Haematology Flashcards
What does aminocytosis mean in regards to a blood film?
What does it indicate?
Variation in size of RBCs
Myelodysplastic syndrome and some forms of anaemia
When might Target cells be seen on a blood film?
IDA
Post-splenectomy
What are Heinz bodies caused by?
When might they be seen on a blood film?
Denatured globin
G6PD
Alpha-thalassaemia
When might Howell-Jolly bodies be seen on a blood film?
Post-splenectomy
Severe anaemia
When might Reticulocytes be seen on a blood film?
Haemolytic anaemia
What are Schistocytes?
When might they be seen on a blood film?
Fragments of RBCs
Haemolytic uraemia syndrome
Disseminated intravascular coagulation
Thrombotic thrombocytopenia purpura
Metallic heart valves
Haemolytic anaemia
What are Sideroblasts?
What does the presence of Sideroblasts indicate on a blood film?
immature RBCs that contain blobs of iron
Myelodysplastic syndrome
What are Smudge cells?
What can they indicate if seen on a blood film?
Ruptured white blood cells
Chronic lymphocytic leukaemia
What do Spherocytes indicate if present on a blood film?
Autoimmune haemolytic anaemia
Hereditary spherocytosis
What are causes of microcytic anaemia?
Thalassaemia Anaemia of chronic disease Iron deficiency anaemia Lead poisoning Sideroblastic anaemia
What are causes of normocytic anaemia
3 As and 2 Hs
Acute blood loss
Anaemia of Chronic Disease
Anaplastic anaemia
Haemolytic anaemia
Hypothyroidism
What are the two types of macrocytic anaemia?
Megaloblastic
Normoblastic
What causes megaloblastic anaemia?
Impaired DNA synthesis
Folate deficiency
B12 deficiency
What are causes of normoblastic anaemia?
Alcohol Liver disease Drugs - azathioprine Hypothyroidism Reticulocytosis
What are the initial investigations required in a patient with suspected anaemia?
Hb MCV B12 Folate Ferritin Blood film
What do low serum ferritin levels suggest?
IDA
What do high serum ferritin levels suggest?
Inflammation - infection/cancer
What can be used as a marker of how much transferrin is in the blood?
Total iron binding capacity
What causes an increase in TIBC/transferrin levels?
Iron deficiency
What causes a decrease in TIBC/transferrin levels?
Iron overload
What gives an indication of the total amount of iron in the body?
Transferrin saturation
What kind of sample gives the most accurate results when assessing a patients transferrin saturation?
Fasting sample
What does a reduced transferrin saturation mean?
Reduced iron
What does an increased transferrin saturation mean?
Increased iron
What two things can increase the values of serum ferritin, serum iron, TIBC and Tf % giving the impression of iron overload?
Supplementation with iron
Acute liver damage
What are the three ways that IDA can be corrected?
Blood transfusion
Iron infusion
Oral iron
When should an iron infusion not be given?
During sepsis - iron feeds bacteria
When is oral iron unsuitable?
If malabsorption is the cause of the IDA
What are the causes of B12 deficiency?
Insufficient dietary intake
Pernicious anaemia
What cells produce intrinsic factor?
Parietal cells
What autoantibodies are involved in pernicious anaemia?
Intrinsic factor antibody
Gastric parietal cell antibody
What type of symptoms can be caused by B12 deficiency?
Neurological symptoms Peripheral neuropathy with parathesia Loss of vibration sense or proprioception Visual changes Mood or cognitive changes
How can dietary B12 deficiency be treated?
Oral replacement with cyanocobalamin
How can pernicious anaemia be treated?
IM cyanocobalamin (3x weekly for 2 weeks then every 3 months)
If there is a B12 and folate deficiency, what has to be treated first and why?
B12 deficiency first
Treating patients with folate when they have a B12 deficiency can cause subacute combined degeneration of the cord
What is the most common form of inherited haemolytic anaemia?
Hereditary spherocytosis
How is hereditary spherocytosis inherited?
Autosomal dominant
What signs may be suggestive of hereditary spherocytosis?
Jaundice
Gallstones
Splenomegaly
Aplastic crisis in presence of parvovirus
When might a patient with hereditary spherocytosis develop an aplastic crisis?
Parvovirus
What are the features on FBC and blood film which are indicative of hereditary spherocytosis?
Spherocytes on blood film
Raised mean corpuscular haemoglobin concentration
Raised reticulocytes
How is hereditary spherocytosis managed?
Folate supplements
Splenectomy
+/- cholecystectomy if gallstones
What is the pattern of inheritance of G6PD deficiency?
X-linked recessive
In what population is G6PD deficiency most common?
Mediterranean and African patients
What can trigger G6PD crises?
Infections
Medications
Fava beans (broad beans)
What are the signs of G6PD that you might see on a blood film?
Heinz Bodies
Bite cells
Blister cell
How can G6PD deficiency present?
Jaundice (neonatal)
Gallstones
Anaemia
Splenomegaly
How can a diagnosis of G6PD deficiency be made?
G6PD enzyme assay
What medications can trigger a G6PD?
Primaquine Ciprofloxacin Sulfonylureas Sulfasalazine Sulphonamide drugs
