Haem blood test patterns Flashcards
Iron deficiency anaemia:
- Iron
- Ferritin
- TIBC
- Transferrin saturation
- Film
- Reticulocytes
Iron - low Ferritin - low TIBC - high Trans sat - low Film - microcytosis, hypochromia Reticulocytes - low
Anaemia of chronic disease:
- Iron
- Ferritin
- TIBC
- Film
- Reticulocytes
Iron - low Ferritin - high TIBC - low Film - normocytic OR microcytic Reticulocytes - low
Sideroblastic anaemia:
- Iron
- Ferritin
- TIBC
- Transferrin saturation
- Film
- Marrow
Iron - high Ferritin - high TIBC - normal Trans sat - high Film - hypochromic microcytic Marrow - ring sideroblasts
Alpha Thalassaemia: - Iron - Ferritin - TIBC - Transferrin saturation - Film - Reticulocytes (HPLC if HbH?)
Iron - normal/high Ferritin - normal/high TIBC - normal Transferrin saturation - normal Film - microcytic hypochromic, Heinz bodies, Target cells Reticulocytes - High (HPLC - low HbA, HbA2, HbF, high HbH)
Beta Thalassaemia:
- Iron
- Ferritin
- TIBC
- Transferrin saturation
- Film
- Reticulocytes
- HPLC
- Skull XR
Iron - normal Ferritin - normal TIBC - normal Transferrin sat - normal Film - microcytic hypochromic, target cells, nucleated RBC's Reticulocytes - high HPLC - low HbA, high HbA2 and HbF Skull XR - hair on end sign
B12/Folate Deficiency:
- Iron
- Ferritin
- TIBC
- Transferrin saturation
- Film
- Reticulocytes
- Potential antibodies
Iron - normal
Ferritin - normal
TIBC - normal
Trans sat - normal
Film - macrocytosis, hypersegmented neutrophils, macroovalocytes. Target cells if from liver disease.
Reticulocytes - may/may not be present
Ig - anti-patietal cell, anti-intrinsic factor
Haemochromatosis:
- Iron
- Ferritin
- TIBC
Iron - high
Ferritin - high
TIBC - normal/low
ITP:
- PT
- aPTT
- TT
- PLT
- Bleed time
- Additional?
PT - normal aPTT - normal TT - normal PLT - LOW Bleeding time - HIGH Add - autoantibodies
TTP:
- PT
- aPTT
- TT
- PLT
- Bleed time
- Additional?
PT - normal aPTT - normal TT - normal PLT - LOW Bleed time - HIGH Add - MAHA, low Hb, fever, schistocytes, high LDH
Abnormal PLT:
- PT
- aPTT
- TT
- PLT
- Bleed time
- When does this happen?
all normal but
Bleed time HIGH
due to aspirin/other anti-platelet OR high urea
von Willebrand Disease:
- PT
- aPTT
- TT
- PLT
- Bleed time
- Additional?
PT - normal aPTT - HIGH TT - normal PLT - normal Bleed time - HIGH Add - Low factor 8, autoantibodies
Haemophilia:
- PT
- aPTT
- TT
- PLT
- Bleed time
- Additional?
PT - normal aPTT - HIGH TT - normal PLT - normal Bleed time - normal Add - Low factor 8/9
Liver Disease:
- PT
- aPTT
- TT
- PLT
- Bleed time
- Additional?
PT - HIGH aPTT - HIGH TT - normal or HIGH PLT - normal or HIGH Bleed time - normal or HIGH Add - Abnormal LFTs, may be macrocytosis or target cells
DIC:
- PT
- aPTT
- TT
- PLT
- Bleed time
- Additional?
PT - HIGH aPTT - HIGH TT - HIGH PLT - LOW Bleed time - HIGH Add - High D-dimers, low Hb
Warfarin:
- PT
- aPTT
- TT
- PLT
- Bleed time
- Reversal?
PT - HIGH (higher than aptt) aPTT - HIGH TT - normal PLT - normal Bleed time - normal Reversal - 4-factor complex concentrate
Heparin:
- PT
- aPTT
- TT
- PLT
- Bleed time
- Reversal?
PT - HIGH aPTT - HIGH (higher than PT) TT - HIGH (higher than PT) PLT - normal Bleed time - normal Reversal - Protamine
3 causes of warm haemolytic anaemia?
Autoimmune e.g. SLE
Neoplasia e.g. CLL, Lymphoma
Drugs e.g methyldopa
2 causes of cold haemolytic anaemia?
Neoplasia e.g. lymphoma
Infection e.g. EBV, mycoplasma
Causes of normocytic anaemia? (7)
Chronic disease Aplastic anaemia Haemolysis Sickle cell Leukaemia Mixed Iron and B12 deficiency Increased plasma volume e.g. pregnancy, fluid resuscitation after haemorrhage
Causes of microcytic anaemia? (
Iron deficiency Thalassaemia Sideroblastic Lead poisoning Chronic disease (but this is normally normocytic)
Types of Macrocytosis and causes?
Megaloblastic:
- B12/folate deficiency or chemo - also presence of macroovalocytes and hypersegmented neutrophils
Non-Megaloblastic:
- alcohol
- hypothyroidism
- pregnancy
- liver disease
- marrow failure
- reticulocytosis
- -> these can be assoc with anaemia or just isolated macrocytosis
Causes of target cells?
Liver disease
Hyposplenism
Thalassaemia (alpha or beta)
Iron deficiency
Cause of Howell Jolly bodies?
Hyposplenism
Causes of Heinz bodies?
G6PD deficiency Alpha thalassaemia (HbH) Chronic liver disease
Intrinsic causes of haemolytic anaemia? (3)
- Membrane problem - e.g. spherocytosis
- Haem problem - e.g. thalassaemia, sickle cell
- Metabolic problem - e.g. G6PD deficiency
Extrinsic causes of haemolytic anaemia? (4)
- Autoimmune - e.g. SLE, RA
- Splenomegaly - any cause e.g. cirrhosis, Felty’s syndrome
- Vascular damage - burns, vasculitis
- Infection - malaria
Common to both intravascular and extravascular haemolysis?
Both - Increased bilirubin and LDH
Extra - increased urinary/faecal urobilinogen (normal product in excess)
Intra - Haemoglobinaemia, haemoglobinuria (turns black), haemosiderinuria, low haptoglobin
ALL:
- who?
- cells?
- blood test?
- marrow?
- RF?
- Spread?
- Rx?
- Kids
- Lymphocyte progenitor cells
- low Hb, low PLT, low WCC, >20% blasts
- > 20% blasts
- Down syndrome, radiation in pregnancy
- CNS, testes, liver, spleen, lymph nodes
- 2-3 years chemo
CLL:
- who?
- cells?
- blood test?
- buzzwords?
- RF?
- Prognosis?
- Rx?
- adults >50
- clonal B cell population that has undergone cell cycle arrest in G0/G1 - CD20+ (rituximab)
- low Hb, low platelets, High WCC/lymphocytes, low other white cells
- hypogammaglobulinaemia, smudge cells
- autoimmune haemolytic anaemia, ITP
- 1/3 don’t progress, 1/3 will in future, 1/3 currently doing so. Can become high-grade Non-Hodgkin’s
- watch and wait OR chemo
AML:
- who?
- cells?
- blood test?
- marrow?
- buzzwords?
- spread?
- Rx?
- adults
- Myeloid progenitor cells
- low Hb, low platelets, variable WCC but usually neutropaenia
- > 20% blasts
- AUER RODS
- Gums, liver, spleen, lymph (NEVER TO CNS)
- 5 cycles of chemo 1 week apart
Acute promyelotic leukaemia:
- translocation?
- Rx?
t(15; 17)
ALTRA - all-trans retinoic acid
CML:
- who?
- cells?
- bloods?
- marrow?
- buzzwords?
- progression?
- treatment?
- adults
- granulocytes
- low Hb, low PLT, HIGH URATE, high WCC (granulocytes)
- Hypercellular marrow
- Gout, Philadelphia chromosome t(9; 22) BCR-ABL
- Chronic - 3-5 years of proliferation with maturation
- Accelerated - maturation starts to fail and symptoms worsen
- blast crisis - transformation to AML
Rx: Imatanib (tyrosine kinase inhibitor)
Hodgkin’s:
- who?
- cells?
- buzzwords?
- RF?
- Rx?
- younger (15-30)
- CD30+ B lymphocytes
- Reed Steenberg cell, pain on drinking alcohol
- EBV, FHx
- Brontuximan Vedotin (anti-CD30+)
Non-Hodgkin’s:
- RF?
- Cells?
- Types and chromosomes?
- spread?
- Rx?
- EBV, immunosuppression
- Usually B cell - CD20+
- Burkitt’s - t(8; 14) c-myc - African kids EBV, facial tumour, starry sky appearance
- Follicular - t(14; 18) bcl-2 - high grade
- mantle - t(11; 14) - low grade
- CNS, Waldeyer’s ring, marrow, spleen, skin
- Usually R-CHOP (R=Rituximab - CD20+)
Leukoarythroblasts and tear-drop poikilocytes?
Myelofibrosis