NRE Step 1: Hematology Made Simple – Pass with Precision

Anemia (Low Red Blood Cells)

• What it is: When your blood doesn’t have enough red blood cells, which makes you look pale.
• Sizes of Red Blood Cells:
  • Microcytic Anemia: Red blood cells are too small (less than 80fL).
  • Normocytic Anemia: Red blood cells are normal size (80-100fL).
  • Macrocytic Anemia: Red blood cells are too big (more than 100fL).
• Causes of Microcytic Anemia:
  • Iron Deficiency Anemia: Not enough iron.
    • Signs: Pale, short of breath, tired, spoon-shaped nails in adults.
    • Labs: Low iron, low ferritin, high TIBC.
    • PICA: Craving non-food items (like dirt or ice).
    • Plummer Vinson Syndrome: Trouble swallowing because of a web in the food pipe, plus iron deficiency and anemia.
  • Anemia of Chronic Disease: Anemia from long-term sickness.
  • Sideroblastic Anemia: Body can’t use iron correctly.
    • Clue: If a person has anemia and is an alcoholic, takes isoniazid, or has lead poisoning, and their iron levels are normal or high.
  • Thalassemia: Problem with making hemoglobin (part of red blood cells).
    • Alpha Thalassemia: Problems with genes on chromosome 16.
      • If 4 genes are missing, it’s called Hb Bart and babies don’t live.
      • If 3 genes are missing, it’s called Hb H and causes anemia.
      • If 1 or 2 genes are missing, it’s mild.
    • Beta Thalassemia: Problems with genes on chromosome 11.
      • If 2 genes are affected, it’s thalassemia major (more serious).
      • Can get too much iron from blood transfusions.
      • Kids can have severe anemia, poor appetite, pale skin, and a bulging forehead.

Other Anemias

• G6PD Deficiency:
  • Can be triggered by certain infections, fava beans, or medicines like primaquine.
  • Red blood cells change shape and get destroyed easily by the spleen, leading to anemia, yellow skin (jaundice), short breath, and tiredness.
• Sickle Cell Anemia:
  • Inherited.
  • Red blood cells are shaped like sickles.
  • Can cause pain in hands and feet, kidney problems, chest pain.
  • Spleen may stop working.
• Parvovirus B19: Can cause a sudden drop in red blood cell making.
• PNH (Paroxysmal Nocturnal Hemoglobinuria):
  • Anemia where red blood cells break down.
  • Red urine in the early morning.
  • Treated with Eculizumab.

Megaloblastic Anemia

• What it is: A type of macrocytic anemia.
• Causes: Not enough Vitamin B12 or Folic Acid.
  • Vitamin B12 is absorbed in the ileum.
  • Folic acid is absorbed in the jejunum.

Aplastic Anemia

• Bone marrow doesn’t make enough blood cells (pale, infections, bleeding).
• Treatment: Bone marrow transplant.

Leukemia (Blood Cancer)

• Cancer of the bone marrow.
• Too many young (blast) or mature white blood cells.
• Types by Age:
  • ALL (Acute Lymphoblastic Leukemia): Common in children (0-20 years).
    • Signs: Poor appetite, pale, short of breath, weight loss.
    • Bone marrow biopsy shows over 20% blast cells.
  • AML (Acute Myeloid Leukemia): Common in adults (21-50 years).
    • Bone marrow biopsy shows over 20% blast cells.
    • Some types have Auer rods (needle-like shapes in cells).
  • CML (Chronic Myeloid Leukemia): Common in adults (51-60 years).
    • Signs: Anemia, poor appetite, tired, short of breath, weight loss, enlarged spleen.
    • Has a special gene change called Philadelphia chromosome (9:22).
    • Treated with Imatinib.
  • CLL (Chronic Lymphocytic Leukemia): Common in older adults (over 60 years).
    • Smudge cells seen in blood.

Multiple Myeloma

• Cancer of plasma cells.
• Can cause: high calcium, kidney problems, anemia, bone pain.
• Special proteins called Bence Jones protein in urine.

Lymphoma (Cancer of Lymphatic System)

• Hodgkin Lymphoma: Often starts in one area and spreads.
  • Most common type: Nodular sclerosis.
• Non-Hodgkin Lymphoma: Can be more spread out.
  • Examples: Follicular lymphoma, Mantle cell lymphoma, Burkitt lymphoma.
  • Burkitt lymphoma is linked to EBV virus and a specific gene change (8:14).

Bleeding Problems

• Thrombocytopenia: Not enough platelets (cells that help blood clot).
  • Can cause easy bleeding.
  • Immune Thrombocytopenia (ITP): Body attacks its own platelets.
    • Can happen after vaccination or infection.
    • Treated with IVIG, steroids, or spleen removal.
• Thrombotic Thrombocytopenic Purpura (TTP):
  • Fever, kidney failure, nerve problems, anemia, low platelets.
  • Treated with plasma exchange.
• Von Willebrand Disease: Problem with a protein (VWF) that helps platelets stick and blood clot.
• Hemophilia: Genetic bleeding disorder where blood doesn’t clot well.
  • Hemophilia A: Most common (85%), problem with Factor VIII.
  • Hemophilia B: Problem with Factor IX.
  • Hemophilia C: Problem with Factor XI.