Haem

Question 1

Which blood clotting factor is raised in inflammation?

Answer 1

Factor 8 - increase thrombosis risk

Question 2

Which cancers can produce occult blood loss?

Answer 2

GI (gastric, colonal, rectal)

Urinary tract (renal cell carcinoma, bladder)

Question 3

What are the 3 morphological features of leucoerythroblastic anaemia on a blood film?

Answer 3

Teardrop RBC (+aniso & poikilocytosis)

Nucleated RBC

Immature myeloid cells

Question 4

What causes a leucoerythroblastic film?

Answer 4

Bone marrow infiltration - mainly due to malignancy of either haematopoietic or non-haematopoietic origin

Other causes: myelofibrosis, severe infection (miliary TB, severe fungal infection)

Question 5

What are 5 lab features of all haemolytic anaemias?

Answer 5

Anaemia

Reticulocytosis

Raised unconjugsated bilirubin

Raised LDH

Reduced haptoglobins

Question 6

Name 4 inherited haemolytic anaemias and their corresponding red cell defect

Answer 6

Hereditary spherocytosis - membrane

G6PD deficiency - cytoplasm/enzymes

Sickle cell disease - haemoglobin structure

Thalassaemia - haemoglobin quantitative

Question 7

How are acquired haemolytic anaemias classified and how are they differentiated?

Answer 7

Immune vs non-immune mediated

Direct antiglobulin test (DAT) aka Coomb’s test

Question 8

What do you see on a blood film in immune haemolytic anaemia?

Answer 8

Spherocytes

Question 9

Give some examples of diseases which can cause immune haemolytic anaemia

Answer 9

Malignancy eg lymphoma or CLL

Autoimmune eg SLE

Infection eg mycoplasma

Idiopathic

Question 10

What are the causes of non-immune haemolytic anaemia

Answer 10

Infection - malaria (parasites)

Micro-angiopathic haemolytic anaemia - underlying carcinoma or haemolytic uraemic syndrome

Question 11

What features do you expect to see on a microangiopathic film?

Answer 11

RBC fragments

Thrombocytopaenia

Question 12

Briefly summarise the pathophysiology of MAHA in adenocarcinomas

Answer 12

Low grade DIC, platelet activation, fibrinogen converted to fibrin and deposited in microcirculation

RBC pushed under pressure in the microvessels and gets broken up

Question 13

What are the causes of neutrophilia?

Answer 13

Pyogenic infection - pus forming bacteria

Corticosteroids

Tissue inflammation/necrosis (eg colitis, pancreatitis)

Question 14

How would you differentiate between reactive and malignant causes of neutrophilia?

Answer 14

Reactive: toxic granulation, no immature cells, low to moderate increase in neutrophils

Malignant: immature cells, massive increase in neutrophils

Question 15

What are the causes of monocytosis?

Answer 15

Certain chronic infections eg TB, brucella, thyphoid

Viral - CMV, varicella zoster

Sarcoidosis

Chronic myelomonocytic leukaemia (MDS)

Question 16

What are some causes of reactive eosinophilia?

Answer 16

Parasitic infestation

Allergy (eg asthma, rheumatoid, polyarteritis, pulmonary eosinophilia)

Underlying neoplasms (eg Hodgkin’s, T cell NHL)

Drugs (erytheme multiforme)

Question 17

Name the fusion gene associated with chronic eosinophilic leukaemia

Answer 17

FIP1L1-PDGFRa fusion gene