Haematology Investigations Flashcards
Anaemia & Multiple Myeloma
You’re a medical intern on your first rotation. Your consultant thinks your patient has anaemia and wants them to be checked for it.
* Which blood test will check for anaemia?
What accompanying test can also be ordered?
FBC
Blood film
What is found on an FBC?
RBC and Haemoglobin values (HCT, MCV, MCH, MCHC, RDW)
WBC
Platelets
Neutrophils
Lymphocytes
Monocytes
Eosinophils, basophils
Here is an example of an FBC, what is the definition of each test name in the red box?
RBC=number of red blood cells per litre
* HB=amount of haemoglobin per decilitre
* HCT=percentage of red cells by volume
* MCV=mean cell volume=average(mean) size of the red blood cell
* MCH=mean cell haemoglobin=average haemoglobin per red blood cell
* MCHC=mean cell haemoglobin concentration=average haemoglobin per
red blood cell corrected by red cell size
* RDW=red cell distribution width=difference in size between the largest and
smallest red blood cells
Is anaemia a diagnosis?
No, the cause of it is
Define anaemia for males and females
Anaemia is the reduction in Hb concentration
Male: below 13
Female: below 12
What values on the FBC would tell you the colour (e.g. hypochromic)
MCH/MCHC
Give the morphological classification of anaemia and tell me the MCV, MCH, and blood film results expected for each
- Hypochromic Microcytic Anaemia
– Reduced MCV
– Reduced MCH
– Small cells on blood film - Normochromic Normocytic Anaemia
– Normal MCV
– Normal MCH
– Normal size cells on blood film - Macrocytic Anaemia
– Increased MCV
– Increased MCH
– Large cells on blood film
Give the 3 main causes of Hypochromic Microcytic Anaemia
Deficiency: Fe-deficiency anaemia
Genetic: Thalassaemia
Acquired: Sideroblastic anaemia
Half of patients presenting with microcytic anaemia have it due to Fe-deficiency. What are your differentials in this case?
Blood Loss: GI, Uterine,
Haematuria
Malabsorption: Coeliac disease,
Gastrectomy, Inadequate diet
Increased Demands: Pregnancy
Is sideroblastic anaemia microcytic, normocytic or macrocytic?
Genetic Sideroblastic anaemia is normocytic
Acquires sideroblastic anaemia is either microcytic or macrocytic (mostly microcytic)
A patient with Hypochromic Microcytic Anaemia is in the ward. Sideroblastic anaemia with no known genetic component to it was determined to be the cause. What are the causes of acquired sideroblastic anaemia
Alcohol abuse
Isoniazid/B6 deficiency
Trientine (used in Wilson’s as an alternative to penicillamine)
Cu deficiency
Zinc Deficiency
Lead poisoning
What type of anaemia is anaemia of chronic disease?
What is meant by that and what are some examples?
Mostly normocytic but may be microcytic as well
Malignancy
Chronic infection e.g. Tb
Chronic inflammation e.g. RA
Chronic kidney disease (reduced EPO production)
Other chronic conditions (CKD->EPO, crohn’s, HF, COPD…)
Haemolysis is one of the main causes of anaemia. What type of anaemia would haemolysis typically cause?
haemolysis can be divided into intravascular and extravascular causes. Give the Intravascular causes
Extravascular causes can be further subdivided into intrinsic and extrinsic to the RBC. Give 2 intrinsic and 2 extrinsic causes
How would you differentiate between an intravascular or extravascular cause of haemolysis?
What is the significance of a Coomb’s test in a case of haemolysis? What is another term for it?
Normochromic normocytic anaemia but may also less likely cause macrocytic, non-megaloblastic anaemia
Intravascular causes:
DIC
TTP (thrombotic thrombocytopenic purpura)
Malaria
Prosthetic valve degradation
ABO incompatibility
Extravascular causes:
Intrinsic: Sickle Cell Anaemia, G6PD deficiency
Extrinsic: Autoimmune, Hypersplenism!, Drug-induced, vasculitis
Ordering a blood film can differntiate between intravascular and extravascular causes of haemolysis:
Intravascular: Fragmented (schistocytes)
Extravascular: Tear-drop shapes (Extra-vascular)
Coombs or (Direct antiglobulin test) is used to determine if it is an immune or non-immune cause of haemolysis
Your consultant approaches you asking you to investigate a patient just admitted to the ward for “Bone Marrow infiltration”. You note it is a cause of anaemia. What type of anaemia?
Give 3 ddx
Normochromic normocytic anaemia
Leukemia
Multiple Myeloma
Metastatic disease
Myelofibrosis
What infectious diseases are known to cause pancytopenia? Give 3
HIV/AIDS
Viral hepatitis (B&C)
EBV
Parvovirus B19 (mostly reduced RBC)
Bone Marrow infiltration can cause pancytopenia. In an FBC showing pancytopenia, what would be your differential diagnoses?
1) Bone Marrow Infiltration => Leukemia, myelofibrosis, metastatic disease, Multiple Myeloma
2) Bone marrow aplasia: Aplastic anaemia, Nutritional deficiencies (B12, Folate)
3) Blood cell destruction (DIC/TTP) or sequestration (Hypersplenism)
4) Infectious diseases: HIV, Hep B&C, EBV
What is multiple myeloma?
Haematological malignancy characterized by the uncontrolled proliferation of malignant plasma cells in the bone marrow leading to the overproduction of a monoclonal Ig protein => BM infiltration causing Anaemia, Renal damage (raised creatinine), Bence Jones Proteinuria, lytic Bone lesions and hyperCalcemia.
What is meant by Bence-Jones Proteinuria
negative on urine dipstick despite evidence of acute kidney injury from antibodies in the bloodstream typically seen in multiple myeloma
Give 10 causes of Normochromic normocytic anaemia (you must categorize properly for 5/5)
a) Anaemia of chronic Disease
Malignancy
Chronic infection e.g. Tb
Chronic inflammation e.g. RA
Chronic kidney disease (reduced EPO production)
+ Genetic Sideroblastic anaemia
b) Acute/subacute blood loss
c) Haemolysis:
Intravascular causes:
DIC
TTP (thrombotic thrombocytopenic purpura)
Malaria
Prosthetic valve degradation
Extravascular causes:
Intrinsic: Sickle Cell Anaemia, G6PD deficiency
Extrinsic: Autoimmune, Hypersplenism!, Drug-induced
d) BM infiltration: Leukemia, Multiple Myeloma, Myelofibrosis, and metastatic disease
Macrocytic Anaemia can be megaloblastic or non-megaloblastic. What are the 2 main causes of megaloblastic anaemia?
B12/Folate deficiency