Haem ICM Flashcards
Are the Hb values for women higher or lower than the values for men?
Lower:
Men - 130-180
Females - 115-165
What are some causes of anaemia to cause low Hb?
- Blood loss (menorrhagia, trauma)
- Increased cell destruction (Sickle cell, RA)
- Decreased cell production (bone marrow infiltration)
What is erythrocytosis/Polycythaemia?
Where you have too many RBC making the blood thicker and harder to go through the vessels
What are some causes of erythrocytosis/Polycythaemia?
Think of Billy
- Increased cell production (haemochromatosis)
- Chronic hypoxia
- Dehydration
Apart from Iron deficiency, name two other causes of microcytic anaemia?
Thalassemia - having less Hb than normal
Sickle cell disease - sickle shaped RBC making it harder to move across the body, alongside dying earlier
Sideroblastic anaemia - Body produces enough iron but it is unable to be stored into Hb
Apart from B12 and folate deficiencies, what else can cause macrocytic anaemia?
Alcohol consumption
Hypothyroidism
What are some causes of thrombocytopenia? (<150)
Bone marrow dysfunction
Acute blood loss
Drugs - Heparin induced thrombocytopenia
Autoimmune diseases - SLE
What are some causes of primary thrombocytosis? (>450)
Primary Thrombocythemia - rare blood clotting disorder
Polycythaemia Vera
What are some causes of secondary thrombocytosis?
Chronic bleeding from malignancy (bowel cancer)
Infections
Fe Deficiency
What is leucocytosis?
WCC > 11
What is leucopeania?
WCC < 4
What is the most important cause of Neutrophilia? <7.5
Haematological malignancies
- Myeloid leukaemia
What is acute myeloid leukaemia?
Condition where the bone marrow produces too many immature monocytes/granulocytes (WCC) and they are unable to fight properly against infection
What are other causes of neutrophilia?
Infection
Vomiting
Labour
What level of neutropenia should you be concerned about to consider a patient as immuno-compromised?
(Normal <2.0)
<0.5
How would a patient present to make you worry about neutropenic sepsis? (3 marks)
Fever >38
Neutropenia (<0.5)
Signs of sepsis
What are some causes of neutropenic sepsis?
Chemo
Infections
Bone marrow disorder
What blood tests would you order for neutropenic sepsis?
FBC - check WCC CRP - infection U&E / Creatinine - dehydration / AKI LFT - increased bilirubin and ALT (cholestasis - chemo induced) Clotting screen - DIC
Apart from blood sample, what other tests can you do to investigate neutropenic sepsis?
Blood gas - hypo/hyperglycaemia and hyperlactataemia
Blood cultures
Cause of lymphocytosis >4.5
Think of two causes beginning with L
Viral infections
Leukaemia
Lymphomas
Causes of lymphopenia (<1.5)
HIV
Sarcoidosis
If a patient is leucopenic (neutrophils and lymphocytes), spiking fevers and no improvement with abx, what should you be concerned about and how should you investigate this?
Fungal infection
- Serum galactomannan & Beta-d-glucan
First one checks for aspergillosis
What haematological conditions are associated with monocytosis? (>0.8)
Myelodysplastic syndrome (MDS) - not enough healthy blood cells
Hodgkin lymphoma - cancer of the lymphatic system
Acute myeloid leukaemia - cancer that starts from young white blood cells
What type of cells would you see for Hodgkin’s lymphoma?
Reed-sternberg cells
Causes of eosinophilia? (>0.4)
Allergy
Hodgkin’s lymphoma
AML
Eosinophilic leukaemia
Causes of increased ESR
think of dad
HIV
Myeloma/MGUS
Causes of decreased ESR
Polycythaemia
How do you correctly identify iron status? (3 marks)
Serum iron
TIBC
Transferrin saturation
Causes of prolonged thrombin time when checking clotting screen?
Vit K deficiency
Warfarin
DIC
What is Haemoglobinopathies screening?
Group of tests to identify abnormal forms of Hb production to help screen for a Hb disorder
If a patient is being screened for sickle cell or thalassemia for the first time, what else should you add to the sample?
Ferritin - to check for any iron deficiencies
How long does it take for the screening result of sickle cell to come back?
< 1 hour
What are the two confirmatory tests to screen for sickling disorders?
Hb Electrophoresis
High pressure liquid chromatography
What bloods do you send off to screen for thalassemia’s and what would they show?
FBC - microcytic, hypochromic anaemia (small, pale)
- elevated WCC
Iron & Ferritin - raised
What is a confirmatory test for thalassaemia?
Hb electrophoresis
What findings on a blood test indicates multiple myeloma? (C.R.A.B)
C - Calcium - high
R - Renal failure
A - Anaemia (normocytic, normochromic –> same size and shape)
B - Bone lesions/pain
What are the initial investigations for suspecting multiple myeloma/MGUS in a patient presenting with persistent bone pain and over 60? (4 marks)
FBC - low WCC
Calcium - high
ESR - high
Plasma viscosity - high
If the bloods are positive for suspicion of multiple myeloma/MGUS, what are the other initial investigations that should be sent? (B.L.I.P)
B - Bence jones protein (urine electrophoresis) >500mg
L - Light chain assay (serum free)
I - Immunoglobulins (serum)
P - Protein electrophoresis (serum)
What is direct antibody testing / coombs test?
Test to check for antibodies that are destroying the bodies RBC and causing haemolytic anaemia
Besides haemolytic anaemia, what else does the direct antibody test, test for?
acute haemolytic transfusion reaction
What is acute haemolytic transfusion reaction and what triad of symptoms would you see associated with this?
Reaction 24 hours after blood transfusion
Fever
Flank Pain
Reb/Brown urine
Name some risk factors associated for causing acute haemolytic transfusion reaction
- ABO incompatibility
- Pregnancy
- Prior history
What is tumour lysis syndrome and what electrolyte abnormalities would you find with it?
EMERGENCY
Oncological emergency caused by the breakdown of cancer cells after chemo into the bloodstream, causing raised potassium, raised urea, raised phosphate and low calcium
What is haemophilia and factors are deficient in haemophilia A and B?
Haemophilia is a bleeding disorder due to the deficiency of certain clotting factors
Haemophilia A - factor 8 (XIII)
Haemophilia B - factor 9 (IX)
Why does haemophilia effect men more than women?
X linked recessive disorder
Women would need both of their X chromosomes to be affected
Men only have one X chromosome
What is a classic feature of severe haemophilia?
Spontaneous bleeding into joints and muscles
What two things would you want to investigate to diagnose haemophilia?
APTT - would be prolonged
Factor 8 & 9 coagulation assay - decreased/absent
(+ FBC, PT )
What is thrombophilia / hypercoagulable state ?
A condition where your body forms clots too quickly and puts you at a higher risk of developing a DVT and PE
What investigations would you do to check if someone has thrombophilia?
FBC - anaemia, raised WCC and raised or reduced platelet
aPTT - reduced or prolonged (need to distinguish baseline before starting anticoagulation)
Fibrinogen - high in prothrombotic state / low in DIC
PT - prolonged in DIC
D-dimer - normal or raised
Investigate nephrotic syndrome:
albumin - low
creatinine - high
What findings would you see in iron deficiency anaemia?
Low Hb Low MCV Low ferritin Low MCHC High total iron binding capacity High RDW
What group of patients have a higher risk of developing vit b12 / folate deficiencies?
Patients who have had a type of bariatric surgery
How do you distinguish between Vit b12 or folate deficiency?
Fruits & Fegetables –> folate
Beef an bacon –> b12 (more seen in vegans)
If a patient is deficient in those types of food, it will lead to that deficiency
How long after should you recheck a patients hb levels once they’ve started oral ferrous sulphate for iron deficiency anaemia?
2-4 weeks after
If good response to treatment –> 2-4 months
Name two early signs of vit b12 deficiency and who is at risk of developing this?
Limb paraesthesia & peripheral neuropathy
Alcoholics
In what situation would you use haemoglobin electrophoresis?
Microcytic anaemia with normal iron levels
