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Hematology

The study and treatment of blood disorders and malignancies.

โœ“ Introduction to Hematology

โœ“ Introduction to Hematology is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ Red Blood Cell Disorders Basics

โœ“ Red Blood Cell Disorders Basics is an essential biology topic covering living systems, from cellular processes to ecosystems.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ White Blood Cell Disorders Basics

โœ“ White Blood Cell Disorders Basics is an essential biology topic covering living systems, from cellular processes to ecosystems.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ Platelet Disorders Basics

โœ“ Platelet Disorders Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ Coagulation Disorders Basics

โœ“ Coagulation Disorders Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ Anemia Basics

โœ“ Anemia Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ Leukemia Basics

โœ“ Leukemia Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ Lymphoma Basics

โœ“ Lymphoma Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ Myeloma Basics

โœ“ Myeloma Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ Thrombosis Basics

โœ“ Thrombosis Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ Sickle Cell Disease Basics

โœ“ Sickle Cell Disease Basics is an essential biology topic covering living systems, from cellular processes to ecosystems.

Key points: Structure and function, clinical presentation, diagnostic criteria, and evidence-based management.

โœ“ Bleeding Disorders Basics

โœ“ Bleeding Disorders Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ Transfusion Medicine Basics

โœ“ Transfusion Medicine Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ Hematology Ethics Basics

โœ“ Hematology Ethics Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ Hematology Careers

โœ“ Hematology Careers is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ Advanced Hematology

โœ“ Advanced Hematology is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ Red Blood Cell Disorders

โœ“ Red Blood Cell Disorders is an essential biology topic covering living systems, from cellular processes to ecosystems.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ White Blood Cell Disorders

โœ“ White Blood Cell Disorders is an essential biology topic covering living systems, from cellular processes to ecosystems.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ Platelet Disorders

โœ“ Platelet Disorders is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ Coagulation Disorders

โœ“ Coagulation Disorders is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ Anemia

โœ“ Anemia is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ Leukemia

โœ“ Leukemia is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ Lymphoma

โœ“ Lymphoma is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ Myeloma

โœ“ Myeloma is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ Thrombosis

โœ“ Thrombosis is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ Sickle Cell Disease

โœ“ Sickle Cell Disease is an essential biology topic covering living systems, from cellular processes to ecosystems.

Key points: Structure and function, clinical presentation, diagnostic criteria, and evidence-based management.

โœ“ Bleeding Disorders

โœ“ Bleeding Disorders is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ Transfusion Medicine

โœ“ Transfusion Medicine is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ Hematology Ethics

โœ“ Hematology Ethics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

โœ“ Hematology Research

โœ“ Hematology Research is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Time complexity (Big-O), space complexity, correctness proof, and practical implementation trade-offs.

Key Clinical Formulas & Scores

ISTH DIC Score (Disseminated Intravascular Coagulation):
Platelet count: >100,000=0, <100,000=1, <50,000=2
Fibrinogen: >100 mg/dL=0, <100 mg/dL=1
PT prolongation: <3 sec=0, 3-6 sec=1, >6 sec=2
D-dimer: No increase=0, Moderate increase=2, Strong increase=3
Score โ‰ฅ5 = overt DIC (repeat daily)
Score <5 = non-overt DIC (repeat in 1-2 days)
4T Score for HIT (Heparin-Induced Thrombocytopenia):
Thrombocytopenia: >50% fall & nadir โ‰ฅ20=2, 30-50% fall or nadir 10-19=1, <30% or nadir <10=0
Timing: Day 5-10 or โ‰ค1 day if recent heparin=2, consistent but unclear=1, <4 days without recent=0
Thrombosis: Proven thrombosis=2, progressive/recurrent=1, none=0
Other causes: None=2, Possible=1, Definite=0
Score 0-3=low, 4-5=intermediate, 6-8=high probability
Revised International Prognostic Scoring System (IPSS-R) โ€” MDS:
Cytogenetics: Very good=0, Good=1, Intermediate=2, Poor=3, Very poor=4
Blasts %: โ‰ค2%=0, <5%=1, 5-10%=2, >10%=3
Hemoglobin: โ‰ฅ10=0, 8-10=1, <8=1.5
Platelets: โ‰ฅ100=0, 50-100=0.5, <50=0.5
ANC: โ‰ฅ0.8=0, <0.8=0.5
Risk: Very low โ‰ค1.5, Low โ‰ค3, Intermediate โ‰ค3.5, High โ‰ค4.5, Very high >4.5
R-IPSS (IPSS for CLL):
Del(17p) or TP53 mutation: 4 points
IGHV unmutated: 2 points
ฮฒ2-microglobulin >3.5 mg/L: 2 points
Del(11q): 1 point
Age >65: 1 point
Score: 0-1 low, 2-3 intermediate, 4-10 high risk
Rai staging: 0=lymphocytosis, I=lymphadenopathy, II=splenomegaly, III=anemia, IV=thrombocytopenia
Sickle Cell Disease โ€” Acute Chest Syndrome Criteria:
New pulmonary infiltrate on CXR (segmental or greater) + โ‰ฅ1 of:
โ€ข Fever >38.5ยฐC
โ€ข Hypoxia (PaOโ‚‚ <70 mmHg or SpOโ‚‚ drop >3%)
โ€ข Tachypnea
โ€ข Chest pain
โ€ข Cough or wheezing
Most common cause of death in SCD adults
Pathogenesis: vaso-occlusion, infection, fat embolism from bone marrow necrosis

Core Concepts

Anemia Classification

Microcytic (MCV <80): iron deficiency (most common), thalassemia, anemia of chronic disease, sideroblastic. Normocytic (MCV 80-100): acute blood loss, hemolysis, bone marrow failure, CKD, anemia of chronic disease. Macrocytic (MCV >100): B12/folate deficiency, alcohol, liver disease, MDS, medications (methotrexate, AZT), hypothyroidism, reticulocytosis. Workup: reticulocyte count (corrected), ferritin, TIBC, transferrin saturation, B12, folate, hemoglobin electrophoresis, bone marrow biopsy if needed.

Hemostasis & Coagulation

Primary hemostasis: platelet adhesion (vWF), activation (TXAโ‚‚, ADP), aggregation (fibrinogen-GPIIb/IIIa). Secondary hemostasis: extrinsic (TF-VIIa), intrinsic (XII-XI-IX-VIII), common (X-V-II-I). Coagulation tests: PT (extrinsic + common, monitor warfarin/INR), aPTT (intrinsic + common, monitor heparin), TT (fibrinogen โ†’ fibrin), fibrinogen, D-dimer. Von Willebrand disease: most common inherited bleeding disorder. Type 1 (partial quantitative deficiency, most common), Type 2 (qualitative defects), Type 3 (complete deficiency). Treatment: desmopressin (DDAVP) for Type 1, vWF concentrate, antifibrinolytics (tranexamic acid).

Lymphoma Classification (WHO)

Hodgkin Lymphoma: Reed-Sternberg cells (CD15+, CD30+), subtypes: nodular sclerosis (most common), mixed cellularity, lymphocyte-rich, lymphocyte-depleted. Non-Hodgkin: B-cell (DLBCL most common, follicular, Burkitt, MCL, marginal zone) vs T-cell. Staging (Ann Arbor): I=single node region, II=2+ regions same side diaphragm, III=both sides diaphragm, IV=disseminated extranodal. B symptoms: fever >38ยฐC, drenching night sweats, weight loss >10% in 6 months. Treatment: ABVD (HL), R-CHOP (DLBCL), bendamustine + rituximab (indolent).

Clinical Case Studies

Case 1: Iron Deficiency Anemia

Patient: 45-year-old female, fatigue, dyspnea on exertion ร— 3 months. Heavy menstrual bleeding ร— 2 years. Exam: pallor, koilonychia (spoon nails), angular cheilitis. Labs: Hgb 8.2, MCV 68 fL, ferritin 8 ng/mL (low), TIBC 480 (high), transferrin saturation 8%, RDW elevated.

Diagnosis: Iron deficiency anemia (microcytic, hypochromic).

Management: (1) Oral iron replacement: ferrous sulfate 325 mg (65 mg elemental iron) daily or every other day (better absorption). Take with vitamin C, avoid tea/coffee/calcium. Continue until ferritin >50 and Hgb normalized + 3 months to replenish stores. (2) Identify source: colonoscopy (rule out colorectal cancer in age >40), gynecologic evaluation for menorrhagia. (3) Parenteral iron (IV ferric carboxymaltose) if malabsorption, intolerance, or severe deficiency.

Case 2: Deep Vein Thrombosis & Anticoagulation

Patient: 58-year-old male, unilateral left leg swelling, pain, erythema ร— 3 days. PMH: obesity (BMI 38), recent knee surgery 2 weeks ago. D-dimer elevated. Duplex US: DVT in left common femoral vein.

Diagnosis: Provoked DVT (surgery + immobility).

Management: (1) Anticoagulation for 3-6 months: rivaroxaban 15 mg BID ร— 21 days then 20 mg daily, or apixaban 10 mg BID ร— 7 days then 5 mg BID. (2) Compression stockings to reduce post-thrombotic syndrome. (3) Ambulation as tolerated (not bed rest). (4) Thrombophilia testing NOT recommended for provoked DVT (does not change management). (5) IVC filter only if anticoagulation absolutely contraindicated. Discharge when stable on DOAC.

Case 3: Acute Myeloid Leukemia

Patient: 62-year-old male, fatigue, recurrent infections, easy bruising ร— 6 weeks. CBC: WBC 45,000, Hgb 8.5, platelets 35,000. Peripheral smear: myeloblasts with Auer rods. Bone marrow biopsy: 45% blasts. Flow cytometry: CD13+, CD33+, MPO+. Cytogenetics: t(8;21) โ€” favorable risk.

Diagnosis: Acute myeloid leukemia (AML) with favorable cytogenetics.

Management: Induction: 7+3 regimen (cytarabine 100-200 mg/mยฒ continuous infusion days 1-7 + daunorubicin 60 mg/mยฒ days 1-3). Goal: complete remission (blasts <5%). Consolidation: high-dose cytarabide (HiDAC) ร— 3-4 cycles for favorable risk. Allogeneic stem cell transplant if intermediate/high risk or relapse. Supportive: transfusions, tumor lysis prophylaxis (rasburicase/allopurinol), antifungal prophylaxis (posaconazole), PJP prophylaxis (TMP-SMX). Prognosis: t(8;21) has ~60-70% long-term survival with chemo.

Practice Questions

Q1: A patient on day 7 of heparin has platelet drop from 250 to 80, new DVT, and 4T score of 6. What is the next step?
A: Intermediate probability HIT (4T 4-5=intermediate, 6-8=high). Stop all heparin immediately (including flushes and catheters). Start non-heparin anticoagulation: argatroban IV or fondaparinux. Do NOT use warfarin until platelets recovered (>150). Do NOT give platelets. Send anti-PF4/heparin antibodies and serotonin release assay.
Q2: What is the first-line treatment for a newly diagnosed DLBCL?
A: R-CHOP: rituximab 375 mg/mยฒ + cyclophosphamide 750 mg/mยฒ + doxorubicin 50 mg/mยฒ + vincristine 1.4 mg/mยฒ (max 2 mg) + prednisone 100 mg days 1-5, repeated every 21 days ร— 6-8 cycles. Addition of rituximab improved OS from ~50% to ~70%.
Q3: A patient has Hgb 9.5, MCV 72, ferritin 350, TIBC 200 (low), transferrin saturation 15%. What type of anemia?
A: Anemia of chronic disease (ACD): normal/high ferritin (acute phase reactant), low TIBC, normal/high iron stores but impaired iron utilization. May coexist with iron deficiency (ferritin <100 suggests combined). Treat underlying condition.
Q4: What is the mechanism of action of direct oral anticoagulants (DOACs)?
A: Direct factor Xa inhibitors (rivaroxaban, apixaban, edoxaban) directly inhibit factor Xa. Dabigatran directly inhibits thrombin (factor IIa). Advantages: no monitoring, fixed dosing, fewer drug interactions than warfarin. Reversal: andexanet alfa for Xa inhibitors, idarucizumab for dabigatran.
Q5: A sickle cell patient presents with fever 39.5ยฐC, cough, chest pain, and new infiltrate on CXR. What is the diagnosis?
A: Acute chest syndrome (ACS). Most common cause of death in adults with SCD. Treatment: IV antibiotics (cefuroxime + azithromycin for atypical coverage), oxygen, IV fluids (avoid overhydration), simple transfusion or exchange transfusion if severe/hypoxic, incentive spirometry, pain management. Hydroxyurea for prevention.

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