Haematology Flashcards
Differential DIagnosis of lymphadenopathy
- Lipoma - usually large and soft; may not be in usual lymph node area
- Abscess - tender and erythematous, may be fluctuant
- Sebaceous cyst - intradermal locations
- Thyroid nodule
- Secondary to recent immunisation
Causes of ecchymoses
- trauma
- thrombocytonpenia or platelet dysfunction
- coagulation disorders
- Aquired
- Vitamin K Deficient
- Liver disease
- Anticoagulants
- DIC
- COngenital
- Haemophilia A and B
- Von Willebrands
- Aquired
- senile ecchymoses due to loss of skin elasticity
Felty’s syndrome
- rheumatoid arthritis
- neutropenia
- splenomegaly
- can also be associated with
- thrombocytopenia
- haemolytic anaemia
- skin pigmentation
- leg ulceration
Thrombocytopenia causing petechiae
Platelet count <100 x 10^9/L
Increased destruction
- Immunological
- ITP
- SLE
- Drugs - quinine, sulfonamide, methyldopa
- Non-immunological
- damage eg prosthetic heart valve
- consumption eg DIC
- Loss eg haemorrhage
Reduced productions
- Marrow aplasia
- marrow invasion
Sequestration in hypersplenism
Platelet dysfunction causing petechaie
- Congenital or familial
- Aquired
- myeloproliferative disease
- dysproteinaemia
- chronic renal failure, chronic liver disease
- drugs like aspirin
Petechiae as a result of small vessel diseaswe
- infection
- infective endocarditis
- septicaemia eg meningococcal
- viral exanthemata
- drugs eg steroids
- Scurvy (vitamin c deficiency) - classically perifollicular purpura on the lower limbs
- Cushings syndrome
- Vasculitis
- polyarteritis nodosa
- fat embolism
- dysproteinaemia
Causes of localised lymphadenopathy
- Inguinal nodes
- infection of lower limb
- sexually transmitted disease
- abdominal or pelvic malignancy
- immunisations
- Axillary nodes
- infections of the upper limb
- carcinoma of the breast
- disseminated malignancy
- immunisations
- Epitrochlear nodes
- infection of the arm
- lymphoma
- sarcoidosis
- Left supraclavicular nodes
- metastatic malignancy from the chest, abdomen or pelvis
- Right supraclavicular nodes
- malignancy from the chest or oesophagus
Causes of generalised lymphadenopathy
- lymphoma - rubbery and firm
- leukaemia - CLL/ALL
- infections
- viral - CMV, EBV, HIV
- bacterial - TB, brucellosis, syphilis
- protozoal - toxoplasmosis
- connective tissue disease - RA, SLE
- infiltration - sarcoid
- drugs - phenytoin
Causes of local lymphadenopathy
- local acute or chronic infection
- metastases from carcinoma or other solid tumour
- lymphoma, espcially hodgkins disease
Causes of a massive splenomegaly
- Common
- Chronic myeloid leukemia
- Myelofibrosis
- Rare
- Malaria
- Kala azar
- Primary lymphoma of the spleen
Causes of a moderate splenomegaly
- Same as for massive
- portal hypertension
- lymphoma
- acute or chronic leukemia
- thalassaemia
- storage diseases
Causes of a small splenomegaly
- as for moderate and massive
- polycythaemia rubra vera
- essential thrombocythaemia
- haemolytic anaemia
- megaloblastic anaemia (rare)
- Infection
- viral - EBV, hepatitis
- bacterial - infective endocarditis
- protozoal - malaria
- connective tissue disorders
- rheumatoid arthritis
- Systemic lupus erythematosus
- polyarteritis nodosa
- Infiltrations - amyloid, sarcoid
Signs of severe anaemia
- pallor
- tachycardia
- wide pulse pressure
- systolic ejection murmurs due to a compensatory rise in cardiac output
- cardiac failure if myocardial reserve is reduced
Causes of a pancytopenia
- Aplastic anaemia : severe hypoplasia of the erythroid, myeloid and platelet precursor cell lines in the bone marrow
- Marrow infiltration by leukemia, lymphoma, carcinoma, myeloma, myelofibrosis, granulomata
- other: subleukemic phase of acute leukemia, pernicious anaemia, hypersplenism, SLE, folate deficieny, paroxysmal nocturnal haemoglobinuria
Causes of a microcytic anaemia
- iron deficieny - chronic bleeding, malabsorption, hookworm, pregnancy
- thalassaemia minor
- sideroblastic anaemia
- long standing anaemia of chronic disease
Causes of a macrocytic anaemia
Megaloblastic bone marrow (oval macrocytes)
- B12 deficiency due to pernicious anaemia, gastrectomy, tropical sprue or bacterial overgrowth, ileal disease, poor diet
- Folate deficiency due to dietary deficiency (alcoholics), malabsorption (coeliac disease), increased cell turnover (pregnancy, leukemia, chronic haemolysis or inflammation), anti-folate drugs (phenytooin,methotrexate, sulfasalazine)
Non-megaloblastic bone marrow (round macrocytes)
- alcohol
- cirhhosis
- reticulocytosis
- hypothyrodism
- marrow infiltration
- myelodysplastic syndrome
- myeloproliferatice disease
Causes of a normocytic anaemia
Bone marrow failure
- Aplastic anaemia - drugs, SLE,radiation, viral hepatitis, pregnancy, Fanconi syndrome
- ineffective haematopoeisis - myelodysplastic syndrome, paroxysmal nocturnal haemoglobinuria
- infiltration
Anaemia of chronic disorders
- chronic inflammation
- malignancy
- endocrine deficiency’s
- liver disease
- chronic renal failure
- malnutriton
Haemolytic anaemia
- intracorpuscular defects - hereditary spherocytosis, elliptosis, haemoglobinopathis
- extracorpuscular defects - immune -autoimmune incompatible blood transfusion, hypersplenism, trauma, microangiopathic, malaria
Signs of polycythemia rubra Vera
-plethoric appearance including engorged conjunctival and retinal vessels -scratch marks from prutitis -splenomegaly -bleeding tendency -peripheral vascular and ischemic heart disease -gout -mild hypertension
Causes of polycythemia
Absolute polycythemia (increased red cell mass) -idiopathic polycythemia rubra vera -secondary polycythemia -increased erythropoietin (renal disease, HCC, uterine fibroma, virile sing syndromes, cushing’s, phaechromocytome) -hypoxia states ( erythropoietin secondarily increased in chronic lung disease, sleep apnoea, living at high altitude, cyanosis congenital heart disease, abnormal haemoglobins, CO poisoning)
Ann Arbor Staging
STAGE I Disease confined to a single lymph node region or a single extra-lymphatic site. (IE) STAGE II Disease confined to 2 or more lymph node regions on one side of the diaphragm STAGE III Disease confined to lymph nodes on both sides of the diaphragm with or without localized involvement of the spleen (IIIS) other extra lymphatic organ or site (IIIE) or both (IIIES) STAGE IV Diffuse disease with one of more extra lymphatic organs (with or without lymph node disease) For any stage a= no symptoms B= fever, weight loss greater than 10% in 6 months, night sweats E involves direct invasion from lymph node into surrounding tissue
