Haematology Flashcards
when might MCV be normal in anaemia?
- normocytic anaemia
- mixed microcytic AND macrocytic anaemia
causes of microcytic anaemia?
- Fe def
- chronic disease
- thalassaemia
- sideroblastic anaemia
causes of macrocytic anaemia?
- B12 def
- folate def
- XS alcohol
- reticulocytosis
- hypothyroidism
- multiple myeloma
- myeloproliferative disorders
- myelodysplasia
- aplastic anaemia
causes of normocytic anaemia?
- chronic disease
- haemolytic anaemia
- acute blood loss
- marrow infiltration
where is iron absorbed? which form is it in when it gets absorbed?
- upper small bowel
- ferrous (Fe2+)
what are the components of an iron profile?
- serum iron
- serum TIBC
- serum ferritin
- transferrin saturation
- serum soluble transferrin receptors
describe the iron profile for someone who is iron deficient
- low serum iron
- high TIBC
- low serum ferritin
- low transferrin
- high transferrin receptors
what is the single best blood marker for iron deficiency?
- serum ferritin
- (but be careful bc it’s also an acute phase reactant)
what might cause iron overload?
- haemochromatosis
- frequent blood transfusions
describe the iron profile of someone with iron overload
- high serum iron
- high ferritin
- high transferrin
- low TIBC
describe the iron profile in anaemia of chronic disease (ACD)
- normal / low serum iron
- low TIBC
- low transferrin
- high ferritin (if inflammation)
- normal transferrin receptors
give an example of ileal disease which could lead to B12 def. how could this be diagnosed?
- small bowel bacterial overgrowth
- trialling ABx and then checking B12 levels
- hydrogen breath test
how can hereditary spherocytosis be tested for? what happens?
- osmotic fragility test
- spherocytes are fragile and breakdown more easily
how can autoimmune haemolytic anaemia be tested for? what happens?
- direct antiglobulin test (DAT) / coombs’ test
- the cells agglutinate (stick together)
how can haemolytic anaemia be classified?
- inherited
- acquired
examples of inherited causes of haemolytic anaemia?
- spherocytosis
- thalassaemia
- SCA
- G6PD
examples of acquired IMMUNE causes of haemolytic anaemia?
- autoimmune warm type
- autoimmune cold type
- transfusion reaction
- HDN
- adverse drug event
examples of acquired NON-IMMUNE causes of haemolytic anaemia?
- malaria
- hypersplenism
- burns
- mechanical heart valve
how can polycythaemia be classified?
- apparent (low blood volume making RBC look high)
- true
key cause of apparent polycythaemia?
dehydration
underlying disease which could give polycythaemia?
polycythaemia rubra vera
secondary causes of polycythaemia?
- lung disease
- chronic smoking
- high altitude environment
- renal cell carcinoma
- polycystic kidneys
- HCC
causes of neutrophilia?
- bacterial infection
- inflammation
- malignancy
- myeloproliferative disorders
- post-MI
- corticosteroid use
- renal failure
causes of neutropenia?
- post-chemo
- post-radio
- clozapine / carbimazole use
- viral infection
- felty syndrome (along with RA and splenomegaly)
causes of lymphocytosis?
- viral
- chronic infections (TB)
- CLL
- lymphoma
causes of eosinophilia?
- allergic disorders
- parasitic infection
- eczema and other skin stuff
- hodgkin’s disease and other malignancies
causes of thrombocytosis? (non-reactive)
- essential thrombocythaemia
- CML
- myelodysplasia
causes of reactive thrombocytosis?
- infection / inflammation
- malignancy
- bleeding
- pregnancy
- post-splenectomy
causes of thrombocytopenia relating to bone marrow failure?
- infectious mononucleosis
- drug-induced
- leukaemia
- aplastic anaemia
- myelofibrosis
- myeloma / bony mets (BM infiltration)
- myelodysplasia
- megaloblastic anaemia
causes of thrombocytopenia relating to increased platelet destruction?
- autoimmune idiopathic thrombocytopenia (AITP)
- heparin-induced thrombocytopenia (HIT)
- hypersplenism
- TTP / HUS
- DIC
- post-blood transfusion
causes of pancytopenia?
- aplastic anaemia
- myeloma / bony mets (BM infiltration)
- hypersplenism
- megaloblastic anaemia
- sepsis
- SLE
what is pancytopenia?
low RBCs, WCC and platelets
causes of a raised ESR?
- infectious disease
- multiple myeloma
- GCA, PMR
- anaemia
- renal disease
when are acanthocytes seen on blood film?
- post-splenectomy
- liver disease
when are target cells seen on blood film?
- thalassaemia
- iron deficiency
- post-splenectomy
- liver disease
when are burr cells seen on blood film?
- post-splenectomy
- liver disease
- uraemia
when are fragmented cells seen on blood film?
- haemolytic anaemia
- HUS
- TTP
- mechanical heart valves
- DIC
when are “tear drop” cells seen on blood film?
myelofibrosis
what kinds of abnormalities can be seen inside RBCs on blood film?
- heinz bodies
- howell-jolly bodies
- pappenheimer bodies
- basophilic stippling
- cabot rings
which conditions can cause heinz bodies to form?
any unstable state of Hb
which conditions can cause howell-jolly bodies to form?
- hyposplenism
- post-splenectomy
which conditions can cause pappenheimer bodies to form?
- post-splenectomy
- haemolytic anaemia
- sideroblastic anaemia
which conditions can cause basophilic stippling to form?
- lead poisoning
- thalassaemia
- myelodysplasia
which conditions can cause cabot rings to form?
- myelodysplasia
- megaloblastic anaemia
what kinds of abnormalities can be seen inside WBCs?
- hypersegmented neutrophils
- toxic granulation of neutrophils
- auer rods
- smear cells
which conditions can cause hypersegmented neutrophils to form?
- megaloblastic anaemia
- chronic infection
which conditions can cause toxic granulation of neutrophils to form?
- bacterial infection
- poisoning
- burns
- chemotherapy
which condition can cause auer rods to form?
AML
which condition can cause heinz bodies to form?
CLL
what is the most effective blood test to assess liver function?
prothrombin time (PT)
when should a pt have a target INR of 3.5 (3-4)?
where there is recurrent DVT / PE in a pt with a therapeutic INR
what might bloods show in DIC?
- high PT and APTT
- low fibrinogen
- high D-dimer
what is APTT used for most commonly?
to monitor a heparin infusion
causes of bleeding where INR is raised?
- warfarin
- heparin (sometimes)
- liver disease
- DIC
causes of bleeding where APTT is raised?
- heparin
- haemophilia A / B
- liver disease
- DIC
give a cause of bleeding where fibrinogen is affected. what happens?
- DIC
- it drops
