AANP/AANP SUMMARIES 2025-
2026
Immunization contraindications -Neomycin - IPV, MMR, varicella
streptomycin, polymyxin B, neomycin - IPV vaccinia (smallpox)
Baker's yeast - Hep B
Gelatin - MMR
infants dx with SCID (severe combined immunodeficiency) -
rotavirus (increases risk of intussusception)
Live attenuated vaccines -MMR, Varicella, intranasal flu
NO - pregnancy, immunocompromised
who is eligible for high dose Flu vaccine? -- The high-dose
influenza vaccine (Fluzone®) is indicated for individuals 65 years
and older.
- adjuvanted influenza vaccine (Fluad®) has been approved for
those 65 years and older. This vaccine is designed to potentially
elicit a greater immunogenic response in the elderly
leading cause of death -10-44 years - unintentional injury
45-54 years - COVID, heart disease #2
55-64 - cancer, hert disease #2
10-14 years - suicide #2, cancer #3
15-24 years - homicide #2, suicide #3
New cancer cases -Men: #1 prostate, #2 lung, #3 colon, #4
urinary #5 melanoma
Female: #1 breast #2 lung, #3 colon #4 uterus, #5 melanoma
deaths by cancer
-Men: #1 lung, #2 prostate #3 colon, #4 pancreas, #5 liver
Women: #1 lung, #2 breast, #3 pancreas, #4 colon, #5 uterine
,lung cancer screening guidelines -- annual CT ages 50- 80 years
who smoke or have a > or = 20 pack-years smoking history
- discontinue once pt has not smokedd x15 years
PSA screening -men age 55-69 years, decision should be
individual
no recommended > ge 70
colorectal screening -all age 45 - 75
> 76 years, individualized
FIT test annually
stool DNA Q3 years
colonoscopy Q10 years
flexible sigmoidoscopy Q5 years
CT colonography Q5 years
breast cancer screening -women age 45-54 annual mammogram
40-44 can consider mammogram
> 55 mammogram annually or Q2 years
screen until < 10 year life expectancy
cervical cancer screening -begin age 21 (USPSTF) 25 (ASC)
discontinue age 65 if normal hx
HPV Q5 years, Pap Q3 years OR HPV/Pap co-test Q5 years
HPV vaccine -The 2-dose regimen HPV vaccine is recommended
for all boys and girls at age 11-12 to prevent HPV-associated
cancers later in life
size of RBC -MCV (volume)
RBC size remain unchanged during lifespan ( 90d)
Color of RBC -MCH
MCHC
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,RDW -- red cell distribution width
- variation in size
- always goes UP with nch change to MCV EXCEPT with
thalassemia
- normal 11.5 - 15 %
- abnormal > 15% = new cells differ in size when compared to
older cells
hemoglobin & hematocrit ratio -1:3
Wintrobe's Classification of RBC -microcytic MCV < 80 fL
normocytic MVC 80-96 fL
macrocytic MCV > 96 fL
RBC hemoglobin content -* small RBC are always pale RBC
hemoglobin = RBC color source
RBC = 90% hemoglobin
normochromic MCHC 31-37 g/dL (MCH 310-370 g/L)
hypochromic MCHC <31 g/dL (MCH < 310 g/L)
reticulocyte percentage -% of baby RBCs
body's normal response to anemia via increasing # of young
RBCs
- normal 1-2%
- reticulocytosis > 2% in response to anemia
Following hemogram - order... -based on hemogram results:
-Ferritin
- B12/folate
- electrophoresis
normocytic, normochromic anemia with normal RDW -- anemia of
chronic disease (#1 in elderly): body is compensating due to
chronic nature of disease
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, - CKD: erythropoetin supply diminishes when GFR < 49
-acute blood loss: body is unable to compensate, loosing blood
too fast
- check iron, B12 and folate next
microcytic, hypochromic with elevated RDW -- IDA (most common
in childhood, pregnancy, reproductive women, #2 in elderly)
- IDA origin often GI blood loss over time
- plumbism (lead toxicity)
- next step: Ferritin and/or lead levels (if suspected)
microcytic, hypochromic normal RDW -- alpha or beta
thalassemia minor
- loos like IDA with normal RDW
- @ risk alpha: Asian or African
- @ risk beta: African, Mediterranean, Middle East
- next step: electrophoresis (one and done!! at diagnosis!)
-offer genetic counseling prior to pregnancy
macrocytic, normochromic with elevated RDW -- Vit B12
deficiency - common with vegan diet (pernicious anemia), causes
neuropathy, CNS irritation, smooth red tongue
- Folate deficiency
- next step: B12 and folate levels
macrocytosis without anemia -- alcohol (mosts common) > 5
drinks/day in men, >3 drinks per day in females
- anti-epileptic drugs (carbamazepine, Tegretol, phenytoin,
methotrexate
Carbamazepine labs -- an cause bone marrow suppression.
- CBC with differential is recommended monthly for 2-3 months
after starting the medication
4|Page
2026
Immunization contraindications -Neomycin - IPV, MMR, varicella
streptomycin, polymyxin B, neomycin - IPV vaccinia (smallpox)
Baker's yeast - Hep B
Gelatin - MMR
infants dx with SCID (severe combined immunodeficiency) -
rotavirus (increases risk of intussusception)
Live attenuated vaccines -MMR, Varicella, intranasal flu
NO - pregnancy, immunocompromised
who is eligible for high dose Flu vaccine? -- The high-dose
influenza vaccine (Fluzone®) is indicated for individuals 65 years
and older.
- adjuvanted influenza vaccine (Fluad®) has been approved for
those 65 years and older. This vaccine is designed to potentially
elicit a greater immunogenic response in the elderly
leading cause of death -10-44 years - unintentional injury
45-54 years - COVID, heart disease #2
55-64 - cancer, hert disease #2
10-14 years - suicide #2, cancer #3
15-24 years - homicide #2, suicide #3
New cancer cases -Men: #1 prostate, #2 lung, #3 colon, #4
urinary #5 melanoma
Female: #1 breast #2 lung, #3 colon #4 uterus, #5 melanoma
deaths by cancer
-Men: #1 lung, #2 prostate #3 colon, #4 pancreas, #5 liver
Women: #1 lung, #2 breast, #3 pancreas, #4 colon, #5 uterine
,lung cancer screening guidelines -- annual CT ages 50- 80 years
who smoke or have a > or = 20 pack-years smoking history
- discontinue once pt has not smokedd x15 years
PSA screening -men age 55-69 years, decision should be
individual
no recommended > ge 70
colorectal screening -all age 45 - 75
> 76 years, individualized
FIT test annually
stool DNA Q3 years
colonoscopy Q10 years
flexible sigmoidoscopy Q5 years
CT colonography Q5 years
breast cancer screening -women age 45-54 annual mammogram
40-44 can consider mammogram
> 55 mammogram annually or Q2 years
screen until < 10 year life expectancy
cervical cancer screening -begin age 21 (USPSTF) 25 (ASC)
discontinue age 65 if normal hx
HPV Q5 years, Pap Q3 years OR HPV/Pap co-test Q5 years
HPV vaccine -The 2-dose regimen HPV vaccine is recommended
for all boys and girls at age 11-12 to prevent HPV-associated
cancers later in life
size of RBC -MCV (volume)
RBC size remain unchanged during lifespan ( 90d)
Color of RBC -MCH
MCHC
2|Page
,RDW -- red cell distribution width
- variation in size
- always goes UP with nch change to MCV EXCEPT with
thalassemia
- normal 11.5 - 15 %
- abnormal > 15% = new cells differ in size when compared to
older cells
hemoglobin & hematocrit ratio -1:3
Wintrobe's Classification of RBC -microcytic MCV < 80 fL
normocytic MVC 80-96 fL
macrocytic MCV > 96 fL
RBC hemoglobin content -* small RBC are always pale RBC
hemoglobin = RBC color source
RBC = 90% hemoglobin
normochromic MCHC 31-37 g/dL (MCH 310-370 g/L)
hypochromic MCHC <31 g/dL (MCH < 310 g/L)
reticulocyte percentage -% of baby RBCs
body's normal response to anemia via increasing # of young
RBCs
- normal 1-2%
- reticulocytosis > 2% in response to anemia
Following hemogram - order... -based on hemogram results:
-Ferritin
- B12/folate
- electrophoresis
normocytic, normochromic anemia with normal RDW -- anemia of
chronic disease (#1 in elderly): body is compensating due to
chronic nature of disease
3|Page
, - CKD: erythropoetin supply diminishes when GFR < 49
-acute blood loss: body is unable to compensate, loosing blood
too fast
- check iron, B12 and folate next
microcytic, hypochromic with elevated RDW -- IDA (most common
in childhood, pregnancy, reproductive women, #2 in elderly)
- IDA origin often GI blood loss over time
- plumbism (lead toxicity)
- next step: Ferritin and/or lead levels (if suspected)
microcytic, hypochromic normal RDW -- alpha or beta
thalassemia minor
- loos like IDA with normal RDW
- @ risk alpha: Asian or African
- @ risk beta: African, Mediterranean, Middle East
- next step: electrophoresis (one and done!! at diagnosis!)
-offer genetic counseling prior to pregnancy
macrocytic, normochromic with elevated RDW -- Vit B12
deficiency - common with vegan diet (pernicious anemia), causes
neuropathy, CNS irritation, smooth red tongue
- Folate deficiency
- next step: B12 and folate levels
macrocytosis without anemia -- alcohol (mosts common) > 5
drinks/day in men, >3 drinks per day in females
- anti-epileptic drugs (carbamazepine, Tegretol, phenytoin,
methotrexate
Carbamazepine labs -- an cause bone marrow suppression.
- CBC with differential is recommended monthly for 2-3 months
after starting the medication
4|Page
