1. General Hematology Slide Review

2. 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 child’s problem?

3. Iron Deficiency Anemia

4. 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?

5. Folate deficiency Unpasteurized Goat’s Milk

6. 7 yo boy with: – fever x 1 week –Hemoglobin 9g/dl –WBC 1,200 –Plt 32K –Ferritin 6000

7. What’s his diagnosis? Hemophagocytic syndrome

8. 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, Kawasaki’s) Diagnosis: –Fever, splenomegaly –Cytopenias (>2 cell lines) –Elevated ferritin, triglyceride –Hemophagocytosis in marrow, spleen, lymph nodes Prompt diagnosis/treatment essential

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

10. Elliptocytes Hereditary Elliptocytosis

12. 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…

13. What is the cause of this peripheral smear? Glucose 6-Phosphate dehydrogenase (G6PD) deficiency

14. 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

15. Newborn in your practice – healthy, no prenatal complications His newborn screen results comment on a “fast” band seen on hemoglobin separation

16. What’s his diagnosis? Hemoglobin H disease

17. Hemoglobin H Disease Caused by 3-gene deletion  thal Excess  chains Tetramers precipitate forming red cell inclusions High O 2 affinity leading to reduced O 2 carrying capacity

18. 2 yo AAM presents with pain in lower extremities x 2 days Peripheral smear and hemoglobin separation reveal this… What’s the diagnosis?

19. Homozygous sickle cell anemia

20. Same patient presents with h/o fever and marked pallor Hemoglobin 2.5g/dl Retic 0.1% What’s your diagnosis?

21. Aplastic Crisis Parvovirus B19 infection

22. What does this child have?

23. 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 Chédiak-Higashi

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

25. Pseudothrombocytopenia EDTA

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

27. What’s the diagnosis? Immune Thrombocytopenic Purpura