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Haematology - Path > Haematological changes in systemic disease > Flashcards

Haematological changes in systemic disease Flashcards

1
Q

What can be the first presentation of cancer?

A

Anaemia

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2
Q

What are the 4 main types of anemia associated with cancer/systemic disease?

A
  • Iron deficiency anemia - Anaemia of chronic disease - Leucoerythroblastic anaemia - Haemolytic anaemias
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3
Q

What two types of cancer can also cause secondary polycythemia?

A

Renal cell cancer and liver cancer

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4
Q

What is the most common cause of Fe deficiency anaemia?

A

Occult blood loss e.g. GI cancers, urinary tract cancers

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5
Q

What are the laboratory findings for Fe deficiency anaemia?

A
  • Reduced ferritin - Transferrin saturation - Low Hb - Low MCV
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6
Q

What is leuco-erythroblastic anemia?

A

Red cell and white cell precursor anaemia. Causes a variable degree of anaemia

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7
Q

What the morphological features of leuco-erythroblastic anaemia on a blood film?

A
  • Tear drop red blood cells (aniso and poikilocytosis)
  • Nucleated RBCs
  • Immature myeloid cells
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8
Q

What does this blood film show?

A

Leuco-erythroblastic anaemia

  • tear drop poikilocytes
  • Nucleated red blood cells
  • myelocytes
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9
Q

What are the 3 main causes of bone marrow infiltration that causes a leucoerythroblastic film?

A
  • Cancer - haemopoietic e.g leukemia/lymphoma/myeloma. Or non-haempoitetic e.g. breast/bronchus/prostate
  • severe infection e.g. miliary TB, severe fungal infection
  • myleofibrosis - massive splenomegaly, dry tap on BM aspirate
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10
Q

What are the most common distinguishing features of haemolysis? (any aetiology)

A
  • anaemia - though may be compensated
  • reticulocytosis
  • raised bilirubin (unconjugated)
  • raised LDH - intracellular enzyme
  • Reduced haptoglobins
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11
Q

What are the two pathogenic groups of haemolytic anaemias?

A
  • Inherited - defects of the red cell
  • Acquired - defects of the environment in which the red cell finds itself. Can be immune or non-immune
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12
Q

What test can distinguish between immune and non-immune types of acquired haemolytic anaemias?

A

Direct Antiglobulin (DAT or Coombs test)

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13
Q
  1. What are findings on haematological studies are associated with auto-immune haemolysis?
  2. What can be the underlying cause of auto-immune haemoloysis?
A
  1. Anaemia, reticulocytosis, raised unconjugated bilirubin, raised LDH, Positive DAT
  2. Idiopathic or underlying lymphoma/CLL/SLE
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14
Q

What are the two main causes of acquired haemolytic anaemia/non-immune/DAT negative?

A
  • Infection - malaria
  • Micro-angiopathic Haemolytic anaemia (MAHA)
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15
Q
  1. What are the main findings in blood studies for MAHA?
  2. What conditions are MAHA associated with?
A
  1. Red cell fragments, low platelets, DIC/bleeding
  2. Underlying adenocarcinoma and Haemolytic Uremic syndrome (E.coli infection)
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16
Q

What does this blood film show?

A

MAHA - Micro-angio-pathic haemolytic anaemia

  • red cell fragments
  • thrombocytopenia
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17
Q

Micro angiopathy can happen because of malignancy e.g. adenocarcinomas.

Describe the underlying mechanism

A
  • Adenocarcinoma, low grade DIC
  • Platelet consumption occurs
  • Leading to fibrin deposition and degradation
  • Red cell fragmentation occurs - microangiopat
  • Bleeding occurs
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18
Q

What are the two main causes of true polycythemia in cancer?

A

True polycythemia is raised red cell mass

  1. Secondary raised EPO appropriate/inappropriate e.g. hepatocellular cancer, bronchial cancer, renal cancer
  2. Polycythemia vera (PV) e.g. Clonal myleoproliferative disorder acquired mutations in JAK2
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19
Q

What types of white blood cells are there?

A
  1. Normal mature phagocytes - neutrophils, eosinophils and basophils
  2. monocytes
  3. immunocytes - T and B lymphocytes, NK cells

Immature - blasts present in a small percentage. Many immature cells are not normal

20
Q

What does this blood film show?

A

Chronic lymphocytic leukemia

  • WBC increased mature cells
21
Q

What does this blood film show?

A

Acute myeloid leukemia

  • WBC increased immature cells
22
Q

What can cause neutrophilia?

A
  • Corticosteroids
  • Underlying neoplasia
  • Tissue inflammation e.g. colitis, pancreatitis
  • myeloproliferative/leukaemic disorders
  • infection
23
Q

Most localised and systemic infections cause a neutrophilia. Which infections characteristically do not cause a neutrophilia?

A
  • Brucella
  • Typhoid
  • many viral infections
24
Q

What are the differences between

  1. Reactive neutrophilia
  2. Malignant neutrophilia?
A
  1. Reactive neutrophilia - reaction and increase in neutrophils in response to infection/inflammation. Presence bands and toxic granulation
  2. Malignant neutrophilia - neutrophilia, basophilia, plus immature cells myleocytes, and splenomegaly. This suggests a myleoproliferative (CML)

*neutroPENIA plus myeloblasts - AML - Acute Myeloid Leukemia

25
Q

What does this show?

A

Reactive neutrophilia

  • Nuclear polymorphs
  • neutrophilia
  • toxic granulation
26
Q

What does this blood film show?

A

Chronic Myeloid Leukemia

  • Neutrophilia
  • Basophilia
  • Immature cells such as myleocytes
  • splenomegaly
27
Q

What can cause a reactive eosinophilia?

A
  • Parasitic infection
  • Allergic diseases e.g. asthma, rheumatoid
  • Underlying neoplasms esp. Hodgkin’s, T-cell NHL
  • Drugs - reaction erythema multiforme
28
Q

What are the underlying cause of Chronic Eosinophilic leukemia?

A

Eosinophils form part of the ‘clone’.

FIP1L1-PDGFRa fusion gene

29
Q

What conditions/chronic infections/ haematological disorders can moncytosis be seen?

A
  • TB, Brucella, typhoid
  • Viral, CMV, Varicella zoster
  • Sarcoidosis
  • Chronic myelomonocytic leukemia (MDS)
30
Q

What in the following categories causes an elevated neutropil count?

  1. Infection
  2. Inflammation
  3. Neoplasia
  4. Myeloproliferative
A
  1. Bacterial infections
  2. Auto-immune and Tissue necrosis
  3. All types
  4. CML
31
Q

What in the following categories causes an elevated eosinophil count?

  1. Infection
  2. Inflammation
  3. Neoplasia
  4. Myeloproliferative
A
  1. Parasitic infections
  2. Allergic e.g. asthma, atopy, drug reactions
  3. Hodgkin’s and NHL
  4. N/A
32
Q

What in the following categories causes an elevated Basophil count?

  1. Infection
  2. Inflammation
  3. Neoplasia
  4. Myeloproliferative
A
  1. Pox viruses
  2. N/A
  3. N/A
  4. CML
33
Q

What in the following categories causes an elevated monocyte count?

  1. Infection
  2. Inflammation
  3. Neoplasia
  4. Myeloproliferative
A
  1. Chronic e.g. TB, Brucella
  2. N/A
  3. N/A
  4. CMML
34
Q

What is the difference between a secondary and primary lymphocytosis?

A

SECONDARY lymphocytosis - is reactive, and is a polyclonal response to an infection or chronic inflammation

PRIMARY lymphocytosis - is a monoclonal lymphoid proliferation, as seen in CLL, NHL

35
Q

What are the causes of a reactive lymphocytosis?

A
  • EBV, CMV, Toxoplasma
  • Infectious hepatitis, rubella, herpes infections
  • Autoimmune disorders
  • Sarcoidosis
36
Q

What conditions has the following lymphocytes?

  1. Normal blood film
  2. Infective mononucleosis
  3. CLL and NHL
  4. Acute lymphoblastic leukemia
A
  1. Normal blood - mature lymphocytes
  2. IM - Recactive/atypical lymphocytes
  3. CLL and NHL - small lymphocytes and smear cells
  4. ALL - Lymphoblasts
37
Q
  1. What does this blood film show?
  2. What could this be a sign of?
A
  1. Lymphocytosis
  2. Could be EBV infection or early CLL
38
Q

What does this blood film show?

A

CLL - Chronic lymphocytic leukemia

39
Q

What does this blood film show?

A

Acute lymphoblastic leukemia

presence of lymphoblasts

40
Q

What does flow cytometry show?

A

Known as immunophenotyping - flow cytometry looks at the antigens expressed on the cells.

Blue - CD4

Green - CD34

Purple - CD7

41
Q

Is EBV monoclonal or polyclonal?

A

Polyclonal, and B cells so amount of kappa and lambda light chains are normal, and in usual proportions

42
Q

What are the 2 different light chains that B cells can have?

A

Kappa and Lambda

43
Q

Is CLL monoclonal or polyclonal?

A

CLL is monoclonal. One mother B cell with the mutation will proliferate meaning only one of the light chains, either kappa or lambda will be produced. This means that one light chain is measured to be a lot higher than the other. This is usually a sign of a worse prognosis.

44
Q

What is the diagnosis?

39 year old woman

Had breast cancer over 4 years ago

Presents with jaundice and hepatomegaly

Hb = 87

Bilirubin = 50, conjugated (elevated)

DAT negative

Blood film - nucleated red blood cells

A

Bone marrow metastases from breast cancer

45
Q

What is the diagnosis?

45 year old male

3 week history of sore throat

Recent episode of shingles

EBV IgG serology positive

FBC: Raised lymphocytes, normal neutrophils

Blood film: Reactive lymphocytes, no abnormal cells

Monoclonal

A

Mature B cells, monoclonal

CLL

46
Q
A

Haematology - Path (11 decks)

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