haematology quiz Flashcards
83-year-old man with no abnormal physical findings
chronic lymphocytic leukaemia
RBC, Hb and Hct are high
polycythaemia - need to decide if true or pseudo (ie shocked and lost plasma would -> high hb)
ddx:
* hypoxia from chronic lung disease or cyanotic heart disease
* inappropriate epo secretion - cyst/tumour
* intrinsic marrow disease
Polycythaemia vera
High plt – so likely to be a bone marrow
high RBC Hb PCV, WBC, neutrophils and basophils
Smoking – wouldn’t explain the thrombocytosis
Combination of both thrombocytosis and Hb that make the dx
test to confirm polycythaemia vera
Analysis for JAK2 V617F mutation
Bone marrow aspiration and trephine biopsy
Serum erythropoietin - Would expect epo to be low – suppress by high Hb
Would like to stop her smoking because at increased risk with polycythaemia vera
left shifts
reactive neutrophilia
toxic granulaton and vacuolation are reactive changes
High red and white cell
High neutrophil, lymphocytes, monocytes, eosinophils, basophils
Normal Hb
Splenomeg
Chronic myeloid leukaemia – high neutrophil eosinoiphil and basophil, normal Hb
AML – not if normal Hb and plts
Isolated thrombocytopenia in elderly man – expect immune thrombocytopenia
Peripheral gangrene
can be due to abnormality of vasculature, or of circulating blood
Non-accidental injury
Coagulation abnormality eg Haemophilia if inherited
Thrombocytopenia eg ALL, immune of thrombocytopenia
Normal on L
R – pokilocytosis, hypochromia, microcytosis
causes of microcytosis
IDA
thalassaemia
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
Major – would have to be transfusion dependant
Trait – would have normal Hb, low MCV
questions to ask if suspecting IDA
Diet
Menstrual history
History of pregnancies
Blood loss
what is haemoglobin A2 in IDA
low
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 – neutropenia and splenomegaly
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
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)
What is the most likely diagnosis?
Osteomyelitis
ddx - septic arthritis, haemorrhage into the joint following minor trauma, non-accidental injury
osteomyelitis more likely than septic arthritis because:
* radiological abnormality, which indicated something wrong with the bone
* osteomyelitis slightly more common
Not haemophilia – because female
Thrombocytopenia – wouldn’t account for ESR, fever etc
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
brought back with increased pain and swelling
Joint aspiration yielded haemorrhagic fluid
brought back as the effusion had not resolved
The joint was surgically explored (dark blood) and a biopsy was taken (‘synovitis’)
Post operatively the wound bled persistently
what test would you do
A coagulation screen showed a normal prothrombin time (PT) and a prolonged activated partial thromboplastin time (aPTT)
Severe deficiency In factor 8
A 21-year-old woman presented with abdominal pain, bruising and altered level of consciousness
She had a low grade fever
Her platelet count was 15 × 109/l
Her bilirubin was increased and LDH was greatly increased
Her creatinine was marginally increased
Microspherocytes
Red cell fragments
Anaemia
Circulating nucleated red cells
dx?
Thrombotic thrombocytopenic purpura - MAHA
Autoimmune – wouldn’t have fragments and microspherocutes
ddx - HUS, meningococcal septicaemia, TTP
features of TTP
classic pentad of clinical features:
* Microangiopathic haemolytic anaemia
* Thrombocytopenia
* Fever
* Neurological abnormalities
* Renal impairment
pathophysiology of TTP
defect in vWF cleaving protease (or ADAMTS13)
autoimmune
-> large multimers of vWF -> plt thrombi -> Clinical features
rx of TTP
plasma exchange
On this presentation, temperature 39.70C, BP 115/95, pulse rate 96 beats/minute, generalized lymphadenopathy, pharynx inflamed, mild hepatomegaly, spleen palpable 2 cm below left costal margin
WBC 11.2 × 109/l, lymphocyte count 7.8 × 109/l, Hb 109 g/l, numerous atypical lymphocytes
What test would you do?
screening test for infectious mononucleosis
