Review - Clinical XXII (Hematology)

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V5.5

[Verse 1: The bass gets incredibly thick. The M.C. delivers the lines with a rapid, bouncing Latin Rap flow, rolling his R's and emphasizing the syllables.]
(M.C.) * G.6.P.D open up, G.6.P.D. G.6.P.D.!
Heinz bodies, bite cells.
TREAT avoid oxidant medications “dapsone, methylene blue, primaquine, rasburicase, nitrofurantoin, Temp/sulpha, quinolones”.

[Chorus / The Reggaeton Hook: The brass section explodes into a massive, triumphant melody. The beat is irresistible. The M.C. layers his vocals to create a catchy, stadium-sized dance chorus.]
(M.C.) * Sickle cell Sickle Sickle “onset during the first year of life”.
Acute painful “vaso-occlusive” episodes in the spine and long appendicular bones;
last hours to days, may be low-grade fever.
May cause strokes , priapism.
They aren’t associated with increased hemolysis.
Acute chest syndrome “acute chest pain, hypoxemia, and pulmonary infiltrates”.
Gallstones, hepatomegaly, splenomegaly.
Retinopathy or pulmonary hypertension may develop!

[Verse 2: The beat strips back to just the heavy Dembow percussion and a single acoustic guitar chord. The M.C. raps at double speed.]
(M.C.) Renal papillae infarction “hyposthenuria and hematuria” more often trait than disease
TREAT folic acid supplementation and transfusions for aplastic  or hemolytic crises.
Painful episodes with hydration, analgesics, oxygen if hypoxic, and V.T.E. prophylaxis if hospitalized.
Hydroxyureaand L-glutamine .
Exchange transfusions for severe vaso-occlusive crises, acute chest syndrome, prolonged priapism, and stroke!

[Bridge / The Breakdown: The kick drum switches to a four-on-the-floor house beat. The M.C. delivers these facts with a cool, laid-back swagger.]
(M.C.) * Direct Coombs testing for autoimmune hemolytic anemias.
Indirect test for blood crossmatching .
Direct Coombs positive for complement only in cold agglutinin disease.

Neutropenia A.N.C. below 1800, risk of serious infection rises if below 500

Felty syndrome “immune neutropenia with rheumatoid arthritis and splenomegaly.”

[Verse 3: The Dembow beat comes crashing back in, accompanied by loud brass stabs. The flow is incredibly tight.]
(M.C.) * Polycythemia vera “rarely before 40”
Headache, dizziness, tinnitus, blurred vision, fatigue.
Pruritus after warm shower, epistaxis. Bleeding, P.U.D.
Hct above 49 in males 48 in females.
Elevated B.12 and hyperuricemia.
Treat with phlebotomy, aspirin (allopurinol, diphenhydramine, S.S.R.I.)

Essential thrombocytosis; mostly over 60, venous thromboses, erythromelalgia.
Philadelphia chromosome favors C.M.L. Treat with hydroxyurea and aspirin!

[Verse 4 / Rapid Fire: The M.C. catches a fierce pocket, snapping every word precisely on the snare.]
(M.C.) * Primary myelofibrosis; after 50; J.A.K.2, C.A.L.R., M.P.L. genes;
marrow fibrosis “dry tap”; anemia; profound splenomegaly; teardrop poikilocytosis. Supportive therapy, S.C.T.

C.M.L. “middle age”; fatigue, night sweats, and low-grade fevers related to the hypermetabolism.
Median W.B.C. around 150,000, left shift.
Definitive diagnosis by bcr/abl.
Treat with T.K. inhibitor “imatinib, nilotinib, dasatinib”!

[Outro / Fade Out Dance: The brass plays a final, repeating melodic loop. The M.C. shouts out the final diagnoses over the fading beat.]
(M.C.) * Myelodysplastic syndrome; cytopenias with a hypercellular marrow. Pelger-Huët neutrophils!

C.L.L. “usually indolent”, lymphocytosis, immunosuppression, bone marrow failure. Richter syndrome!

Hodgkin; “bimodal distribution; 20s and after 50”.
B symptoms, tendency to arise within single lymph node areas and orderly spread!
(Echoing) ...orderly spread!

[Ending: A signature reggaeton beat drop—the sub-bass slides all the way down, the brass hits one final triumphant note, and a splash cymbal rings out. Total silence.]

4223/7500

[Intro: 95 BPM. A bright, acoustic Spanish guitar plays a catchy melodic riff. The brass section hits a dramatic chord, and the heavy Dembow beat drops in with reggaeton air-horns. The Latin M.C. hypes up the track with a rhythmic chant.] (M.C.) * P.N.H.; with or without pancytopenia, C.D.55 and C.D.59 deficient. If severe, eculizumab, stem cell transplantation. P.N.H C.D.55 and C.D.59 deficient! C.D.55 and C.D.59 deficient! [Verse 1: The bass gets incredibly thick. The M.C. delivers the lines with a rapid, bouncing Latin Rap flow, rolling his R's and emphasizing the syllables.] (M.C.) * G.6.P.D open up, G.6.P.D. G.6.P.D.! Heinz bodies, bite cells. TREAT avoid oxidant medications “dapsone, methylene blue, primaquine, rasburicase, nitrofurantoin, Temp/sulpha, quinolones”. [Chorus / The Reggaeton Hook: The brass section explodes into a massive, triumphant melody. The beat is irresistible. The M.C. layers his vocals to create a catchy, stadium-sized dance chorus.] (M.C.) * Sickle cell Sickle Sickle “onset during the first year of life”. Acute painful “vaso-occlusive” episodes in the spine and long appendicular bones; last hours to days, may be low-grade fever. May cause strokes , priapism. They aren’t associated with increased hemolysis. Acute chest syndrome “acute chest pain, hypoxemia, and pulmonary infiltrates”. Gallstones, hepatomegaly, splenomegaly. Retinopathy or pulmonary hypertension may develop! [Verse 2: The beat strips back to just the heavy Dembow percussion and a single acoustic guitar chord. The M.C. raps at double speed.] (M.C.) Renal papillae infarction “hyposthenuria and hematuria” more often trait than disease TREAT folic acid supplementation and transfusions for aplastic or hemolytic crises. Painful episodes with hydration, analgesics, oxygen if hypoxic, and V.T.E. prophylaxis if hospitalized. Hydroxyureaand L-glutamine . Exchange transfusions for severe vaso-occlusive crises, acute chest syndrome, prolonged priapism, and stroke! [Bridge / The Breakdown: The kick drum switches to a four-on-the-floor house beat. The M.C. delivers these facts with a cool, laid-back swagger.] (M.C.) * Direct Coombs testing for autoimmune hemolytic anemias. Indirect test for blood crossmatching . Direct Coombs positive for complement only in cold agglutinin disease. Neutropenia A.N.C. below 1800, risk of serious infection rises if below 500 Felty syndrome “immune neutropenia with rheumatoid arthritis and splenomegaly.” [Verse 3: The Dembow beat comes crashing back in, accompanied by loud brass stabs. The flow is incredibly tight.] (M.C.) * Polycythemia vera “rarely before 40” Headache, dizziness, tinnitus, blurred vision, fatigue. Pruritus after warm shower, epistaxis. Bleeding, P.U.D. Hct above 49 in males 48 in females. Elevated B.12 and hyperuricemia. Treat with phlebotomy, aspirin (allopurinol, diphenhydramine, S.S.R.I.) Essential thrombocytosis; mostly over 60, venous thromboses, erythromelalgia. Philadelphia chromosome favors C.M.L. Treat with hydroxyurea and aspirin! [Verse 4 / Rapid Fire: The M.C. catches a fierce pocket, snapping every word precisely on the snare.] (M.C.) * Primary myelofibrosis; after 50; J.A.K.2, C.A.L.R., M.P.L. genes; marrow fibrosis “dry tap”; anemia; profound splenomegaly; teardrop poikilocytosis. Supportive therapy, S.C.T. C.M.L. “middle age”; fatigue, night sweats, and low-grade fevers related to the hypermetabolism. Median W.B.C. around 150,000, left shift. Definitive diagnosis by bcr/abl. Treat with T.K. inhibitor “imatinib, nilotinib, dasatinib”! [Outro / Fade Out Dance: The brass plays a final, repeating melodic loop. The M.C. shouts out the final diagnoses over the fading beat.] (M.C.) * Myelodysplastic syndrome; cytopenias with a hypercellular marrow. Pelger-Huët neutrophils! C.L.L. “usually indolent”, lymphocytosis, immunosuppression, bone marrow failure. Richter syndrome! Hodgkin; “bimodal distribution; 20s and after 50”. B symptoms, tendency to arise within single lymph node areas and orderly spread! (Echoing) ...orderly spread! [Ending: A signature reggaeton beat drop—the sub-bass slides all the way down, the brass hits one final triumphant note, and a splash cymbal rings out. Total silence.]

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