Sandbox:Sogand

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Abnormal hematosis

Mycosis fungoides

Stage IA-IIA

Stage IIA

Stage III

Stage IV

Differentiating [disease name] from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]

On the basis [symptom 1], [symptom 2], and [symptom 3], [disease name] must be differentiated from disseminated intravascular coagulation (DIC) , thrombotic thrombocytopenic purpura (TTP),systemic vasculitis , [disease 4], [disease 5], and [disease 6].

Abnormal hematosis

•Patient history-sign & symptom: Deep soft tissue bleeding Muscocutaneus bleeding •Screen test CBBC-plt-PT&PTT-BT-TT

Hx of deep soft tissue bleeding

Hx of moscucotaneus bleeding

Coagulopathy

Plt disorder

Family history

Normal plt count

Low plt count

Diseases	Clinical manifestations							Para-clinical findings																		Gold standard	Additional findings
	Symptoms			Physical examination
								Lab Findings													Occur				Histopathology
	Diarrhea	Abdominal pain	decrease urin	Physical exam 1	Physical exam 2	fd	CBC	PC	PT	PTT	FDP	D-dimer	LDH	haptoglobin	Coombs test	PBS	BUN	Cr	S/C		Pediatric	Adult		Imaging 3
Disseminated intravascular coagulation (DIC)								NL/_	↑	↑	↑	↑
Hemolytic uremic syndrome							Hemolitic anemia		NL	NL	NL	↑	↑	↑			↑	↑			+++	+
Thrombotic thrombocytopenic purpura (TTP)																					+	+++
Systemic vasculitis
Diseases	Symptom 1	Symptom 2	Symptom 3	Physical exam 1	D	Physical exam 3		Lab 1	Lab 2	Lab 3											Imaging 1	Imaging 2		Imaging 3	Histopathology	Gold standard	Additional findings
Differential Diagnosis 4
Differential Diagnosis 5
Differential Diagnosis 6

Differentiating between Hemoglobinopathies

				Gene type	Red blood cell (RBC) count g/dl				Hemoglobin pattern	Differentiating Symptoms
					Hemoglobin g/dl	MCH /pg	Hemoglobinpattern
Alpha Thalassemia				-+/++	Normal	Normal	Normal		Normal	None
				-+/-+ --/++	Normal or low	<26	Normal		Normal	Mild anemia
				--/-+	8 to 10	<22	HbH &asymp 10 to 20%		HbH 10 to 20%	Chronic hemolytic anemia
				Hb Bart’s hydrops fetalis --/--	<6	<20	Hb Bart’s 80 to 90%, Hb Portland &asymp; 10 to 20%, HbH <1%		Hb Bart’s 80 to 90%, Hb Portland 10 to 20%, HbH <1%	Life-threatening fetal anemia
β-thalassemia	Heterozygous			&β/++	9 to 15		HbA2 >3.2%
				&β/+-			HbF 0.5 to 6%
				&β/--		19 to 25
	Compound heterozygous			&beta; + /&beta; 0
	Homozygous			&beta;+/&beta;+	<7
				&beta; 0 /&beta; 0
Sickle cell Disease					6 to 9
HBC

Pathophysiology

1. The pathophysiolgy of xxx disease in unknown.
2. But it may follow xxx pathway
   • It is believed that xxx might work on yyy to produce zz.

Pathology

• Idiopathic
• Itarogenic
• cardiac

References

History & clinical symptoms

Blood test

hemolysate

Diagnosis of abnormal hemoglobins

Diagnisis of β-thalassemia

Dignisis of α-thalassemia

Alkaline electrophoresis • acid electrophoresis •HPLC

Electrophoresis HPLC • HbA2,Hbf

Electrophoresis HPLC • DNA testing

Evidence of abnormality,comparison of mobility with that of known abnormalities, if HBS suspected: solubility test

Separation/quantification

Evalution of all data and findings

Evalution of all data and findings

Diagnisis of β-thalassemia

Dignisis of α-thalassemia

DNA sequencing if needed

DNA sequencing if needed(thalassemia major, thalassemia intermedia

Evaluation of all data and findings(including blood count ethnic and origin

Diagnosis of hemoglobinopathy