最新Abnormal CBCs - Yale University：异常CBCS -耶鲁大学教学讲义PPT课件.ppt

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1、进入夏天，少不了一个热字当头，电扇空调陆续登场，每逢此时，总会想起那一把蒲扇。蒲扇，是记忆中的农村，夏季经常用的一件物品。　　记忆中的故乡，每逢进入夏天，集市上最常见的便是蒲扇、凉席，不论男女老少，个个手持一把，忽闪忽闪个不停，嘴里叨叨着“怎么这么热”，于是三五成群，聚在大树下，或站着，或随即坐在石头上，手持那把扇子，边唠嗑边乘凉。孩子们却在周围跑跑跳跳，热得满头大汗，不时听到“强子，别跑了，快来我给你扇扇”。孩子们才不听这一套，跑个没完，直到累气喘吁吁，这才一跑一踮地围过了，这时母亲总是，好似生气的

2、样子，边扇边训，“你看热的，跑什么？”此时这把蒲扇，是那么凉快，那么的温馨幸福，有母亲的味道！　　蒲扇是中国传统工艺品，在我国已有三千年多年的历史。取材于棕榈树，制作简单，方便携带，且蒲扇的表面光滑，因而，古人常会在上面作画。古有棕扇、葵扇、蒲扇、蕉扇诸名，实即今日的蒲扇，江浙称之为芭蕉扇。六七十年代，人们最常用的就是这种，似圆非圆，轻巧又便宜的蒲扇。　　蒲扇流传至今，我的记忆中，它跨越了半个世纪，也走过了我们的半个人生的轨迹，携带着特有的念想，一年年，一天天，流向长长的时间隧道，袅AbnormalC

3、BCs-YaleUniversity：异常CBCS-耶鲁大学LEARNINGOBJECTIVESIdentifycommonabnormalitiesofcompletebloodcountsandinterpretthemusingtheavailableindicesFormulateacompletedifferentialdiagnosisforanemiaandthrombocytopeniaRecognizewhenadditionalstudiesmightbeneededtofurth

4、erclarifythediagnosiswhentheCBCisabnormalCASE1Youhavejustadmitteda2year-oldboywithahistoryofintermittentbloodstreakedstools.Onexamhehaspallor,tachycardia,anda2/6systolicejectionmurmurattheupperleftsternalborder.Hishemoglobinis3.1g/dL.Whatadditionalhisto

5、ricalinformationwouldyouwanttoknow?Whatelsewouldyouliketoknowabouthisinitialassessment?Howwillthisinformationchangemanagement?Whatotherlabvalueswouldyoulikeandwhatadditionaltestingwouldyouconsider?PERIPHERALBLOODSMEARRef:9,10NormalRBCsMicrocytic,Hypochr

6、omicMacrocyticMegaloblasticAnemiawithHypersegmentedNeutrophilsHOWDOESTHERETICULOCYTECOUNTHELPYOU?Calculatethe“correctedreticulocytecount”orReticulocyteIndex(RI)(MeasuredHct/ExpectedHct)*Retic%/MaturationFactorMaturationFactorsvarywithHctRIshouldbe>2,ind

7、icatingadequateresponseForourpatient,RI=(12.8/36)*0.9=0.32/2.5=0.13InappropriatelylowresponseinthefaceofanemiaHct>36%135-26%1.525-16%2<15%2.5WHATTYPEOFANEMIADOESYOURPATIENTHAVEANDWHATISYOURDIAGNOSIS?Microcytic,hypochromicanemiaInappropriatelylowreticulo

8、cytecountProbablyduetoamixofbloodlossanddietaryrelatedirondeficiencyanemia(IDA)WHATOTHERTESTINGWOULDYOUCONSIDERFORTHISPATIENT?TestChangeinIDANotesFerritinLowAccurateindicatorofironstoresCanbefalselyelevatedifinflammationpresentTo