Haematology Quiz Flashcards
What normal ranges are we expected to know?
- Percentages of white cells are meaningless unless you use them to produce an absolute count
- What are the two possible explanations of
Neutrophils 1%
Lymphocytes 99%
- The percentages of white cells don’t mean anything unless you also have the absolute count
- I.E. 99% lymphocytes and 1% neutrophils could be due to a massive lymphocytosis or a massive neutropoenia
- An absolute count is required
- Percentages of white cells are meaningless unless you use them to produce an absolute count
- What are the two possible explanations of
Neutrophils 1%
Lymphocytes 99%
CLL
•The RBC, Hb and Hct are high•The patient appears to be polycythaemic
–Is it a true or a pseudo-polycythaemia?
–Is he hypoxic from chronic lung disease or cyanotic heart disease?
–Does he have inappropriate erythropoietin secretion from a cyst or tumour?
–Does he have an intrinsic bone marrow disease?
•In this blood count there are no clues as to the cause of the polycythaemia
FBC of a 67-year-old woman with facial plethora
She is a smoker and has coronary artery disease
List all the abnormalities present and state the most likely diagnosis
- Chronic myeloid leukaemia
- Polycythaemia vera
- Pseudo-polycythaemia
- Renal artery stenosis
- Smoking induced hypoxia
PV
How would you investigate her further?
How would you investigate her further?
A 69-year-old man in the Intensive Care Unit
- He has extensive atheromatous disease and diabetes mellitus
- He has had an abdominal aortic aneurysm replaced by a graft and has had a stormy post-operative course with
–Sepsis
–Acute renal failure
–Respiratory impairment
His FBC shows:
–WBC 37.5 × 109/l
–Neutrophil count 35 × 109/l
–Lymphocyte count 0.8 × 109/l
–Monocyte count 1.2 × 109/l
–Myelocytes and metamyelocytes 0.5 × 109/l–Hb 110 g/l–MCV 89 fl
–Platelet count 514 × 109/l
Film comments:
–Toxic granulation and vacuolation
–Left shift
–Rouleaux
Reactive neutrophilia
- Chronic myeloid leukaemia
- Normal for age and gender
- Reactive neutrophilia
- Laboratory error
- Acute myeloid leukaemia
CML
•It is gangrene•It could be due to–Abnormalities of the vessels
–Abnormality of the circulating blood
- Think of a vascular abnormality that could cause it
- Think of three abnormalities of the blood that could be responsible
•Non-accidental injury•Coagulation abnormality•Thrombocytopenia
FBC of a North African woman with an 18-month old baby—most likely diagnosis.
- Normal for a North African
- Beta thalassaemia major
- Lead poisoning
- Beta thalassaemia trait
- Iron deficiency anaemia
Iron deficiency anaemia
- Rheumatoid arthritis
- Anaemia of chronic disease
- Iron deficiency anaemia resulting from use of aspirin or non-steroidal anti-inflammatory drugs (NSAID)
- Neutropenia or thrombocytopenia from drug toxicity
- Felty syndrome
- Increased erythrocyte sedimentation rate (ESR)
- A 10-year-old girl presented with a painful right knee that had started when she knocked her knee in a swimming pool
- The next day she had become unwell with malaise, anorexia and fever
- Her GP prescribed amoxicillin for ‘otitis media’
- Next day her mother took her to an Accident and Emergency Department
- She was afebrile
- Her right knee was painful and swollen
- X-ray of the knee showed patchy changes in density in the right medial tibial plateau
- Blood tests showed
–WBC 6.6 × 109/l
–ESR 60 mm in 1 h (NR 0‒10)
–C-reactive protein (CRP) 27 mg/l (NR 0‒10)
Osteomyelitis
- A 1-year-old boy, an only child, presented to an Accident and Emergency department with a swollen right elbow following minor trauma
- On clinical examination and radiology there was no evidence of bony injury•He was sent home
- Work out a differential diagnosis and as we work through the case history note the errors in management
- What analgesic would you not use?
Aspirin
Coagulation screen
Haemophilia A
- Autoimmune thrombocytopenic purpura
- Hereditary spherocytosis
- Infectious hepatitis
- Meningococcal meningitis
- Thrombotic thrombocytopenic purpura
Thrombotic thrombocytopenia purport
What is thrombotic thrombocytopenia purpura?
How should the pt with thrombotic thrombocytopenia purpura be treated?
