Clinical haematology

Question 1

What does the colour of a RBC indicate?

Answer 1

• 1/3 of the cell needs to be white to be normal
• largely a uniform size between them all

Question 2

What causes a high WBC count? Leukocytosis

Answer 2

• infection
• post op, or traumatic event
• leukaemia

Question 3

What causes a low WBC count? Leukopenia

Answer 3

• chemotherapy: neutropenia —> sepsis - Drugs - Severe infection - Immune disorders

Question 4

What are neutrophils?

Answer 4

• common phagocytic cells
• increase with bacterial infection
• most common

Question 5

How do Lymphocytes respond to reaction?

Answer 5

• increase during viral infection - can appear reactive or atypical

Question 6

How do children’s WBC count differ from and adults?

Answer 6

• children have a reversed differential - higher lymphocytes than neutrophils: immune system is still developing up to around age 10

Question 7

What is the Erythrocyte Sedimentation Rate ?

Answer 7

• how long does it take for the RBC take to sediment - an increase in acute phase proteins causes faster sedimentation - non-specific

Question 8

How do Babies blood counts present differently?

Answer 8

• higher Hb - HIgher WBC and Hct/PCV - HIgher WBC

Question 9

How do children’s blood count present differently?

Answer 9

• lower Hb - reversed differential

Question 10

How does ethnicity affect the blood count results?

Answer 10

Africans/ Afro caribbeans - lower neutrophil - slightly lower platelet counts

Question 11

What are some causes of Normocytic Anaemias?

Answer 11

• Blood loss - Chronic diseases - Renal failure, decreased Epo production - other acute reasons ( usually in 20’s)

Question 12

What are some causes of Microcytic Anaemia?

Answer 12

• Iron deficiency - Thalassaemia

Question 13

What are some causes non-megaloblastic Macrocytic anaemias?

Answer 13

• Large RBC with no DNA involvement
• Alcohol
• Liver Disease

Question 14

What are some causes of megaloblastic macrocytic anaemia?

Answer 14

• Large RBC with DNA affected
• B12 & Folate deficiency
• Chemotherapy
• AZT ( HIV treatment)

Question 15

What are the clinical symptoms of B12 and folate deficiency?

Answer 15

• weight loss
• fatigue
• Glossitis (swollen tongue)
• jaundice
• dementia
• paraesthesia
• neuropathy

Question 16

Define Poikilocytosis.

Answer 16

variation in RBC shape

Question 17

Define Anisocytosis.

Answer 17

Variation in RBC size

Question 18

Define Dimorphic RBC.

Answer 18

• responding anaemia or post-transfusion, where there is a variety of different RBCs

Question 19

What is Thrombocytopenia and what are its two presenting forms?

Answer 19

Low platelets due to

> Decreased production

• Congenital (rare)
• Acquired: BM damage due to drugs, Alchohol, Blood malignancy

> Increased destruction

• Congenital ( from maternal antibodies)
• Aquired: ITP (idiopathic), Infections, drug-induced

Question 20

Describe the morphology and occurrence of left-shifted immature neutrophils.

Answer 20

• during infections, Myeloproliferative disorders (MPD), Leukemias

Question 21

Describe the morphology and occurrence of Toxic granulation

Answer 21

• Acute infection
• dark granulated cytoplasm

Question 22

Describe the morphology and occurrence of Mylocytes v. Immature

Answer 22

• Severe Infections
• Leukemias
• BM

Question 23

Describe the morphology of hypersegmented (right-shifted) neutrophils

Answer 23

• Megaloblastic conditions
• B12 & Folic acid deficiency
• multilobular in appearance

Question 24

What is Lymphocytosis and when would it present?

Answer 24

• higher than normal lymphocyte levels in an FBC or in a blood film

Presents in

• Viral infections: measles, chickenpox, IM
• Some bacterial infections
• Stress-related: Post MI
• Vigorous exercise
• smoking
• LPD’s i.e CLL (chronic lymphatic leukaemia)

Question 25

What is Lymphocytopenia and when does it present?

Answer 25

• Lower than normal lymphocyte levels in an FBC or a blood film

Presents

• Acute stress: surgery/ trauma
• Acute/ Chronic Renal Failure
• Carcinoma
• AIDS/HIV
• Cytotoxic therapy
• Some inherited: SCID (severe combined immunodeficiency )

Question 26

What is neutrophilia and when does it present?

Answer 26

• higher than normal neutrophil levels in an FBC or blood film

Presents

• Acute/ chronic bacterial infections
• a few viral, fungal and artistic infections
• Tissue damage
• Inflammation (UC, RA?)
• Malignant dx
• MPD and leukaemias
• Cytokines (Granulocyte-Colony Stimulating Factor)
• Drugs: Corticosteroids, lithium

Question 27

What is neutropenia and when does it present?

Answer 27

• lower than normal neutrophil levels in an FBC or blood film

Presents

• Bacterial infection and some viral, fungal parasitic infections
• Anti-cancer drugs
• Irradiation
• BM replacement with Ca
• Aplastic anaemia
• Autoimmune neutropenia: associated with dx
• Inherited (rare): Chediak Higashi syndrome (child hood)