7: Approach to interpreting blood results

Question 1

What are reactive changes?

Answer 1

Increased in white cell count (e.g neutrophils, platelets) in response to inflammation or infection

Question 2

Which disease are megaovalocytes and hypersegmented neutrophils a feature of?

Answer 2

Megaloblastic anaemia

caused by Vit B12 / folate deficiency

Question 3

What is an autoimmune cause of megaloblastic anaemia?

Answer 3

Pernicious anaemia

Coeliac disease

Causing poor absorption of Vit B12 and folate

Question 4

What happens if you give someone folate BEFORE B12 in B12/folate deficiency?

Answer 4

Acute demyelination

Question 5

In megaloblastic anaemia, is the bone marrow hypocellular or hypercellular?

Why?

Answer 5

hypercellular

In B12/folate deficiency, cells can’t divide

Large EPO drive to increase bone marrow activity - ineffective erythropoiesis

Lots of crap cells produced by the bone marrow

Question 6

Steroids can cause which blood abnormality?

Answer 6

Neutrophilia

Increased neutrophil release into the circulation

Question 7

What is Coombs test used for?

Answer 7

Differentiating between AUTOIMMUNE (+ve) and OTHER causes of haemolytic anaemia (e.g spherocytosis, sickle cell, thalassaemia, acquired causes…)

Question 8

What investigations would you do for suspected hereditary spherocytosis?

Answer 8

FBC (most importantly retic. count)

Blood film (for spherocytes)

Question 9

How is hereditary spherocytosis treated?

Answer 9

If young and failing to thrive: splenectomy

If older and asymptomatic: supportive management, folic acid (to buffer in case of crisis requiring reticulocytosis)

Question 10

Why are children with hereditary spherocytosis short statured?

Answer 10

Increased bone marrow hyperplasia

Chronically due to constant haemolysis

More energy dedicated to that and less to growth