Hematology Flashcards
High MCV, Normal MCHC
Provisional diagnosis?
Megaloblastic macrocytic anemia secondary to vitamin B12 deficiency / Folate deficiency
High MCV, Normal MCHC
4 causes?
Vitamin B12 deficiency
• Poor intake of vitamin B12
• Pernicious anaemia
Folate deficiency
• Reduced dietary intake
• malabsorption d/t tropical sprue
* increased Folate demands (pregnancy)
High MCV, Normal MCHC
2 investigations for each D/Dx
• Serum B12 & Folate : reduced
• Schiling test
• Peripheral blood film: Large hypersegmented neutrophils, Oval macrocytes
• Bone marrow study: Hypercellular , macroblasts
Lifetime vegetarian. Low Hb, High MCV, PBF show segmented neutrophils, low serum vitamin B12.
A) Provisional diagnosis
Megaloblastic macrocytic anaemia secondary to vitamin B12 deficiency
Lifetime vegetarian. Low Hb, High MCV, PBF show segmented neutrophils, low serum vitamin B12.
Name 1 medication
Hydroxocobalamin intramuscular injection
Lifetime vegetarian. Low Hb, High MCV, PBF show segmented neutrophils, low serum vitamin B12.
Neuropsychiatric complications if left untreated.
- Paraesthesia
- Balance Disorder
- Peripheral neuropathy
- Optic neuropathy
A patient presented with headache and pruritus after a warm bath. He has 30 pack year of smoking. His face is plethora & infected conjunctivitis. Hematocrit = 55%
Provisional diagnosis
Polycythemia secondary to smoking or polycythemia rubra vera
A patient presented with headache and pruritus after a warm bath. He has 30 pack year of smoking. His face is plethora & injected conjunctivitis. Hematocrit = 55%
2 causes & investigations for each cause
- PRV - Genetic testing for JAK2 kinase mutation
- Secondary polycythemia (Smoking): ABG for O2 saturation and carboxyghemoglobin level
- Serum erythropoietin level: High in secondary polycythemia, low in PRV
A 22 years old lady, known case of b thalassemia major, afebrile and comes for first time of blood transfusion. 30 minutes later, nurse noticed her temperature increase.
Give 4 signs and symptoms that you want elicit from this lady.
• Elevated temperature (Febrile)
• Tachycardia
• Hypotension
• Respiratory distress- dyspnea, tachypnea
• Oliguria, anuria
• Shock
A 22 years old lady, known case of b thalassemia major, afebrile and comes for first time of blood transfusion. 30 minutes later, nurse noticed her temperature increase.
Name 4 acute adverse reactions that occur during blood transfusion.
- AHTR - Acute Hemolytic transfusion reaction
- TRALI - Transfusion related Acute lung injury
- FNHTR - Febrile Non Hemolytic transfusion reaction
- Allergic and anaphylaxis reaction
A 22 years old lady, known case of b thalassemia major, afebrile and comes for first time of blood transfusion. 30 minutes later, nurse noticed her temperature increase.
What is your immediate action?
• Stop blood transfusion
• Anticipate hypotension, renal failure, DIC
• Change hydration with normal saline
• Low-dose epinephrine
A 20 years old lady come to your clinical with bruising on hand. Investigation was done and her platelet count is low, with normal RBC and WBC.
Give 4 aspects of history that you want to take to find out the diagnosis of this isolated low platelet count.
• Onset (Acute / chronic)
• Recent blood transfusion (Hemodilution)
• Recent medication (Antiplatelets)
• Family history of thrombocytopenia
A 20 years old lady come to your clinical with bruising on hand. Investigation was done and her platelet count is low, with normal RBC and WBC.
Give 4 signs that you want to elicit from clinical examination.
• Organomegaly
• Petechiae, ecchymoses, purpura
• Bleeding mucous membrane
• Joint, soft tissue bleeding
• Ischemic limb / necrosis
A 20 years old lady come to your clinical with bruising on hand. Investigation was done and her platelet count is low, with normal RBC and WBC.
Define thrombocytopenia.
A platelet count less than 150,000/microL (mcL) (150 x 10 9 /L)
Young man, multiple joint swelling, easy bruising even minor trauma, brother has similar symptoms
Platelet: a value (normal)
PT time: 12 sec
APTT: 50 sec
State the abnormality in above investigation?
Prolonged APTT
Young man, multiple joint swelling, easy bruising even minor trauma, brother has similar symptoms
Platelet: a value (normal)
PT time: 12 sec
APTT: 50 sec
Explain 2 causes of the abnormality.
- Hemophilia A or B
- X-linked recessive disorders
- Factor VIII (A) or Factor IX (B) deficiency
- Leading to defective intrinsic coagulation and prolonged APTT. - Severe Von Willebrand Disease (VWD)
- This autosomal disorder
- vWF deficiency or dysfunction
- reducing Factor VIII levels and causing prolonged APTT.
Young man, multiple joint swelling, easy bruising even minor trauma, brother has similar symptoms
Platelet: a value (normal)
PT time: 12 sec
APTT: 50 sec
State your provisional diagnosis + Justification.
Haemophilia.
- Hemophilia is X-linked inherited recessive genetic disorder, which typically affects male.
- The patient and his brother are affected with same disease
- They inherit homogenous recessive trait of hemophilia.
Young man is presented with recurrent epistaxis and bruising over his limbs, no hepatosplenomegaly and lymphadenopathy, FBC result:
Hb: value (normal)
WBC: value (normal)
Platelet: 18x10^9 /mm3 (low)
What abnormality in those finding?
Low platelet count - thrombocytopenia
Young man is presented with recurrent epistaxis and bruising over his limbs, no hepatosplenomegaly and lymphadenopathy, FBC result:
Hb: value (normal)
WBC: value (normal)
Platelet: 18x10^9 /mm3 (low)
List 2 d/dx
- Immune thrombocytopenic purpura
- Dengue infection
Young man is presented with recurrent epistaxis and bruising over his limbs, no hepatosplenomegaly and lymphadenopathy, FBC result:
Hb: value (normal)
WBC: value (normal)
Platelet: 18x10^9 /mm3 (low)
2 investigations to confirm
I. PT and APTT – normal in ITP
ii. Antinuclear antibody test – positive in ITP
iii. Exclude infection – dengue serology
Boy presented with spontaneous bleeding into joints in emergency department for the second time. His brother suffered the same condition too. He also has hematoma & hemarthrosis.
Provisional diagnosis & type of the disease
Haemophilia
• Hemophilia A: Factor XIII deficiency
• Hemophilia B: Factor IX deficiency (Christmas disease)
Boy presented with spontaneous bleeding into joints in emergency department for the second time. His brother suffered the same condition too. He also has hematoma & hemarthrosis.
D/dx
• Thrombocytopenic purpura
• Von Willebrand disease
• Bernard-Soullier syndrome
• Glanzman thrombosthenia
• Vitamin K deficiency
Boy presented with spontaneous bleeding into joints in emergency department for the second time. His brother suffered the same condition too. He also has hematoma & hemarthrosis.
Investigations
• FBC
• PBF
• Prolonged aPTT, Normal PT
• Normal bleeding time
Boy presented with spontaneous bleeding into joints in emergency department for the second time. His brother suffered the same condition too. He also has hematoma & hemarthrosis.
What abnormalities in coagulation profile
Prolonged APTT, normal PT
