Haematological changes in systemic disease Donald mcdonald 250821

Question 1

Primary disorders - germline inherited

Answer 1

FIX - deficiency = haemophilia B
excess = FIX padua

erthryocytes
deficiency = beta thalassaemia
excess = VHL gene = chuvash polycythaemia

Question 2

Primary disorders - acquired

Answer 2

e.g. leukaemia

Question 3

secondary disorders - erythrocytes

Answer 3

excess - cyanotic heart disease/hypoxia

deficiency - anti RBC antibodes - immune haemolysis

Question 4

describe the causes and findings of iron deficiency and underlying malignancy

Answer 4

microcytic hypochromic anaemia reduced ferritin transferrin saturation raised TIBC

causes - blood loss e.g. gastric/renal cell cancer, maenorrhagia

Question 5

describe what youd see on blood film in leuco erythroblastic anaemia?

Answer 5

teardrop RBCs, nucleated RBCs, immature myeloid cells

Question 6

causes of leucoerythroblastic anaemia film

Answer 6

malignant (haemopoietic, non haemopaetic), severe infection (miliary TB, severe fungal infection), myelofibrosis (massive splenomegaly, dry tap on bM aspirate)

Question 7

common features of haemolytic anaemias

Answer 7

anaemia, reticulocytosis, unconjugated bilirubin raised (pre-hebatic, LDH raised (intracellular contents of RBC), haptoglobins reduced,

Question 8

Haemolytic anaemias can be divided into

Answer 8

inherited and acquired

Question 9

inherited haemolytic anaemias

Answer 9

membrane (hereditary spherocytosis), cytoplasm (G6PD), Haemoglobin (SICKLE CELL)

Question 10

acquired haemolytic anaemias

Answer 10

immune, non-immune

Question 11

Immune mediated anaemia - DAT positive what will you see on blood film

Answer 11

spherocytes, agglutination, dat positive

Question 12

non-immune mediated anaemia what will you see on blood film

Answer 12

RBC fragments (schistocytes)< thrombocytopenia, DAT negative

Question 13

causes of non-immunemediated anaemia

Answer 13

infection (malaria),
paroxysmal nocturnal haemoglobinuria (hams test positive)
microangiopathic haemolytic anaemia (MAHA - adenocarcinoma, HUS, TTP)

Question 14

female with breast cancer recent jaundice and hepatomegaly, low reticulocytes,dat negative, immature cells in blood film

Answer 14

leucoerythroblastic anaemia due to BM mets

Question 15

causes of neutrophilia

Answer 15

corticosteroids, neoplasia, tissue inflammation (colitis or pancreatitis), myeloproliferative or leukemic disorders, pyogenic infection (most likely)

Question 16

evaluating neutrophils - reactive infection

Answer 16

neutrophilia, toxic granulation, no immature cells, only neutrophils, heavy granulation, vacuoles in the neutrophils

Question 17

evaluating neutrophils - malignant

Answer 17

neutrophilia, basophilia, immature cells (myelocytes)+ splenomegaly = CML

neutropenia +myeloblasts = AML

Question 18

how does the kappa lambda ratio change in monoclonal b cell lymphocytosis

Answer 18

becomes mainly kappa, or mainly lambda- monoclonal

Question 19

Lymphocytosis causes

Answer 19

EBV, CMV, infectious hepatitis, rubella, herpes, Autoimmune sarcoidosis

Question 20

Eosinophilia causes

Answer 20

parasites, allergy, hodgkins, reaction erythema multiforme, chronic eosinophilic leukemia

Question 21

chronic vs acute myeloid leukaemia

Answer 21

chronic - proliferation increased, differentiation normal

acute - proliferation increased and differentiation blocked

Question 22

how is a leukaemia/lymphoma diagnosis establoshed

Answer 22

morphology ( large small, mature, immature) immunophenotype (myeloid, lymphoid, t or b lineage) , cytogenetics (chromosome translocations etc) , molecular genetics