The Curbsiders Internal Medicine Podcast

Reboot #167 LIVE! CBC Abnormalities

Aug 23, 2021

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ADVICE

Prioritize Absolute Counts

Look at absolute counts (ANC, absolute lymphocytes, absolute monocytes) rather than percentages on the CBC differential.
Use absolute values to prioritize causes and next steps when a CBC abnormality appears.

INSIGHT

When CBCs Warrant Urgent Review

Blasts or very high counts or basophilia on a CBC are immediate red flags requiring urgent hematology evaluation.
Basophilia particularly raises suspicion for myeloproliferative neoplasm and needs prompt attention.

ADVICE

Repeat Labs Before Referring

Repeat an abnormal CBC before escalating workup or consults to see if it resolves.
If persistent neutrophilia, advise smoking cessation and re-evaluate as smoking commonly raises counts.

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Enjoy this Curbsiders classic and stay tuned this Wednesday, August 25, 2021 for a brand new CBC Abnormalities Triple Distilled episode.

Take a deep dive into common CBC abnormalities. We recorded LIVE at joint grand rounds between Walter Reed NMMC and Uniformed Services University with hematologist, Dr. Mary Kwok MD. Topics include: which parts of the complete blood count (CBC) are most important, interpreting the differential, when to order flow cytometry, who needs a hematology consult and simplified approaches to patients with leukocytosis, leukopenia, erythrocytosis and thrombocytopenia.

Credits

Written, Produced and Edited by: Matthew Watto MD, FACP
Cover Art and Infographic by: Matthew Watto MD, FACP
Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP
Guest: Mary Kwok MD

Sponsor: American College of Physicians acponline.org/100curb

ACP CME 100 virtual video package includes 75 hours of practice-changing updates by expert faculty from Internal Medicine Meeting 2021 acponline.org/100CURB.

Plus enjoy an exclusive: 25 bonus CME sessions and access until June 1, 2024!

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Time Stamps*

Time Stamps refer to ad-free version

00:00 Intro; Paul shame’s the audience; Guest bio
03:17 Guest one-liner, book recommendation* –Emperor of All Maladies (book) by Siddhartha Mukherjee, When Breath Becomes Air (book) by Paul Kalanithi; Career advice -set goals for whatever you’re learning.
08:43 Picks of the week: John Wick 3 (film); The Movies That Made Me (podcast) by Joe Dante; The Tim Ferriss Podcast with Julie Rice of Soul Cycle; Infinity Chamber (film) by Travis Milloy
11:50 A case of asymptomatic leukocytosis; Red flags; Repeat the CBC until it’s normal
17:30 The peripheral smear; Leukemoid reaction
20:00 The physical exam; When to send flow cytometry?
22:18 A case of lymphopenia; benign ethnic neutropenia; What to look for in the history
27:10 A case of erythrocytosis; Checking EPO levels; JAK2 mutation; Differential Diagnosis; Therapeutic Phlebotomy; Physical findings of Polycythemia Vera
36:53 A case of thrombocytopenia; Lab workup; Differential diagnosis; Pathophysiology; Culprit meds
45:35 Advice for internists
46:36 Take Home Points
47:46 Dr. Kwok’s disclaimer
48:10 Outro and post credit scene