytic anemia secondary to
  what?

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Folate deficiency

• Unpasteurized Goats Milk

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• 7 yo boy with
• fever x 1 week
• Hemoglobin 9g/dl
• WBC 1,200
• Plt 32K
• Ferritin 6000

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Whats his diagnosis?

• Hemophagocytic syndrome

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Hemophagocytic Syndrome

• Non-malignant disorder of antigen-presenting
  macrophages
• Caused by
• Uncontrolled hemophagocytosis
• Defective NK cell function
• Cytokine upregulation
• Familial and sporadic forms

• Appears in association with
• Bacterial, parasitic or viral (EBV) infections
• Malignancy
• Drugs
• Connective tissue disorders (SLE, Kawasakis)
• Diagnosis
• Fever, splenomegaly
• Cytopenias (2 cell lines)
• Elevated ferritin, triglyceride
• Hemophagocytosis in marrow, spleen, lymph nodes
• Prompt diagnosis/treatment essential

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What is this?

• 14 month old African-American child presents with
  mild anemia HPD obtained and when reviewed
  showed these cells.
• What are they?

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• Elliptocytes
• Hereditary Elliptocytosis

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• 5 yo African-American boy recently presented with
  fever. Prescribed Bactrim for presumed otitis
  media. Brought back in by mom due to increased
  fatigue and this peripheral smear

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What is the cause of this peripheral smear?

• Glucose 6-Phosphate dehydrogenase (G6PD)
  deficiency

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G6PD Deficiency

• Jaundice in first 24 hours of life (pathologic
  jaundice)
• G6PD gene located on X chromosome females can
  be affected
• Common in certain ethnic groups

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• Newborn in your practice healthy, no prenatal
  complications
• His newborn screen results comment on a fast
  band seen on hemoglobin separation

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Whats his diagnosis?

• Hemoglobin H disease

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Hemoglobin H Disease

• Caused by 3-gene deletion a thal
• Excess b chains
• Tetramers precipitate forming red cell inclusions
• High O2 affinity leading to reduced O2 carrying
  capacity

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• 2 yo AAM presents with pain in lower extremities
  x 2 days
• Peripheral smear and hemoglobin separation reveal
  this
• Whats the diagnosis?

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Homozygous sickle cell anemia
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• Same patient presents with h/o fever and marked
  pallor
• Hemoglobin 2.5g/dl
• Retic 0.1
• Whats your diagnosis?

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Aplastic Crisis

• Parvovirus B19 infection

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What does this child have?
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Chédiak-Higashi

• Autosomal recessive
• Absence of pigment in eyes, skin and hair
• Giant granules in leukocytes
• Increased susceptibility to infections
• Defective movement
• Decreased granulation
• Decreased microbicidal activity

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• Frantic doctor refers a child to your practice
  with a platelet count of 20K.
• Child has no bleeding problems and is completely
  healthy.
• Whats your diagnosis?

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Pseudothrombocytopenia

• EDTA

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• Another child presents with epistaxis, wet
  purpura in mouth and bruises/petechiae over trunk
  and extremities
• Platelet count 2K with remainder of counts normal

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Whats the diagnosis?

• Immune Thrombocytopenic Purpura