Haematology

Question 1

What are the components of the haematological examination?

Answer 1

Observation
- Bruising, pigmentation, cyanosis, jaundice, excoriation, leg ulcers, frontal bossing

Hands:

• Koilonychia, vasculitis, palmar crease pallor
• Arthropathy: RA + Felty’s, haemochormatosis, recurrent haemarthroses, secondary gout

Arms

• Epitrochlear LN (?NHL), bruising, palpable purpura (vasculitis, dysglobulinaemia or bacteraemia)
• Axilla: LN

Face

• Eyes: Jaundice, pallor, scleral haemorrhage, scleral injection (polycythaemia)
• Mouth: gum hypertrophy (AML, scurvy), ulcers (MTX), candida, haemorrhage, atrophic glossitis (iron, B12 or folate deficiency), angular stomatitis. Tonsillar enlargement.

Posterior

• Cervical LN
• Spinal tenderness

Anterior

• Supraclavicular LN
• Sternal, clavicular, shoulder tenderness
• Spring hips for pelvic tenderness
• Inguinal LN
• Testes and PR for melaena

Lower limbs

• Leg ulcers: hereditary spherocytosis, sickle cell, thalassaemia, macroglobulinaemia, Felty’s
• Neuro exam for B12 deficiency, hypothyroidism or lead poisoning (anaemia + peripheral neuropathy)

Other

• Fundoscopy: hyperviscosity changes (engorgement, haemorrhages), leukaemic infiltration
• Temperature chart (malignancy, infection in immunosuppression)

Question 2

What is the DDx for splenomegaly?

Answer 2

Portal hypertension
Myelofibrosis
CML
Malaria
Kala-azar
AIDS with MAC
Leukaemia
Lymphoma
EBV
Infective endocarditis
Sickle cell anaemia
Splenic vein thrombosis

Question 3

What are the clinical characteristics of myelodysplatic syndrome?

Answer 3

Macrocytic anaemia
- Transfuse
- Epo
- Iron chelation
Leucopenia
- ABx
AML

Question 4

What are the differentials for lymphadenopathy?

Answer 4

Lymphoproliferative disease 
- Lymphomas, particularly NHL
- Small lymphocytic leukaemia
- CLL, ALL
Solid organ mets
Infections
- HIV
- TB
- Hep B
- EBV, CMV
- Brucellosis, toxoplasmosis
- Typhoid fever
SLE, RA
Infiltrative
- Sarcoidosis
- Amyloidosis
Drugs
- Phenytoin, carbamazepine