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4 - Y5 a Path lectures 2021/22 > Haem 1: Systemic disease & intro to haematopathology > Flashcards

Haem 1: Systemic disease & intro to haematopathology Flashcards

1
Q

• Patient with new Dx of lymphoma on biopsy of neck node has new onset: Jaundice, Anaemia, Raised LDH

What are the DDx?

A
  • Lymphoma with pathological nodes compressing bile duct, anaemia of inflammation (post-hepatic)
  • Lymphoma Stage 4 with BM and liver infiltration (hepatic)
  • Lymphoma Stage 1 and AIHA (pre-hepatic)
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2
Q

What are the principles of haematological disorder?

A
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3
Q

Give some examples of primary haematological disorders

A
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4
Q

Give some examples of secondary haematological disorders

A
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5
Q

Name some haematological changes caused by systemic disease

A
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6
Q

Name some different types of anaemia

A
  • iron deficiency,
  • leucoerythroblastic,
  • microangiopathic,
  • auto-immune haemolytic
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7
Q

What may anaemia be the first presentation of?

A
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8
Q

Can anaemia result from chronic inflammation?

A

yes

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9
Q

What is seen on bloods and blood film in anaemia?

A
  • microcytic hypochromic anaemia,
  • reduced ferritin & TF saturation,
  • raised TIBC
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10
Q

What is anaemia indicative of until proven otherwise?

A

bleeding (find cause!!)

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11
Q

Where might the occult blood loss be from in anaemia?

A
  • GI cancers – gastric, colorectal
  • Urinary tract cancers (less commonly) – Renal cell carcinoma (physician’s tumour), Bladder cancer
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12
Q

What might the bleeding in anaemia be due to?

A
  • Menorrhagia in pre-menopausal women
  • GI blood loss in men and post-menopausal women
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13
Q

What is Leucoerythroblastic anaemia?

A
  • Red and white cell precursor anaemia
  • variable degree of anaemia
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14
Q

What are the morphological features of Leucoerythroblastic anaemia on blood film?

A

Morphology on peripheral blood film

  • Teardrop RBCs – aniso and poikilocytosis
  • Nucleated (normal in BM) RBCs (left purple cell)
  • Immature myeloid cells (right purple cell)
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15
Q

What does this show?

A

normal peripheral blood film

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16
Q

What does this show?

A
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17
Q

What does a Leucoerythroblastic blood film usually indicate?

A

bone marrow infiltration

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18
Q

What are the causes of a Leucoerythroblastic blood film?

A
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19
Q

What is Haemolytic anaemia?

A

shortened RBC survival → low Hb

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20
Q

What are some common lab features of all haemolytic anaemias?

A
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21
Q

What are the 2 groups of haemolytic anaemias?

A
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22
Q

Which test is used to identify Immune-mediated haemolytic anaemia?

A

DAT positive (direct antiglobulin/Coomb’s test)

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23
Q

Which test is used to identify Non-immune-mediated haemolytic anaemia?

A

DAT negative (acquired haemolytic anaemia)

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24
Q

What is immune-mediated haemolytic anaemia associated with?

A
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25
Q

What does the arrow show?

A

spherocytes (seen in immune-mediated haemolytic anaemia)

26
Q

What are the 2 types of AIHA?

27
Q

Compare warm AIHA vs cold AIHA

28
Q

Compare the direct vs indirect Coombs tests

29
Q

What are the classic features of Non-immune-mediated haemolytic anaemia

A
  • RBC fragments (schistocytes),
  • Thrombocytopenia,
  • DAT-negative
30
Q

What are the causes of Non-immune-mediated anaemia?

31
Q

what are the causes of Micro-angiopathic haemolytic anaemia (MAHA)?

32
Q

what are the causes of Micro-angiopathic haemolytic anaemia (MAHA)?

33
Q

Compare peripheral blood with bone marrow

34
Q

How do you Investigate an abnormal WBC

35
Q

What are the Causes of neutrophilia

36
Q

What do these images show?

37
Q

What is the difference seen between reactive infection/malignancy in neutrophilia

38
Q

What are the two types of Eosinophilia

39
Q

When is Monocytosis seen?

A

rare, seen in some chronic infections and primary haematological disorders

40
Q

Summarise an increased phagocyte count (infection, inflammation, neoplasia, myeloproliferative)

41
Q

What is Lymphocytosis?

42
Q

What are the causes of Lymphocytosis?

A
  • EBV, CMV, Toxoplasma
  • Infectious hepatitis, rubella, herpes. infections
  • Autoimmune disorder
  • Sarcoidosis
43
Q

What is Lymphopenia?

44
Q

What are the causes of lymphopenia?

A
  • HIV
  • Autoimmune disorders
  • Inherited immune deficiency syndromes
  • Drugs(chemotherapy)
45
Q

How is Lymphocytosis morphology evaluated?

46
Q

What is Clonality in a B-cell lymphocytosis?

A

light chain restriction

47
Q

What is the difference between polyclonal and monoclonal?

A

Polyclonal= kappa and lambda (reactive)

Monoclonal (kappa ONLY or lambda ONLY (malignant)

48
Q

How is leukaemia classified and evaluated?

49
Q

Describe the difference between normal myeloid differentiation and acute myeloid leukaemia differentiation

50
Q

Which Acquired somatic mutations can cause leukaemia and lymphoma?

51
Q

What is the point of a tissue biopsy is ?lymphoma and leukaemia?

52
Q

What does this show?

A

B-cell acute lymphoblastic lymphoma

53
Q

What does this show?

A

Multiple myeloma

54
Q

Describe B-cell acute lymphoblastic lymphoma

A
  • TdT +ve (indicates immature cells; used in. VDJ rearrangement)
  • CD19 +ve (indicates B-cell lineage)
  • SurfaceIg- ve(abnormal)
55
Q

Describe Multiple myeloma

A
  • TdT -ve(normal)
  • Surface Ig +ve(normal)
  • CD138 +ve(abnormal)
56
Q

What is Precise classification is used for in leukaemia/lymphoma

57
Q

What are some associated clinical problems
in lymphoma/leukamia

58
Q
59
Q

What is the explanation for the anaemia?

A
  • IDA
    • would not expect jaundice
    • would not give nucleated red cells in PB
  • Anaemia of chronic disease
  • BM mets from breast Ca
  • MAHA
    • Not get leucoerythroblastic problems in blood as BM is healthy
  • AIHA
    • AIHA is DAT-positive
60
Q

What is the likely Dx?

4 - Y5 a Path lectures 2021/22 (37 decks)

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