66.2 📚 國考版醫垫國考 / PGY OSCE

66.2.0.1 📌 Cram Sheet

66.2.0.1.1 🔥 高 yield 12
  1. MCV 分類< 80 micro / 80-100 normo / > 100 macro
  2. Microcytic = TAILS
  3. Macrocytic megaloblastic = B12/folate
  4. Reticulocyte > 2-3% = 補償 (hemolysis/blood loss)
  5. Mentzer < 13 = thal / > 13 = IDA
  6. Direct Coombs + = AIHA
  7. Iron alternate day > daily (22E)
  8. B12 def 神經 (SCD); folate 沒神經
  9. PV = JAK2 V617F
  10. TTP pentad: schisto + thrombocytopenia + neuro + AKI + fever
  11. PNH eculizumab
  12. G6PD bite + Heinz
66.2.0.1.2 🔢 必背
項目 æ•žå­—
Anemia 男 Hgb < 13
Anemia 女 Hgb < 12
Anemia å­•å©Š Hgb < 11
MCV micro < 80
MCV macro > 100
Mentzer index MCV / RBC
Mentzer < 13 thal
Mentzer > 13 IDA
Ferritin IDA < 30
PV Hgb (M) > 16.5
PV Hct (M) > 49%

66.2.0.2 ⭐ 高 yield

66.2.0.2.1 TAILS
  • Thalassemia
  • Anemia of chronic disease (later)
  • Iron deficiency
  • Lead poisoning
  • Sideroblastic
66.2.0.2.2 IDA Iron Studies
  • Fe ↓
  • TIBC ↑
  • Ferritin ↓ (< 30)
  • % saturation ↓
66.2.0.2.3 ACD vs IDA
IDA ACD
Fe ↓ ↓
TIBC ↑ ↓
Ferritin ↓ normal/↑
BM iron absent trapped in macrophages
66.2.0.2.4 Hemolysis Markers
  • LDH ↑
  • Indirect bili ↑
  • Haptoglobin ↓
  • Reticulocyte ↑
  • Schistocytes (if MAHA)
66.2.0.2.5 AIHA Workup
  • DAT (Coombs):
    • IgG ± C3: warm AIHA
    • C3 only: cold AIHA
  • Cold agglutinin titer
  • Treat warm: steroid + rituximab; cold: avoid cold + rituximab
66.2.0.2.6 B12 vs Folate
B12 Folate
MCV ↑ ↑
Hypersegmented + +
MMA ↑ normal
Homocysteine ↑ ↑
Neurological + −
Common cause Pernicious anemia, vegan, ileum Diet, MTX, alcohol, pregnancy
Replace IM 1000 ÎŒg PO 1-5 mg
66.2.0.2.7 Polycythemia DDx
Hgb EPO Cause
PV ↑ ↓ JAK2 mutation
Secondary ↑ ↑ Hypoxia, EPO tumor
Relative ↑ normal Dehydration
66.2.0.2.8 TTP Pentad
  • Schistocytes (MAHA)
  • Thrombocytopenia
  • Neurological
  • AKI (renal)
  • Fever
  • ADAMTS13 < 10%
  • Treat: PLEX + steroid + caplacizumab (anti-vWF nanobody, 22E)

66.2.0.3 🎯 自我檢枬

  1. MCV < 80 + ferritin 5 → IDA
  2. Mentzer 11 → Thal
  3. Schistocyte + thrombocytopenia + AKI? → TTP
  4. JAK2 V617F? → PV
  5. B12 vs folate 神經? → B12 +; folate −
  6. Iron dosing 22E? → Alternate day
  7. PNH treatment? → Eculizumab
  8. Cold AIHA causes? → Mycoplasma, EBV, lymphoma
  9. Aplastic anemia BM? → Hypocellular pancytopenia
  10. Caplacizumab target? → vWF (TTP, 22E new)

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