HAEM/ONCO Flashcards

1
Q

What information does FBC provide?

A

overview of bone marrow function
infection state
anaemia

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2
Q

What type of blood sample is an FBC?

A

venous - EDTA sample

purple top

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3
Q

How are Haemoglobin levels interpretation?

A

High Hb = erythrocytosis - due to dehydration, EPO elevation and chronic hypoxia

Low Hb = Aneamia - check MCV

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4
Q

How to interpret MCV in anaemia?

A

High MCV >100fL = macrocytosis
- due to vitB12/Folate def, alcoholism, medications, liver disease

Low MCV <80fL = microcytosis
- due to iron def, sickle cell, thalassemia, chronic disease

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5
Q

What role do platelets have?

A

Formation of blood clots

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6
Q

Causes of thrombocytopenia?

A
bone marrow dysfunction 
acute blood loss 
heparin induced 
liver disease
autoimmune - SLE/ITP 
infections 
hypersplenism
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7
Q

Thrombocytosis can be divided into…..

A

Primary
- essential thrombocythemia, polycythemia vera, CML and myelofibrosis

Secondary

  • infections/inflammatory conditions
  • splenectomy
  • acute bleed/malignancy
  • iron deficiency
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8
Q

How is WCC interpreted?

A
>11 = leucocytosis 
<4 = leucopenia 

> 50 - consider the possibility of hyperviscosity

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9
Q

How are Neutrophils interpreted?

A
<2 = neutropenia
>7.5 = neutrophillia
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10
Q

Causes of neutrophillia?

A
vomiting
infection 
dehydration, trauma and burns 
HAEMTOLOGICAL MALIGNANCIES 
drugs 
surgery 
labour
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11
Q

Causes of neutropenia?

A
HAMAETOLOGICAL MALIGNANCIES 
viral infections 
bacterial sepsis
splenomagely 
chemo/drugs 
SLE
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12
Q

How to interpret Lymphocytes?

A

> 4.5 lymphocytosis

<1.5 lymphocytopenia

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13
Q

Causes of Lymphocytosis?

A

viral infections
lymphomas/leukaemia
splenectomy
B-thalassemia

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14
Q

Causes of Lymphocytopenia?

consideration in chronic lymphocytopenia?

A

acute phase of viral/bacterial infections
HIV/COVID
chemo or Bone marrow trasnsplant

chronic lymphocytopenia consider opportunistic infections

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15
Q

How to interpret monocytes?

A

> 0.8 = monocytosis

<0.2 - monocytopenia

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16
Q

Causes of monocytosis?

A

infectious disease = Malaria, TB, typhoid
infective endocarditis
AML, hodgkins lymphoma

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17
Q

Causes of Eosinophilia?

A
drugs - erythema multiforme, steven johnson syndrome 
parasitic infection 
allergy/atopy 
pemphigus 
sarcoidosis 
hodgkins, AML, esophillic leukaemia 
RA, SLE and polyarterits nodosa
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18
Q

What is the Hematocrit?

A

Measure of RBC in serum sample as percentage

MCV x proportion of sedimented cells in centrifuged sample

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19
Q

How is Basophil level interpreted?

A
>0.1 = basophillia 
<0.1 = basopenia
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20
Q

Causes of Basophillia?

A
IgE mediated hypersensitivity
hypothyroid 
drugs 
AML/CML 
Polycythemia rubra/vera
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21
Q

Causes of Basopenia?

A
leucocytosis 
thyroxicosis 
haemorrhage 
cushing's 
allergic reaction 
drugs
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22
Q

What can RBC do?

A

help to identify any haemoglobinopathy

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23
Q

What type is the Blood film sample?

How is it done?

A

taken from EDTA bottle (purple top)
Small drop of blood placed onto slide and spread thinly
revied by Haem SpR/consultant

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24
Q

What does anisocytosis mean? when is it seen?

A

variation of RBC sizes

seen in myelodysplastic syndrome
some forms of anaemia

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25
Target cells seen in...
Iron deficiency anaemia | post-splenectomy
26
What are Heinz bodies? | When are they seen?
denatured globin seen in.... G6PD and a-thalassemia
27
Howell Jolly Bodies are... | seen in...
blobs of DNA in RBC post-splenectomy severe anaemia
28
Reticulocytes are... | seen in...
immature RBC seen in haemolytic anaemia
29
Schistocytes are... | seen in...
fragments of FBC ``` seen in... haemolytic uraemic syndrome DIC TTP Metallic heart valves haemolytic anameia ```
30
Sideroblasts are... | what does it indicate?
Immature RBCs with blobs of iron indicates... myelodysplastic sydrome
31
What are smudge cells? | seen in....
ruptured WBCs seen in chronic lymphocytic leukaemia
32
sphreocytes
spherical RBCs - not normal bi-concave disc indicative of... hereditary spherocytosis autoimmune haemolytic anaemia
33
What is tumour lysis syndrome?
metabolic abnormalities resulting from rapid cell death in the treatment of haematological disease
34
What are findings suggestive of TLS?
``` hyperkalaemia hyperuriciamia hyperphosphataemia hypocalcaemia AKI (raised creatinine and urea) ```
35
What type of sample is the clotting profile?
Citrate sample (light blue) citrate sequesters Ca2+ - preventing clotting
36
What results are included in the clotting profile?
PT APTT Thrombin time INR
37
What is PT? | prolonged when?
Time take for sample to clot once calcium and tissue factor is introduced - normal ia 11-14 secs prolonged in vitK def, warfarin use, DIC, Liver disease and factor 7 deficiency
38
What is APTT? | Prolonged when?
time taken for sample to clot when Calcium and contact factor are introduced - normally 32-38 seconds prolonged when vit K def, warfarin use, DIC, liver disease, hemophilias, Unfractionated heparin and factor 12 deficiency
39
What is thrombin time? | prolonged when?
time taken for sample to clot when thrombin is introduced prolonged when unfractionated heparin DIC thrombolysis
40
What is INR?
value calculated to asses the anticoagulant effect of warfarin on warfarin the target range is 2-3
41
What is D-Dimer? | What do the values mean?
bi-product molecule of fibrinolysis orginally developed to detect and monitor DIC but now more used as an aid to rule out possible thrombus under 50s = <230ng/l D-dimer units over 50s = adjusted value
42
Raised D-dimer?
``` DIC, thrombosis aortic dissection malignancy infection pregnancy inflammation ```
43
How is d-dimer interpretated?
negative d-dimer can helpt to rule out a thrombosis - potential cause of PE and DVT negative d-dimers may be due to the embolism being made up of another substance = air, fat or amniotic fluid However positive D-dimer is not diagnostic - calculate Wells score
44
What is Haemophilia? | What tests results are suggestive of it?
x-linked recessive disorder of coagulation Blood tests - Prolonged APTT bleeding, thrombin and PT are all normal
45
What is the thrombophilia screen designed for?
provide evidence of inherited deficiencies for naturally occuring anticoagulants these include: antithrombin protein S protein C
46
What does transfusion reaction usually present with?
flushing, chills, dyspnoea, fever presence of RFs - ABO incompatibility - pregnancy or transfusion - transplantation or immunocompromised - IgA deficiency - prior hx of transfusion recation
47
What are haematinics? | what does the sample test for?
Haematinics are nutrients required for the formation of blood cells. ``` Ferritin transferrin/TIBC serum iron B12 Folate ```
48
What type of sample is haematinics?
Serum seperating tube (SST) - yellow/gold tube
49
What is ESR?
ESR is erythrocyte sedimentation rate used to asses possible inflammation or 'acute phase'
50
When is ESR raised?
infection, inflammatory disease, anaemia, pregnancy, paraproteinemias, neoplastic conditions and sickle cell crisis
51
When is there decreased ESR ?
polycythemia hyperviscosity spherocytosis sickle cell disease
52
How is sickle cell/haemoglobinopathies screened/tested for?
EDTA (purple) bottle - HPLC (chromatography), electrophoresis and PCR are done - if first time screen - check ferritin levels to rule out anaemia
53
Confirmatory/definitive test for Sickle cell disease?
HB electrophoresis/HPLC - HBS (80-90%) - some patients may have raised HbF
54
Tests done for Thalassemias?
HPLC electrophoresis exact genotypes established with PCR
55
What does urine bence jones protein test involve? | What are the indications?
Involves a clean catch urine sample being sent to lab - check for immunoglobulin light chains aka bence jones proteins
56
Most accurate method to detect bence jones proteins?
immunoelectrophoresis
57
Reasons for abnormal results in bence jones urine test
amyloidosis - buildup of protein in tissue/organ CLL /Lymphoma MGUS - build up of m-protein chronic renal failure
58
What is serum electrophoresis used for? | What does the sample involve?
Primarily used to screen/detect/assess/monitor paraproteinaemia
59
Uses of urinary electrophoresis?
typically performed in worsening kidney disease | Bence Jones protein
60
Mprotein/paraprotein spikes found in gammaglobulin region of electrophoresis can indicate...
``` multiple myeloma lymphoma CLL amylodoisis MGUS Walderstorms macroglobulinaemia RA, SLE, liver cirrhosis and chronic infections ```
61
Indications of Reticulocyte count?
help distinguish between anaemia from either... - acute blood loss - due to destruction of RBCs - decreased RBC production monitor bone marrow response to chemo, bone marrow transplant, Follow-up after iron def anaemia tx
62
What sample type is reticulocyte count?
EDTA sample (purple)
63
What is the direct antibody test? | What is it commonly known as?
Test for immunoglobulins targeting against RBCs aka Direct coombs test
64
When is the direct antibody test done?
Investigation of - autoimmune haemolytic anaemia - acute haemolytic transfusion reaction
65
What type of sample is the direct antibody test?
EDTA sample
66
What Ix done in Acute lymphocytic leukaemia? | Findings?
FBC - neutropenia, anaemia and thrombocytopenia Blood film - blast cells flow cytometry done to check lineage affected - b lymphocytes
67
What Ix done Chronic lymphocytic leukaemia? | Findings?
FBC - lymphocytosis and anaemia Blood film - smudge/smear cells immunophenotyping to confirm type of leukaemia - well differentiated B lymphocytes
68
What Ix done in Acute Myeloid leukaemia? | Findings?
Blood film - blast cells (auer rods)
69
What Ix done in Chronic Myeloid Leukaemia? | Findings?
Blood film - granulocytes of varying stages in maturation | - thrombocytosis can be present also
70
What Ix done in Hodgkin's lymphoma? | Findings?
Blood film - reed sternberg cells Bloods - normocytic anaemia, eosinophillia and raised ldh
71
Staging in Hodgkin's lymphoma?
Staging - Ann-Arbour staging 1 = single lymph node 2 = 2+ lymph nodes - same side of diaphragm 3 = nodes on both sides of diaphargm affected 4 = spread beyond lymph nodes
72
What Ix done in burkitt's lymphoma? | Findings?
excisional lymph node biopsy - starry sky appearance Bloods - normocytic anaemia ESR/LDH measured for prognostic purposes CT CAP = staging purposes
73
What Ix done in Multiple myeloma? | Findings?
Bloods - low WCC, elevated ESR/calcium and plasma viscosity Urea and creatinine raised Bence-jones protein in urine or monoclonal proteins in blood Bone marrow aspirate - confirms diagnosis Whole body MRI - check for bone lesions blood film = roleaux formaton Skull XR - lytic lesions aka raindrop skull
74
What is Waldenstrom's macroglobulinaemia? What Ixs are done? findings?
condition affecting older men involving the secretion of a monoclonal IgM paraprotein Biospy of bone marrow FBC low complement (esp. C4) high ESR
75
What Ix done in Haemophillia? Findings?
clotting profile - prolonged APTT - bleeding time, thrombin time, prothrombin time normal
76
Describing procedure of Bone marrow aspiration
1. slides - blood assessed under microscope by senior hematologist 2. Immunophenotype - identifying cell lineage as well as confirming diagnosis, classifying and monitoring response to tx 3. cytogenetic = chromosomal sequencing - check for genetic disease 4. trephine = 'coring' biopsy - more detailed identification of the degree of infiltration - if malignancy