Review - Clinical XXIII (Hematology)

vaudeville, ragtime, musical theater (show-tune)

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V5.5

[Verse 1: The stride piano locks into a bouncy, toe-tapping rhythm. The Showman delivers the lyrics like a fast-talking auctioneer.]
(Showman) M.G.U.S.; marrow clonal plasma cells below 10 percent; M-protein below 3 3 3 3 no end-organ damage!
Waldenström macroglobulinemia; I.g.M. in low-grade non-Hodgkin.
Hyperviscosity, bleeding, anemia.
Plasmapheresis, rituximab and bendamustine!

[Verse 2: The music gets a little dramatic, with minor chords on the piano and a creeping upright bass.]
(Showman) * Localized amyloidosis “hoarseness, proptosis and visual disturbance (orbits).

Systemic amyloidosis “H.F., nephrotic syndrome, malabsorption, hepatic dysfunction, autonomic insufficiency, carpal tunnel syndrome, and peripheral neuropathy.
Treat melphalan, cyclophosphamide, dexamethasone, lenalidomide, bortezomib, and daratumumab!

[Chorus / The Transfusion Tango: A Barbershop Quartet joins in, harmonizing behind the Showman as the beat swings.]
(Showman & Barbershop Quartet) * Transfusion-associated Graft versus Host Disease; fever, rash, diarrhea, hepatitis, L.A.P., pancytopenia. Usually fatal.
In recipients with immune defects, lymphoproliferative disorders!

T.R.A.L.I. “noncardiogenic pulmonary edema after transfusion”.
Cardiogenic edema in Taco! Both within 6 hours.

Posttransfusion purpura, rare, sudden, within a week.
Severe thrombocytopenia and bleeding typical. e- wig treatment!

[Tap Dance & Patter Break: The piano plays a rapid descending scale. A 10-second tap dance solo clatters across the stage. The Showman jumps right back in, speaking even faster!]
(Showman) * Cryoprecipitate in hypofibrinogenemia, D.I.C.
P.C.C. for warfarin overdoses.
F.F.P. for coagulation factor deficiencies, T.T.P., for massive R.B.C. transfusion!

I.V. I.G. for immunodeficiencies and autoimmune “I.T.P., Kawasaki, Myasthenia gravis, Guillian Barré, S.L.E.”!

Plasmapheresis for Guillian Barré, A.N.C.A. R.P.G.N., Goodpasture, Myasthenia gravis, hyperviscosity syndromes, T.T.P.!

[Verse 3: The snare drum plays a marching beat. The Showman lists off the platelet disorders with sharp, comedic timing.]
(Showman) * I.T.P., diagnosis of exclusion.
Prednisone ± I.V.I.G., anti-D (rarely splenectomy). Platelet transfusions if active bleeding!

T.T.P. pentad; microangiopathic hemolytic anemia, thrombocytopenia, fever, kidney disease, and neurologic abnormalities. Pslasma exchange!

H.U.S. have a recent or current diarrheal illness, often bloody.
Stool culture for E coli, stool assays for Shiga toxin!

P.T, a.P.T.T, fibrinogen within the normal range in most T.T.P. or H.U.S.!

H.I.T.; heparin induced heparin thrombocytopenia within 5–14 days.
P.F.4-heparin antibody E.L.I.S.A.
Stop heparin, start direct thrombin inhibitor or fondaparinux!

[Outro / The Grand Finale: The whole imaginary orchestra joins in—piano, brass, and cymbals. The Showman belts out the final primary care goals with absolute Broadway flair.]
(Showman) * Hey one sea goal of below 7 for many nonpregnant adults.
Lower goals for individuals with good health and low treatment risks!

Type 2 diabetes, insulin if symptoms of hyperglycemia are present or above 10 A one sea; above 300 glucose!
(Big finish, ritardando)

Hypertension, goal at least below 130 over 80...
With encouragement to achieve below 120!

[Ending: A classic Vaudeville "Shave and a Haircut, Two Bits" musical sting played by the piano and trumpet. A final, loud crash cymbal. The sound of a theater crowd applauding. Total silence.]

4110/7500

[Intro: 115 BPM. A lively ragtime piano intro starts up. A snare drum snaps on the off-beats. A muted trumpet does a comical wah-wah-wah. The Vaudeville Showman taps his cane on the stage and addresses the audience with huge theatrical energy.] (Showman) * Let's Go!. M and M M and M, Lytic lesions in the axial skeleton, X ray. Lytic Lytic Bone scan is not useful in myeloma, prefer am are am are. and Pet city. Pet city.! gamma or beta globulin spike. High total protein, calcium, proteinuria, E.S.R. Amyloidosis. Spinal cord compression. Infection. Treat; lenalidomide, bortezomib, daratumumab; dexamethasone, S.C.T.! [Verse 1: The stride piano locks into a bouncy, toe-tapping rhythm. The Showman delivers the lyrics like a fast-talking auctioneer.] (Showman) M.G.U.S.; marrow clonal plasma cells below 10 percent; M-protein below 3 3 3 3 no end-organ damage! Waldenström macroglobulinemia; I.g.M. in low-grade non-Hodgkin. Hyperviscosity, bleeding, anemia. Plasmapheresis, rituximab and bendamustine! [Verse 2: The music gets a little dramatic, with minor chords on the piano and a creeping upright bass.] (Showman) * Localized amyloidosis “hoarseness, proptosis and visual disturbance (orbits). Systemic amyloidosis “H.F., nephrotic syndrome, malabsorption, hepatic dysfunction, autonomic insufficiency, carpal tunnel syndrome, and peripheral neuropathy. Treat melphalan, cyclophosphamide, dexamethasone, lenalidomide, bortezomib, and daratumumab! [Chorus / The Transfusion Tango: A Barbershop Quartet joins in, harmonizing behind the Showman as the beat swings.] (Showman & Barbershop Quartet) * Transfusion-associated Graft versus Host Disease; fever, rash, diarrhea, hepatitis, L.A.P., pancytopenia. Usually fatal. In recipients with immune defects, lymphoproliferative disorders! T.R.A.L.I. “noncardiogenic pulmonary edema after transfusion”. Cardiogenic edema in Taco! Both within 6 hours. Posttransfusion purpura, rare, sudden, within a week. Severe thrombocytopenia and bleeding typical. e- wig treatment! [Tap Dance & Patter Break: The piano plays a rapid descending scale. A 10-second tap dance solo clatters across the stage. The Showman jumps right back in, speaking even faster!] (Showman) * Cryoprecipitate in hypofibrinogenemia, D.I.C. P.C.C. for warfarin overdoses. F.F.P. for coagulation factor deficiencies, T.T.P., for massive R.B.C. transfusion! I.V. I.G. for immunodeficiencies and autoimmune “I.T.P., Kawasaki, Myasthenia gravis, Guillian Barré, S.L.E.”! Plasmapheresis for Guillian Barré, A.N.C.A. R.P.G.N., Goodpasture, Myasthenia gravis, hyperviscosity syndromes, T.T.P.! [Verse 3: The snare drum plays a marching beat. The Showman lists off the platelet disorders with sharp, comedic timing.] (Showman) * I.T.P., diagnosis of exclusion. Prednisone ± I.V.I.G., anti-D (rarely splenectomy). Platelet transfusions if active bleeding! T.T.P. pentad; microangiopathic hemolytic anemia, thrombocytopenia, fever, kidney disease, and neurologic abnormalities. Pslasma exchange! H.U.S. have a recent or current diarrheal illness, often bloody. Stool culture for E coli, stool assays for Shiga toxin! P.T, a.P.T.T, fibrinogen within the normal range in most T.T.P. or H.U.S.! H.I.T.; heparin induced heparin thrombocytopenia within 5–14 days. P.F.4-heparin antibody E.L.I.S.A. Stop heparin, start direct thrombin inhibitor or fondaparinux! [Outro / The Grand Finale: The whole imaginary orchestra joins in—piano, brass, and cymbals. The Showman belts out the final primary care goals with absolute Broadway flair.] (Showman) * Hey one sea goal of below 7 for many nonpregnant adults. Lower goals for individuals with good health and low treatment risks! Type 2 diabetes, insulin if symptoms of hyperglycemia are present or above 10 A one sea; above 300 glucose! (Big finish, ritardando) Hypertension, goal at least below 130 over 80... With encouragement to achieve below 120! [Ending: A classic Vaudeville "Shave and a Haircut, Two Bits" musical sting played by the piano and trumpet. A final, loud crash cymbal. The sound of a theater crowd applauding. Total silence.]

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