Haem 1: Systemic disease & intro to haematopathology Flashcards
• Patient with new Dx of lymphoma on biopsy of neck node has new onset: Jaundice, Anaemia, Raised LDH
What are the DDx?
- 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)
What are the principles of haematological disorder?
Give some examples of primary haematological disorders
Give some examples of secondary haematological disorders
Name some haematological changes caused by systemic disease
Name some different types of anaemia
- iron deficiency,
- leucoerythroblastic,
- microangiopathic,
- auto-immune haemolytic
What may anaemia be the first presentation of?
Can anaemia result from chronic inflammation?
yes
What is seen on bloods and blood film in anaemia?
- microcytic hypochromic anaemia,
- reduced ferritin & TF saturation,
- raised TIBC
What is anaemia indicative of until proven otherwise?
bleeding (find cause!!)
Where might the occult blood loss be from in anaemia?
- GI cancers – gastric, colorectal
- Urinary tract cancers (less commonly) – Renal cell carcinoma (physician’s tumour), Bladder cancer
What might the bleeding in anaemia be due to?
- Menorrhagia in pre-menopausal women
- GI blood loss in men and post-menopausal women
What is Leucoerythroblastic anaemia?
- Red and white cell precursor anaemia
- variable degree of anaemia
What are the morphological features of Leucoerythroblastic anaemia on blood film?
Morphology on peripheral blood film
- Teardrop RBCs – aniso and poikilocytosis
- Nucleated (normal in BM) RBCs (left purple cell)
- Immature myeloid cells (right purple cell)
What does this show?
normal peripheral blood film
What does this show?
What does a Leucoerythroblastic blood film usually indicate?
bone marrow infiltration
What are the causes of a Leucoerythroblastic blood film?
What is Haemolytic anaemia?
shortened RBC survival → low Hb
What are some common lab features of all haemolytic anaemias?
What are the 2 groups of haemolytic anaemias?
Which test is used to identify Immune-mediated haemolytic anaemia?
DAT positive (direct antiglobulin/Coomb’s test)
Which test is used to identify Non-immune-mediated haemolytic anaemia?
DAT negative (acquired haemolytic anaemia)
What is immune-mediated haemolytic anaemia associated with?