haematology of systemic disease

Question 1

patient diagnosed with lymphoma via biopsy has new onset : jaundice, anaemia, raised LDH what are 3 possible differentials

Answer 1

Lymphoma with pathological lymph nodes compressing the bile duct a anaemia of inflammation (post hepatic)

lymphoma stage 4 with BM and liver infiltration (hepatic)

lymphoma stage 1 with auto immune haemolytic anaemia ( pre hepatic)

Question 2

leuco-erythroblastic anaemia (blood film)

Answer 2

Bone marrow infiltration : variable degree of anaemia, morphological features on blood film

tear drop poikilocytes

nucleated RBC

myelocytes

manifestation of malignancy leukaemia lyhpoma and myleomas, metastatic cancer breast bronchus prostate

Question 3

coombs test +ve haemolytic anaemia causes

Answer 3

malignancy lymphoma cll

autoimmune SLE

infection: mycoplasma

Question 4

DAT -ve haemolytic anaemia causes

Answer 4

MAHA

HUS

RBC fragments thrombocytopenia

activated coagulation system. disseminated coagulation generate fibrin strands, irregular fibrin strand formation, red cells fragmented by strands.

Question 5

raised neutrophil count 2 similar differentials reactive vs cml blood film

Answer 5

reactive neutrophillia - only neutrophils

chronic myeloid leukaemia - raised neutrophils +basophils + precursor cells in bone marrow

Question 6

eosinophilia neoplasia /infection cause

Answer 6

parasitic infection or

hodgkins/ NHL/

Question 7

polyclonal vs monoclonal b-cells

Answer 7

individual B cell will express both kappa and lambda 50/50 suggests healthy B-cells (polyclonal)

kappa or lambda b cells only (monoclonal), lymphoproliferative disorder –> myeloma , CLL , hodgkins, ALL

Question 8

female 39 treated for breast cancer 4 years previously

recent onset jaundice hepatomegaly

HB 87g/L

reiculocyte 15x10^9 (20-92)

Bilirubin 50

DAT -ve

BLOOD FILM: nucleated red blood cells + myelocytes

Answer 8

DAT -VE cant be auto immune haemolytic anaemia

MAHA - no red cell fragments in blood smear, elevated unconjugated bilirubin (prehepatic)

Not iron deficiency except wouldnt see jaundice lack iron but not releasing haem into blood, reticulocyte count is low. No nucleated red cells

anaemia of chronic disease cannot incorporate iron into haem. also not this

anaemia nucleated red cells + myelocytes infilitration of bone marrow metastases from cancer , red and white cell precursors

Question 9

45M

3 week history sore throat

EBV +ve IgG

FBC raised lymphocytes, raised neutrophils

film: reactive lymphoctes

peripheral smear 82% kappa 0% lamda

Answer 9

monclonal so eliminates infectious mononucleosis

B cell malignancy as + markers

no abnormal cells therefore mature B cell lymphoproliferative disorder eg. CLL