Resident report has gotten a makeover! We have a different sub-specialty theme each week. This week we had hematologists, Dr. Sven Olson and Dr. Joe Shatzel, come, they presented two interesting cases with many learning points. Dr. Ashray Maniar (R3) also submitted a case reminding us of a framework for working up thrombocytopenia.
The polycythemia vera case included a gentleman with a splenic vein thrombus, with increased WBCs, RBCs, and platelets. He had a work up for polycythemia. Here is a nice review article from the American Journal of Hematology.
Heme Pearl from each case:
Immature platelet fraction (IPF) can be useful in the work up of thrombocytopenia by helping differentiate thrombocytopenia due to decreased production (low IPF) vs peripheral platelet destruction (high IPF).
Splenic marginal zone lymphoma (SMZL) is a rare, low-grade B-cell non-hodgkin’s lymphoma characterized by massive splenomegaly (We’re talking really massive). Bone marrow infiltration is a very common finding, although circulating cells are detected much less frequently.
When thinking about polycythemia, a useful schema is to differentiate whether you’re dealing with an Epo-driven or Epo-independent process. Remember also that there are some classic Epo-producing tumors (most famously renal cell carcinoma, but think about hepatocellular carcinoma and pheochromocytoma as well)