Polycythemia vera: Clonal proliferation of erythrocytes, leukocytes, and platelets. Elevated erythrocyte mass is the most prominent feature Increased blood viscosity leads to symptoms such as headache, dizziness, pruritus, vertigo, or occlusive vascular lesions (eg, stroke and intermittent claudication)

Platelet and erythrocyte abnormalities may cause symptoms such as gum bleeding, epistaxis, gastrointestinal bleeding, and thromboembolism.

Treatment is mainly by regular phlebotomy to reduce packed cell volume. Early diagnosis and treatment strongly influence prognosis.

Thrombosis and bleeding are frequent in persons with polycythemia vera (PV) and MPD, and the result from the disruption of hemostatic mechanisms because of (1) an increased level of red blood cells and (2) an elevation of the platelet count. There are findings that indicate the additional roles of tissue factor and polymorphonuclear leukocytes (PMLs) in clotting, the platelet surface as a contributor to phospholipid-dependent coagulation reactions, and the entity of microparticles. Tissue factor is also synthesized by blood leukocytes, the level of which is increased in persons with MPD, which can contribute to thrombosis. Rusak et al evaluated the hemostatic balance in patients using thromboelastography and also studied the effect of isovolemic erythrocyte apheresis on patients with polycythemia vera. They concluded that thromboelastography may help to assess the thrombotic risk in patients with polycythemia vera Hyperhomocysteinemia is a risk factor for thrombosis and is also widely prevalent in patients with MPD (35% in controls, 56% in persons with PV). Acquired von Willebrand syndrome is an established cause of bleeding in persons with MPD, accounting for approximately 12-15% of all patients with this syndrome. von Willebrand syndrome is largely related to the absorption of von Willebrand factor onto the platelets; reducing the platelet count should alleviate the bleeding and the syndrome.

Prolonged bleeding time, often associated with Factor VIII deficiency because von Willebrand factor stabilizes Factor VIII in circulation.

Hemophilia A is clotting factor VIII deficiency & Involves Factor VIII deficiency but does not cause prolonged bleeding time.

Anemia is a common sign of colon cancer in elderly

Risk factors: 1) Age. Most people diagnosed with chronic lymphocytic leukemia are over 60 2) Sex. Men are more likely than women to develop chronic lymphocytic leukemia. 3) Race. Whites are more likely to develop chronic lymphocytic leukemia than people of other races. 4) Family history of blood and bone marrow cancers. A family history of chronic lymphocytic leukemia or other blood and bone marrow cancers may increase your risk. 5) Exposure to chemicals. Certain herbicides and insecticides.

Classical Hodgkin's lymphoma can be subclassified into 4 Pathologic subtypes based upon Reed-Sternberg cell morphology and the composition of the reactive cell infiltrate seen in the lymph node biopsy specimen “the cell composition around the Reed-Sternberg cells”.

Hydroxyurea is the standard prophylactic treatment in SCA to reduce the frequency of painful vaso-occlusive crises and acute chest syndrome.

Seminoma is the most common radiosensitive testicular cancer and typically presents as a painless, firm, non-tender swelling in young males.

Normal range in absence of anti coagulant - 0.8-1.2

Penicillin prophylaxis is essential in younger patients (<5 years) to prevent pneumococcal infections but may not be continued in older patients depending on their vaccination status.

Drugs & medications that can induce hemolysis in G6PD deficiency patients include: acetanilide, doxorubicin, Methylene blue, naphthalene, nitrofurantoin, primaquine, pamaquine & sulfa drugs.

Low in IDA

This is a case of hemolytic anemia.

Iron deficiency anemia causes decrease in bone marrow production of RBC so reticulocyte count wouldn’t be high

Sickle cell anemia: In sickle cell trait, usually see HbS concentrations of 35 to 45% of total Hemoglobin because the HbS has a slower rate of synthesis than HbA. If HbS is less than 33%, start thinking about S-alpha-thalassemia. If HbS is greater than 50%, worry about S-Beta-thalassemia or Sickle cell disease with transfusion.

Iron deficiency anemia- Microcytic hypochromic anemia is most commonly associated with iron deficiency anemia, where there is a lack of adequate iron for hemoglobin production. This leads to smaller (microcytic) and paler (hypochromic) red blood cells.

She has Iron deficiency anemia

Autosomal Recessive disorder; Inheriting defect genes from both parents; Thalassemia major, but from one parent; Thalassemia Minor.

By Serum electrophoresis

Serum iron is reflected by TIBC which is an indirect measure of transferrin.

This is a case of Thalassemia.

Patient with malignancy: telling the patient is by the most senior doctor, whether or not to tell the patient is individualized according to the patient's wish and sometimes the family depending upon his mental capacity.

Clincher - Painless neck mass

Factor V and VIII deficiency of the two factors was accompanied by a life-long bleeding tendency in males

After trauma to the knee, the most common underlying cause of significant swelling is hemarthrosis, which refers to the presence of blood within the joint space.

The combination of periorbital swelling, generalized pruritus, lymphadenopathy, hepatosplenomegaly, and an eosinophilic predominance in the blood is highly suggestive of Tropical eosinophilia.

In CML there is chromosomal translocation (Philadelphia) .CML was the first malignancy to be linked with a clear genetic abnormality.

In anemia of chronic disease without iron deficiency, ferritin levels should be normal or high, reflecting the fact that iron is stored within cells, and ferritin is being produced as an acute phase reactant but the cells are not releasing their iron.

In iron deficiency anemia ferritin should be low.

TIBC should be high in genuine iron deficiency, reflecting efforts by the body to produce more transferrin and bind up as much iron as possible;

TIBC should be low or normal in anemia of chronic.

Explanation: Because of its SE it should be discussed thoroughly.

Enoxaparin

Low-molecular-weight heparin is a relatively recent addition to the list of therapies for prophylaxis and treatment of deep venous thrombosis (DVT). As a prophylactic, low-molecular-weight heparin is as effective as standard heparin or warfarin and does not require monitoring of the activated partial thromboplastin time or the International Normalized Ratio.