Haem MRCPCH Flashcards
Acanthocytes - Name four causes for presence of acanthocytes on peripheral film
- Abetalipoproteinaemia
- Severe liver disease
- Vitamin E deficiency in premature neonates
- hereditary acanthocytosis
BASOPHILIA - Name four causes of basophilia
- Myeloproliferative disorders
- chronic myeloid leukaemia (CML)
- basophilic leukaemia
- Reactive disorders, e.g. ulcerative colitis, infection
BASOPHILIC STIPPLING - name four causes
- Ineffective erythropoiesis
- Haemoglobinopathies
- Recovering bone marrow
- Lead poisoning
ECHINOCYTES (BURR CELLS) - give 5 causes
- Liver disease
- Renal failure
- HUS
- Burns
- pyruvate kinase deficiency
ELLIPTOCYTES - give a cause
Hereditary elliptocytosis
EOSINOPHILIA - give four causes
- Parasitic infections
- allergic states, e.g. asthma, eczema
- Drugs
- Polyarteritis
SCHISTOCYTES (fragmented red blood cells)
- Microangiopathic anaemia
- Mechanical haemolytic anaemias
- DIC
- HUS
- Renal failure
Heinz bodies (intracellular Hb precipitate) - give 5 causes
- G6PD deficiency
- haemoglobinopathies
- post-splenectomy
- hyposplenism
- Heinz body haemolysis
Howell– Jolly bodies (intracellular DNA fragments) - 4 causes
- Normal neonatal blood picture
- hyposplenia
- post-splenectomy
- megaloblastic anaemia
Lymphocytopenia (lymphopenia) - causes
- Infection, mainly viral
- malignancy
- stress
- vomiting
- burns
- anorexia
- drugs
- SLE
- Crohn’s disease
- immunodeficiency states (SCID, diGeorge syndrome, acquired, e.g. HIV)
- marrow failure
- aplastic anaemia
- leukaemia
LYMPHOCYTOSIS
- Infection - pertussis, mycoplasma, malaria, viruses
- leukaemia
- Atypical lymphocytosis (EBV, CMV, adenovirus)
- stress
- exercise
- status epilepticus
MACROCYTIC RBCs - 3 causes
- Vitamin B12 or folate deficiency
- aplastic anaemia
- normal neonatal blood picture
MICROCYTIC RBCs - causes
- Iron deficiency
- thalassaemia
- anaemia of chronic disease
MONOCYTOPAENIA - causes
- Autoimmune disorders, e.g. SLE
- Drugs, e.g. corticosteroids, chemotherapy
MONOCYTOSIS
- Chronic bacterial infection
- Malaria
- Typhoid
- TB
- Infective endocarditis
- Post-chemotherapy
- JMML, CML
NEUTROPHILIA - Causes
- Infection
- inflammation
- chronic bleeding
- post-splenectomy
- drugs, e.g. corticosteroids
Reticulocytosis/ polychromatic RBCs - causes
- Haemolysis
- bleeding
- response to haemotinics (e.g. iron)
- marrow infiltration
- co-existent megaloblastic and iron deficiency anaemia?
SPHEROCYTES - causes
- Normal neonatal blood picture
- hereditary spherocytosis
- immune mediated haemolytic disease
- post-splenectomy
TARGET CELLS - Causes
- Severe iron deficiency
- sickle cell disease
- Thalassaemia
- Liver disease
- Post-splenectomy, asplenia
Immune haemolytic anaemia (OHP)
Immune haemolytic anaemia
In this group of disorders, RBCs react with autoantibody +/ − complement, which leads to their destruction by the reticuloendothelial system. Many drugs can induce antibody-mediated haemolysis, e.g. penicillins, cephalosporins, ibuprofen, anti-malarials, rifampicin, antihistamines. Mechanisms are variable. Immune haemolytic anaemia can be divided into isoimmune and autoimmune forms.
Isoimmune
Sensitization induces maternal red cell antibodies that cross placenta and haemolyse foetal and neonatal red cells. Usually, direct Coombs test + ve.
- Rhesus haemolytic disease.
- ABO incompatability.
- Other blood group incompatibilities, e.g. Kell, Duffy, blood groups
Autoimmune
Warm antibody type— mostly IgG
- Rare.
- Majority are idiopathic.
- Other causes: drugs (e.g. penicillin), lymphoid malignancies, autoimmune diseases (e.g. SLE, IBD).
- Variable haemolytic anaemia, mild jaundice, splenomegaly, DCT + ve.
- Warm autoantibodies— often non-specific.
- Treatments include IVIG, steroids, other immunosuppressants, splenectomy, rituximab
Cold antibody type— mostly IgM
- Very rare in children except PCH (see Paroxysmal cold haemoglobinuria).
- RBC antibody reacts most actively < 32 ° C to cause intravascular RBC haemolysis.
- Idiopathic or secondary to EBV or Mycoplasma infection.
- Acrocyanosis in cold, splenomegaly.
- Chronic haemolytic anaemia, DCT − ve for IgG, + ve for C3.
- IgM autoantibodies react best at 4 ° C.
- Treatment: Treatment rarely needed. Warmth, immunosuppression, plasma exchange, and splenectomy may help. Usually, the condition is self-limiting if there is an infectious cause.
Paroxysmal cold haemoglobinuria (PCH)
- 2 ° to infections (varicella, measles, syphilis) and vaccinations.
- Acute onset of intravascular haemolysis, after fever and chills.
- Due to a biphasic antibody, called Donath Landsteiner antibody.
- Antibody fixes on the cells in the cold peripheries and lyses in the central warmth of the body— protect from cold.
- Transfuse as required. Condition is self limiting.
