Haematology Flashcards
What can Myeloid stem cell become?
Platelets
RBC
Basophil, Neutrophil, Eosinophil, Macrophage
What can lymphoid stem cell become?
B cell
T cell
NK cell
What is a reticulocyte?
An immature red blood cell
Lifespan of a RBC?
3 months
What are target cells on a blood film seen in?
Iron deficiency anaemia
Post-splenectomy
What are Heinz Bodies on a blood film seen in?
G6PD
Alpha-thalassameia
What are Howell-Jolly bodies on a blood film seen in?
Post-splenectomy
Severe anaemia
What are Howell-Jolly bodies?
Blobs of DNA material is seen in RBC. This should be removed by spleen.
When are there high levels of reticulocytes?
Haemolytic anaemia
What are schistocytes?
Fragments of RBC
What are schistocytes and causes?
Fragments of RBC due to trauma
Causes:
- Haemolytic uraemic syndrome
- Disseminated intravascular coagulation (DIC)
- Thrombotic thrombocytopenia purpura
- Metal heart valves
- Haemolytic anaemia
What are sideroblasts and what do they indicate?
Sideroblasts are immature RBC
Indicate myelodysplasic syndrome
What are smudge cells on a blood film seen in?
Chronic lymphocytic leukaemia
What are spherocytes on a blood film seen in?
Spherocytes are spherical red blood cells
Seen in autoimmune haemolytic anaemia or hereditary spherocytosis
Causes of microcytic anaemia acronym?
TAILS
T – Thalassaemia
A – Anaemia of chronic disease
I – Iron deficiency anaemia
L – Lead poisoning
S – Sideroblastic anaemia
Causes of normocytic anaemia causes?
3As and 2Hs
A – Acute blood loss
A – Anaemia of Chronic Disease
A – Aplastic Anaemia
H – Haemolytic Anaemia
H – Hypothyroidism
Macrocytic megaloblastic anaemia causes?
B12 deficiency
Folate deficiency
Macrocytic normoblastic anaemia causes?
Alcohol
Reticulocytosis - new RBC turnover
Hypothyroidism
Liver disease
Drugs such as azathioprine
Ix of iron deficient anaemia if no clear cause?
OGD - oesophago-gastroduodenoscopy
+
Colonscopy
(look for cancer of GI tract)
Mx of iron deficient anaemia?
Oral iron (ferrous sulfate) for 3 months
Iron infusion - avoid in sepsis
Blood transfusion
Iron studies in iron deficient anaemia?
Serum ferritin Low
TIBC High
Transferrin High
However, high/normal ferritin can’t rule out iron deficient anaemia could be concurrent inflammation and inflammation increases ferritin
Causes of B12 deficienct?
Insufficient dietary intake
Pernicious anaemia
What is pernicious anaemia?
Antibodies attack the parietal cells or intrinsic factor which are responsible for B12 absorption
Ix for pernicious anaemia?
- Intrinsic factor antibody
- Gastric parietal cell antibody
Mx of B12 deficinecy?
If dietary insufficiency -> oral replacement iwth Cyanocobalamic
If pernicious anaemia -> IM hydroxycobalamin
Why always mx B12 deficiency before folate deficinecy?
Treating patients with folic acid when they have a B12 deficiency can lead to subacute combined degeneration of the cord
Features of haemolysis? (3)
Anaemia
Splenomegaly
Jaundice
What does a positive direct coomb’s test indicate?
Autoimmune haemolytic anaemia
Mx of hereditary spherocytosis?
Folate supplementation + splenectomy
Jaundice after broad beans, infections or antimalarial mx?
G6PD deficiency
Ix to diagnose globin abnormalities?
Haemoglobin electrophoresis
(Diagnostic test for thalassaemia & sickle-cell disease)
Iron studies in thalasaemia?
Serum ferritin High
Transferrin High
TIBC High
What is thalassaemia?
Reduced globin chain synthesis
Sickle cell disease + parvovirus?
Aplastic crisis - sudden fall in haemoglobin
Reduced reticulocyte count
What is sequestration crisis?
Sickle cell crisis where sickling within organs such as lungs or spleen -> blood pooling
Increased reticulocyte count & anaemia
Sickle cell crisis triggers?
Infection
Dehydration
Deoxygenation (High altitude)
Mx of sickle cell crisis?
Analgesia
Rehydrate
Oxygen
Consider:
- Antibiotics
- Blood transfusion
- Exchange transfusion
General mx of sickle cell disease?
Avoid dehydration and triggers
Antibiotic prophylaxis - Penicillin V (phenoxymethylpenicillin)
Hydroxycarbamide can increase HbF production
Leukaemia Ix & Dx?
Ix - FBC within 48hours
Dx - Bone marrow biopsy
Where is a bone marrow biopsy normally taken from?
Iliac crest
Blood film of ALL?
Blast cells
No B- or T-cells
Lots of lymphocyte precursors
Who gets ALL?
Children <5years of adults >45
Down syndrome
Philadelphia chromosome
Px of ALL
Pancytopenia:
Anaemia - lethargy and pallor
Neutropenia - infections
Thrombocytopenia - easy brusiing, petechiae
Hepatosplenomegaly
Fever
Bone pain
Blood film of chronic lymphocytic leukamia
Smear or smudge cells
FBC of CLL?
Lymphocytosis - raised WCC
Anaemia
Thrombocytopenia
What are Auer rods seen in?
Acute myeloid leuakemia
FBC of Chronic myeloid leukemia?
Lots of neutrophils, RBC, platelets
What is Richter’s transformation?
CLL -> Lymphoma (non-Hodgkin’s lymphoma)
Patient with CLL becomes unwell very suddently
What is tumour lysis syndrome?
Release of uric acid from cells being destroyed by chemotherapy -> AKI
S/e of bleomycin?
Lung fibrosis
Chronic myeloid leukaemia mx?
- Imatinib (tyrosine kinase inhibitor)
Others:
- Hydroxyurea
- Interferon-alpha
- Allogenic bone marrow transplant
What is a Reed-sternberg cell seen in?
Hodgkin’s lymphoma
Lymphoma with alcohol-induced pain in the node?
Hodgkin’s lymphoma
Diagnostic test of lymphoma?
Lymph node biopsy
Staging system for Hodgkin’s and Non-Hodgkins lymphoma?
Ann Arbor staging
B symptoms of lymphoma?
Fever
Weight loss
Night sweats
Non-Hodgkin’s lymphoma associated with EBV, malaria and HIV?
Burkitt lymphoma
Non-Hodgkin’s lymphoma associated with H.pylori infection?
MALT lymphoma
Mx of Hodgkin’s lymphoma?
Chemotherapy is mainstay
+/- Radiotherapy
Mx of non-Hodgkin’s lymphoma?
Watchful waiting
Chemo +/- radiotherapy
Rituximab - monoclonal antibodies
Microscopy appearance of Burkitt’s lymphoma?
“Starry sky” appearance
What are the three myeloproliferative disorders?
Primary myelofibrosis
Polycythaemia vera
Essential thrombocythaemia
What is myelofibrosis?
When proliferation of a cell line -> fibrosis of bone marrow
What is extramedullary haematopoiesis?
When the bone marrow is replaced with scar tissue the production of blood cells (haematopoiesis) starts to happen in other areas such as the liver and spleen
-> Hepatomegaly & Splenomegaly
What is raised in polycythaemia vera?
Haemoglobin
(Erythroid cells - RBC)
What is raised in primary thrombocythemia?
Raised platelet count
(Megakaryocyte)
What are the FBC findings in Myelofibrosis?
Anaemia
Leukocytosis or leukopenia
Thrombocytosis or thrombocytopenia
What would a blood film of myelofibrosis show?
Teardrop-shaped RBCs
Poikilocytosis - RBCs varied in size
Blasts - immature red and white cells
Dx for myeloproliferative disorders?
Bone marrow biopsy
Bone marrow aspiration is normally dry due to scar tissue
Mx of primary myelofibrosis?
Allogenic stem cell transplant
Chemotherapy
Supportive
Mx of polycythaemia vera?
Venesection
Aspirin
Consider chemotherapy
Mx of primary thrombocythaemia?
Aspirin
Chemotherapy
