Haematology Flashcards
E.g. microcytic anemia
Iron deficiency
Sideroblastic
Thalassaemia
Chronic disease
E.g. macrocytic anaemia
B12 / Folate deficiency Excessive alcohol Reticulocytosis Hypothyroid Multiple Myeloma & Myeloproliferative disease & Myelodysplasia Aplastic anaemia
E.g. Normocytic anaemia
Chronic disease
Acute blood loss
Haemolytic anemia
Marrow infiltration
Absorption points of:
Iron
B12
Folate
Iron - Duodenum & Jejunum
B12 - Terminal Ileum
Folate - Small bowel
Iron storage molecules
Ferritin anf haemosiderin (ferritin is also acute phase protein so can be elevated in infection / inflammation)
Iron profile in deficiency state
Serum iron
TIBC
Ferritin
Transferrin sats
Serum iron - Reduced
TIBC - Increased (body tries hard to bind more iron)
Ferritin - reduced (low iron stores)
Transferrin sats - reduced
Iron profile in iron overload
Serum iron
TIBC
Ferritin
Transferrin sats
Causes
Serum iron - Raised
TIBC - low
Ferritin - Raised
Transferrin sats - Raised
Haemochromatosis, Frequent blood transfusion
How is Fit B12 absorbed
What disease decreases
Bound by intrinsic factor from parietal cells in stomach
Absorbed from the Ileum
Absence of intrinsic factor (pernicious anaemia)
Disease affecting ileum (e.g. coeliac)
Normal bilirubin production and excretion
Hb degraded and bilirubin liberated
Bilirubin conjugated in Liver and passed into bowel in bile
Converted to urobilinogen some is reabsorbed and excreted in urine and some passed in stool
Biomarkers in haemolysis
Bili, LDH, Hb
Plasma unconjugated bilirubin will rise
inc amounts of urobilinogen in urine
Lactate dehydrogenase will rise
Hb may be excreted in urine or be converted to haemosiderin for excretion
In excessive cases, reticulocytes may be seen
Testing for cause of haemolysis
Osmotic fragility test: spherocytes less resilient to damage
Coomb’s test: tests for autoantibodies in blood (causes agglutination if positive)
Causes of inherited haemolytic anaemia
Abnormal RBC membrane - Spherocytosis Abnormal Hb - Thalassaemia, Sickle cell Abnormal RBC metabolism - G6PD deficiency
Causes of acquired haemolytic anaemia
Immune mediated
- Warm and cold autoimmune, Transfusion reaction, Heamolysis in the newborn, Adverse drug event
Non-immune
- Malaria, Hypersplenism, Mechanical heart valve, burns
Causes of high RBC (high packed cell volume)
Primary polycythemia (Rubra vera)
Secondary polycythemia (Lung disease, RCC, PKD, HCC)
Apparent polycythemia (dehydration)
Causes of neutrophilia
Bacterial infection
Malignancy
Inflammation
Necrosis (e.g. following MI)
Causes of neutropenia
Post-chemo/radiotherapy
Drug: Clozapine, Carbimazole
Viral infection
Immunosuppression
Causes of lymphocytosis
Chronic infection (e.g. TB)
Viral infections
CLL
Lymphomas
Causes of Eosinophilia
Allergic disorders
Atopy
Causes of Thrombocytosis
Myeloproliferative disorders
CML
Myelodysplasia
Infection
Inflammation
malignancy
Causes of thrombocytopenia
Leukaemia
Bone marrow replacement (mets, tumour)
HELLP syndrome
DIC
Hypersplenism
Causes of pancytopenia
SLE Bone marrow infiltration (e.g. with tumour) Hypersplenism Sepsis Aplastic anemia
What is ESR & Causes of a raised ESR
How rapidly RBC form sediment due to plasma proteins. This is non-specific for inflammation as this causes inc in plasma proteins and raised ESR
Infectious disease Neoplasm Connective tissue disorder (esp GCA and Polymyalgia Rheumatica) Anaemia Renal disease
Target cells seen in:
Thalassaemia
Iron deficiency
Post splenectomy
Liver disease
Heinz bodies
Unstable Hb states
E.g Sideroblastic anaemia
Auer rods (WBC abnormality)
Acute Myeloid Leukaemia
Smear cells (WBC abnormality)
CLL
What Factors does prothrombin time check
I, II, V, VII, X
almost the 1972 of Warfarin and so it is used to monitor Warfarin therapy in practice
What is the INR, What is normal?
Target usually
Taget in recurrent DVT/PE
This is a ratio of how quickly blood clots versus a normal person
normal is 1 (1:1)
target 2.5
Recurrent DVT/PE 3.5
APTT factors and when used
It relies on all factors apart from VII
Used to monitor Heparin (used less clinically as LMWH more commonly used and needs less monitoring)
von Willebrand clotting beware
May have normal clotting profiles
DIC Pathophys
Fibrin deposited in microvasculature resulting in infarction (e.g. due to toxins, infection etc)
Clotting factors used up leaving patient prone to bleeding
PT, APTT, Fibrinogen and D-dimer in DIC
Raised PT and APTT since clotting factors used up
Reduced fibrinogen (widespread fibrin formation)
Raised D-dimer (breakdown of fibrin deposits)
What is D-dimer
breakdown product of fibrin
Raised in infection and inflammation but used as non-specific test for DVT/PE
PT, APTT and Fibrinogen in:
Warfarin
Heparin
Warfarin
PT - raised, APTT - normal and Fibrinogen normal
Heparin
PT - normal, APTT - raised and Fibrinogen normal
PT, APTT and Fibrinogen in:
Haemophilia
PT - normal, APTT - raised and Fibrinogen - normal
This is because Haemophilia is deficiency of Factor VIII (A) or IX (B) so they affect APTT (all except VII)
PT, APTT and Fibrinogen in:
Liver disease
PT - high, APTT - high and Fibrinogen normal
Multiple Myeloma CRAB
Calcium (elevated), Renal Failure, Anaemia, Bone Involvement
Anaemia Renal impairment (Tamm-horsfell protein) Plasma cells secrete M-protein (dysfunctional immunoglobulin)
low levels of functional immunoglobulin Bone involvement (pain, hypercalcaemia, lytic lesions - raindrop skull) Hyperviscous blood
Philedelphia chromosome
Seen in:
ALL - Bad prognosis
CML - Good prognosis
