Haematology

Question 1

Go through the Haematological Short Case

Answer 1

Position as for gastrointestinal exam

Hands

• • RA (felty’s)
• • secondary gout
• • haemochromatosis
• • haemarthrosis from bleeding disorders

Rashes

• • petichiae, ecchymoses
• • palpable purpura: vasculitis, dysglobulinaemia, bacteraemia

Axillae

• • central, lateral, pectoral, subscapular

Cervical

• • submental, submandibular, pre/post auricular, occipital
• • superficial/deep jugular
• • supraclavicular

Abdomen

• • hepatomegaly, splenomegaly

Inguinal

• • inguinal ligament, femoral vessels
• • testes and rectal examination

Legs

• • ulcers: hereditary spherocytosis, sickle cell, thalassaemia, macroglobulinaemia, felty’s
• • neuro: B12 deficiency, hypothyroidism, lead poisoning (anaemia + peripheral neuropathy)
• • purpura

Question 2

What are the causes of generalised lymphadenopathy?

Answer 2

• *Haematological (rubbery and firm)**
• lymphoma
• leukaemia (CLL, ALL)
• *Infections**
• viral: CMV, HIV, EBV, others
• bacterial: TB, brucellosis
• protazoal: toxoplasmosis
• *Malignant (very firm)**
• metastases
• reactive
• *CTD**
• RA, SLE
• *Infiltration**
• sarcoid
• *Drugs**
• phenytoin (pseudolymphoma)

Question 3

Polycythaemia

Answer 3

SIGNS OF POLYCYTHAEMIA

• Plethoric appearance
• Scratch marks (generalised pruritus)
• Splenomegaly
• Bleeding tendency (platelet dysfunction)
• Peripheral vascular and ischaemic heart disease
• Gout
• Mild hypertension

CAUSES OF POLYCYTHAEMIA

• Idiopathic: polycythaemia rubra vera
• Secondary polycythaemia Increased erythropoietin:
• Renal disease: polycystic disease, hydronephrosis, tumour, after renal transplantation
• Hepatocellular carcinoma
• Cushing’s syndrome
• Hypoxic states
• Chronic lung disease
• Sleep apnoea
• Living at high altitude
• Cyanotic congenital heart disease
• Abnormal haemoglobins