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Haematology > Haematological Investigations > Flashcards

Haematological Investigations Flashcards

1
Q

Possible Causes of misleading results(Pre-collection)

A

Pre-Collection:
-Physiological: Diurnal vatiation, Physical activity, diet, stress, Posture ,Age and Gender

-Interferences: Smoking, Drugs/Supplements within 8hrs(To be indicated on a form)

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2
Q

Possible Causes of misleading results(During-collection)

A

Interferences:

  • Prolonged tourniquet pressure= haemoconcentration
  • Haemolysis: Difficult phlebotomy, small needle gauge, excessive negative pressure, High WCC/Pseudohypokalaemia
  • Incorrect tube used: wrong anticoagulation-wrong results
  • Clotted Sample: Incorrect cell counts
  • Lipaemic,haemolysed or jaundiced samples
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3
Q

Define what a Full Blood Count(FBC) is

A

A full blood count gives important information about the haematopoietic cells including; RBCs, WBCs and well as Platelets

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4
Q

Define what a Differential count is

A

A differential count gives a breakdown of the white cell count, including N.M.L.E.B and abnormal cells

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5
Q

What happens during the pre-analytics phase

A

A FBC is performed:

  • Venous Blood
  • EDTA-Ethylene diamine tetraacetic acid Tube is used which binds the calcium and prevents clotting
  • Take to lab,ASAP-Unrelaiable after 24hrs, preferebly<12hrs
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6
Q

What are the instruments which are used for the analysis of blood

A

Automated- ADVIA 2120i

  • 150 smaples per hour
  • FBC, Differential count, and Reticulocyte count
  • If there are any abnormalities manual review of slides is to be done by a pathologist
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7
Q

What are the reference ranges which are needed to be compared to to a reference range/internval, to classify a result as normal/abnormal

A

Reference Interval/Range: A set of values established as normal, maximums or minimums for a given analyte and shows the representation of the normal population in which it is standardized which uses a 95% CI

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8
Q

Red Cell Count(RBC)

A

The number of red blood cells in a volume of blood, x 10^9/L

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9
Q

Haemoglobin(Hb)

A

The amount of haemoglobin in a volume of blood, g/dL

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10
Q

Haematocrit(Hct)/Packed Cell Volume

A

The percentage of red blood cells compared to plasma, %

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11
Q

Mean Cell Volume(MCV)

A

Average volume of the RBC, Hct/RBC, measured in femtolitre(fL)

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12
Q

Mean Cell Haemoglobin(MCH)

A

The average weight of haemoglobin in the RBC, Hb/RBC ,measured in picogram(pg)

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13
Q

Mean Cell Haemoglobin Concentration(MCHC)

A

The average concentration of Hb in the RBC volume, Hb x 1000/MCV x RBC, which is measure in g/dL

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14
Q

Red Cell Distribution Width(RDW)

A

The difference in the size between red cells,%

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15
Q

Conditions which will result in a high RBC

A

Increased red cell production

-Example: Polycythaemia and Thalassaemia

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16
Q

Conditions which result in a low RBC

A

Increased red cell destruction/Loss
-Haemorrhage and Haemolysis

Reduced red cell production

  • Haematinic(nutrients needed for rbc development) deficiency
  • Bone Marrow disorders
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17
Q

Conditions which result in high Hb

A

High-Polycythaemia(Primary/Secondary causes)

Primary:

  • Increased red cell production
  • Myeloproliferative disorders

Secondary:

  • Increased oxygen demand(Hypoxia): Smoking, prematurity, Resp/Cardiac disorders and Height above sea levels
  • Renal disease/tumours
  • Exogenous erythropoietin treatment

Artificial: Dehydration

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18
Q

Conditions which results in Low Hb

A

Low- Anaemia

Increased red cell destruction/loss
-Haemorrhage and Heamolysis

Reduced red cell production
-Haematinic deficiency or Bone Marrow disorder

19
Q

Reasons for abnormalities in Haematocrit

A

Acute blood loss-Unreliable

Shock- RCC Low/Hct normal

Pregnancy-RCC normal/Hct low

20
Q

MCV AND MCH

A

Macrocytic:
MCV>100fL
Oval/Round

Normochromic/Normocytic

Microcytic,Hypochromic
MCV<83fL, MCH < 27pg
Reduced haem production

21
Q

MCHC

A

Increased in hereditary spherocytosis

31.5-34.5 g/L

22
Q

RDW

A

High RDW(>14%)

Macrocytosis: High- Megaloblastic
Normal: Other

Microcytosis: High: Iron deficiency
Normal: Thalassemia

23
Q

Platelet Count

A

Platelets which are counted by means of an automated machine which gives a reference range of 150-400 x 10^9/L

24
Q

Pseudothrombocytopenia

A

A false thrombocytopenia which must be verified by a peripheral smear(manually) for a diagnosis

Reasons: Platelet clumping and satellitism-Stick to neutrophils

25
Q

Management of Pseudothrombocytopenia

A

Platelet Count should be repeated and if clumping still occurs,Repeat FBC in heparin(Green top) or Citrate(Blue top)

26
Q

What is a Thrombocytopenia

A

A low platelet count of about <150

Causes:
-Increased consumption/destruction:
Immune mediated

-Abnormal distribution:
Splenomegaaly

-Production:
Megakaryopoesis only
General bone marrow failure

-Dilutional Loss

27
Q

What is a Thrombocytosis

A

A high platelet count of about >400

Causes
-Reactive:
Haemorrhage, Infections and Iron Deficiency

-Malagnancies:
Myeloproliferative neoplasms

28
Q

Leukopenia

A

Refers to a low total white cell count as the range is 4-11 x 10^9/L

Causes:
Infections
• Most often with viral infections
• Sepsis

Increased destruction
• Autoimmune disorders
• Splenomegaly

Reduced production
• Drugs
• Radiation
• Bone marrow failure
• Nutritional deficiencies
• Bone marrow infiltration by malignancy/infection
• Congenital
29
Q

Leucocytosis

A 
Causes:
– Haemorrhage
– Inflammatory conditions
– Haemolysis
– Infections
– Exercise
– Trauma
– Surgery
– Drugs
– Haematological malignancies
– Reactive due to non-haematological malignancies
30
Q

When does one exclude Leukaemia

A

If WCC is >30 x 10^9/ L especially when it is associated with Anemia and Low platelets.

Do a peripheral smear

31
Q

LEUKAEMOID REACTION

A

WCC >50 x 109/L

Usually reactive, important to do a peripheral smear to confirm

Causes:
– Infections
– Haemorrhage
– Drugs
– Infections
– Diabetic ketoacidosis
– Haemolysis
– Necrosis / Abscesses / Sepsis
– Paraneoplastic syndrome
– Asplenia

Usually resolve once underlying cause treated,If not, consider a haematological malignancy

32
Q

DIFFERENTIAL COUNT

A
  • 5 part differential count
  • Absolute values (109/L) preferred
– Neutrophils 2.0 – 7.0
– Lymphocytes 1.0 – 3.0
– Monocytes 0.2 – 1.0
– Eosinophils 0.02 – 0.5
– Basophils 0.02 – 0.1

Children: Lymphocytes higher than neutrophils

33
Q

Neutrophilia

A

Causes:

  • Bacterial infections
  • Drugs
  • Exercise
  • Trauma / Surgery
  • Inflammation
  • Haemorrhage
  • Haemolysis
  • Malignancies
34
Q

Neutropenia

A

Causes:

Infections
– Most often with viral infections
– Sepsis

• Increased destruction
– Autoimmune disorders
– Splenomegaly

• Reduced production
– Drugs
– Radiation
– Bone marrow failure
– Nutritional deficiencies
– Bone marrow infiltration by malignancy/infection
– Congenital
35
Q

Lymphocytosis

A

• Viral infections
• Chronic bacterial infections
• Lymphoproliferative
disorders

36
Q

Lymphopenia

A 
• Sepsis
• Viral infections
• Stress
• Immunosuppression
– Acquired
– Inherited
• Drugs
37
Q

Monocytosis

A 
• Chronic infections
– Tuberculosis
– Brucellosis
• Autoimmune disorders
• Reactive to malignancies
• Certain haematological
malignancies
38
Q

Monocytopenia

A 
• Very rare
• As part of general
leukopenia
• Drugs
• Hairy cell leukaemia
39
Q

Eosinophilia

A

Reactive-Drugs,Parasitic infections,Allergies

40
Q

Basophils

A

Rare
Chicken Pox
Ulcerative colitis

41
Q

What is a Leukoerythroblastic Reaction

Causes:

A

It is a reaction in which there nucleated red blood cells as well as left shifted granulopoiesis-Immature granulocytes

Causes:
*Push Out: Bone marrow infiltration-Malignancies,infections

*Push In: Bone marrow stress(Severe)-Heamolysis and sepsis

42
Q

Reticulocyte

A

A young erythrocyte which comes immediatly after extrussion of the nucleus.

Contains RNA

It reflects bone marrow erythroid activity(In response to an anemia)

-Increase release of reticulocyte

43
Q

Increased Reticulocyte count(Marrow stimulation)

A

Heamorrhage
Haemolysis
haematinic therapy

Polycythaemia
Infection
Inflammation

44
Q

Decreased reticulocyte count

A

Haematinic deficinecy
Drugs
Malnutrition
Uraemia

Haematology (10 decks)

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