Hematology

Question 1

What is esr. How is it measured. Amount of reagent used.

Answer 1

When a volume of blood is mixed with a specific amount of suitable anticoagulant and is allowed to stand in a vertical position in a narrow tube the blood cells settle down leaving the clear plasma above. the sedimentation of red cells that takes place in the first hour is called ESR.
Methods of estimation
Westergren method
Male- 0-10 mm in first hour
Female- 0-20 mm in first hour
Wintrobe method
Male- 0-8 mm in first hr
Female- 0-10 mm in 1st hr
Reagent used 3.8 %na citrate

Question 2

Causes of high esr

Answer 2

Physiological.
Old age
Pregnancy
Vaccination
High altitude

Pathological
MM
TB
SLE
aplastic anaemia
Kala azar
Rheumatoid arthritis

Question 3

Causes of sky high esr

Answer 3

MM
TB
SLE
APLASTIC ANAWMIA
RHEUMATOID ARTHRITIS

Question 4

Causes of low esr

Answer 4

Polycuthemia
Sickle cell anaemia
Spherocytes
Ccf
Hepatic failure

Question 5

Why esr is high in mm

Answer 5

Due to increased levels of monoclonal immunoglobulin .
This causes increase in plasma ciscosity which will cause roleux formation which will increase sedimentation of rbc

Question 6

Why low in polycythemia

Answer 6

There is abnormally high number of rbcs which will decrrease the plasma
Reducing the tendency of rbc to settle quickly

Question 7

Indications of bone marrow aspiration

Answer 7

For diagnosis:
1. Rbc disorders
Aplastic anaemia
Megaloblastic anaemia
Pancytopenia
Sideroblastic anaemia

2. Wbc disorders
   Sub leukemic acute leukemia
   Leukemia
   Agranulocytosis
   Unexplained leukopenia or leukocytosis
3. Platelet disorders
   ITP
   Others
   MM
   Myelodysplasia
   Myelofibrosis
   Lynphoma
   PUO
   Parasitic disease like kala azar
   Glycogen storage disease

For prognosis
Aplastic anaemia
Agranulocytosis

For assessing the effect of treatment

Acute leukemia
To see reccurence of disease

Question 9

Sites of bone marrow aspiration

Answer 9

Body of sternum in adults
Iliac creast in adults and older children
Medial aspect of proximal part of tibia in infants

Question 10

Blood tap

Answer 10

Aspiration of blood without bone marrow particles
Causes
Faulty technique
Aplastic marrow
Myelofibrosis
Hairy cell leukemia
MM
Hodgkin lymphoma
Lymphoma
TB

Question 11

Dry tap

Answer 11

Failure to aspirate any material at all
Causes
Failure to site the tip into the bone marrow
Myelofibrosis
MM
Lymphoma
Hodgkins lymphoma
Hairy cell leukemia
Tb

Question 12

Triphine biopsy

Answer 12

It is a form of aspirating the bone marrow which is performed by rotating a specialised biopsy needle under pressure usually into the iliac crest to obtain a core extending from periosteum into the interstices of the bone marrow cavity

Question 13

Inclusions in pbf

Answer 13

Howell jolly bodies
Heinz bodies
Pappen hiemer body
Basophilic stippling

Question 14

Poikilocytes

Answer 14

Oval cell
Pencil cell
Spherocyte
Stomatocyte
Elliptocyte
Tear drop cell
Sickle cell

Question 15

Causes of anisopoikilocytosis

Answer 15

Anaemias
Sideroblastic
Iron def
Megaloblastic

Hb pathies
Sickle cell disease
Thalessaemia

Bone marrow disorders
Myelodysplastic syndromes

Question 16

Classify anaemia

Answer 16

Morphological class
1.Microcytic hypochromic anaemia
Iron def anaemia
Thalessaemia
Anaemia of chr disease
Sideroblastic anaemia

2. Normocytic normochromic
   Acute blood loss
   Aplastic anaemia
   Haemolytic anaemia
   Renal failure
   Bone marrow failure
3. Macrocytic anaemia
   Megaloblastic: vit b12 def
   Folate def
   Normoblastic: liver disease
   Alcoholism
   Hypothyroidism