HAEM/ONCO Flashcards
What information does FBC provide?
overview of bone marrow function
infection state
anaemia
What type of blood sample is an FBC?
venous - EDTA sample
purple top
How are Haemoglobin levels interpretation?
High Hb = erythrocytosis - due to dehydration, EPO elevation and chronic hypoxia
Low Hb = Aneamia - check MCV
How to interpret MCV in anaemia?
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
What role do platelets have?
Formation of blood clots
Causes of thrombocytopenia?
bone marrow dysfunction acute blood loss heparin induced liver disease autoimmune - SLE/ITP infections hypersplenism
Thrombocytosis can be divided into…..
Primary
- essential thrombocythemia, polycythemia vera, CML and myelofibrosis
Secondary
- infections/inflammatory conditions
- splenectomy
- acute bleed/malignancy
- iron deficiency
How is WCC interpreted?
>11 = leucocytosis <4 = leucopenia
> 50 - consider the possibility of hyperviscosity
How are Neutrophils interpreted?
<2 = neutropenia >7.5 = neutrophillia
Causes of neutrophillia?
vomiting infection dehydration, trauma and burns HAEMTOLOGICAL MALIGNANCIES drugs surgery labour
Causes of neutropenia?
HAMAETOLOGICAL MALIGNANCIES viral infections bacterial sepsis splenomagely chemo/drugs SLE
How to interpret Lymphocytes?
> 4.5 lymphocytosis
<1.5 lymphocytopenia
Causes of Lymphocytosis?
viral infections
lymphomas/leukaemia
splenectomy
B-thalassemia
Causes of Lymphocytopenia?
consideration in chronic lymphocytopenia?
acute phase of viral/bacterial infections
HIV/COVID
chemo or Bone marrow trasnsplant
chronic lymphocytopenia consider opportunistic infections
How to interpret monocytes?
> 0.8 = monocytosis
<0.2 - monocytopenia
Causes of monocytosis?
infectious disease = Malaria, TB, typhoid
infective endocarditis
AML, hodgkins lymphoma
Causes of Eosinophilia?
drugs - erythema multiforme, steven johnson syndrome parasitic infection allergy/atopy pemphigus sarcoidosis hodgkins, AML, esophillic leukaemia RA, SLE and polyarterits nodosa
What is the Hematocrit?
Measure of RBC in serum sample as percentage
MCV x proportion of sedimented cells in centrifuged sample
How is Basophil level interpreted?
>0.1 = basophillia <0.1 = basopenia
Causes of Basophillia?
IgE mediated hypersensitivity hypothyroid drugs AML/CML Polycythemia rubra/vera
Causes of Basopenia?
leucocytosis thyroxicosis haemorrhage cushing's allergic reaction drugs
What can RBC do?
help to identify any haemoglobinopathy
What type is the Blood film sample?
How is it done?
taken from EDTA bottle (purple top)
Small drop of blood placed onto slide and spread thinly
revied by Haem SpR/consultant
What does anisocytosis mean? when is it seen?
variation of RBC sizes
seen in myelodysplastic syndrome
some forms of anaemia
Target cells seen in…
Iron deficiency anaemia
post-splenectomy
What are Heinz bodies?
When are they seen?
denatured globin
seen in….
G6PD and a-thalassemia
Howell Jolly Bodies are…
seen in…
blobs of DNA in RBC
post-splenectomy
severe anaemia
Reticulocytes are…
seen in…
immature RBC
seen in
haemolytic anaemia
Schistocytes are…
seen in…
fragments of FBC
seen in... haemolytic uraemic syndrome DIC TTP Metallic heart valves haemolytic anameia
Sideroblasts are…
what does it indicate?
Immature RBCs with blobs of iron
indicates…
myelodysplastic sydrome
What are smudge cells?
seen in….
ruptured WBCs
seen in chronic lymphocytic leukaemia
sphreocytes
spherical RBCs - not normal bi-concave disc
indicative of…
hereditary spherocytosis
autoimmune haemolytic anaemia
What is tumour lysis syndrome?
metabolic abnormalities resulting from rapid cell death in the treatment of haematological disease
What are findings suggestive of TLS?
hyperkalaemia hyperuriciamia hyperphosphataemia hypocalcaemia AKI (raised creatinine and urea)
What type of sample is the clotting profile?
Citrate sample (light blue)
citrate sequesters Ca2+ - preventing clotting
What results are included in the clotting profile?
PT
APTT
Thrombin time
INR
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
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
What is thrombin time?
prolonged when?
time taken for sample to clot when thrombin is introduced
prolonged when
unfractionated heparin
DIC
thrombolysis
What is INR?
value calculated to asses the anticoagulant effect of warfarin
on warfarin the target range is 2-3
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
Raised D-dimer?
DIC, thrombosis aortic dissection malignancy infection pregnancy inflammation
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
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
What is the thrombophilia screen designed for?
provide evidence of inherited deficiencies for naturally occuring anticoagulants
these include:
antithrombin
protein S
protein C
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
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
What type of sample is haematinics?
Serum seperating tube (SST) - yellow/gold tube
What is ESR?
ESR is erythrocyte sedimentation rate
used to asses possible inflammation or ‘acute phase’
When is ESR raised?
infection, inflammatory disease, anaemia, pregnancy, paraproteinemias, neoplastic conditions and sickle cell crisis
When is there decreased ESR ?
polycythemia
hyperviscosity
spherocytosis
sickle cell disease
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
Confirmatory/definitive test for Sickle cell disease?
HB electrophoresis/HPLC
- HBS (80-90%)
- some patients may have raised HbF
Tests done for Thalassemias?
HPLC electrophoresis
exact genotypes established with PCR
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
Most accurate method to detect bence jones proteins?
immunoelectrophoresis
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
What is serum electrophoresis used for?
What does the sample involve?
Primarily used to screen/detect/assess/monitor paraproteinaemia
Uses of urinary electrophoresis?
typically performed in worsening kidney disease
Bence Jones protein
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
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
What sample type is reticulocyte count?
EDTA sample (purple)
What is the direct antibody test?
What is it commonly known as?
Test for immunoglobulins targeting against RBCs
aka Direct coombs test
When is the direct antibody test done?
Investigation of
- autoimmune haemolytic anaemia
- acute haemolytic transfusion reaction
What type of sample is the direct antibody test?
EDTA sample
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
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
What Ix done in Acute Myeloid leukaemia?
Findings?
Blood film - blast cells (auer rods)
What Ix done in Chronic Myeloid Leukaemia?
Findings?
Blood film - granulocytes of varying stages in maturation
- thrombocytosis can be present also
What Ix done in Hodgkin’s lymphoma?
Findings?
Blood film - reed sternberg cells
Bloods - normocytic anaemia, eosinophillia and raised ldh
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
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
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
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
What Ix done in Haemophillia? Findings?
clotting profile
- prolonged APTT
- bleeding time, thrombin time, prothrombin time normal
Describing procedure of Bone marrow aspiration
- slides - blood assessed under microscope by senior hematologist
- Immunophenotype - identifying cell lineage as well as confirming diagnosis, classifying and monitoring response to tx
- cytogenetic = chromosomal sequencing - check for genetic disease
- trephine = ‘coring’ biopsy - more detailed identification of the degree of infiltration - if malignancy
