Hematology Deep Flashcards
Fe def anaemia causes
1.In females
Menstruation
Pregnancy
Pathological blood loss
2.Adult males and menopausal females
Pathological blood loss
3.Infants and children
Deficient diet
Diminished iron stores
In case of poor person diagnosis
Serum iron profile
Serum iron- 50-17/ umol/ l
Serum fereitin 15-300umol/l
Total iron binding capacity 40-80 umol/l
Percentage saturation pf iron binding protein33%
Lab diagnosis of iron def anaemia
Peripheral blood film shows
RBC microcytic hypochromic
Anisocytosis and poikilocytosis
Ocasional target cells and pencil shaped cells
Biochemical- serum iron decreased less than 10 umol
Serum ferritin decreased less tha 12umol
Tibc increasedmore than 80
Confirmatory diag of thalessaemia
Hemoglobin electrophoresis
Confirmatory diag of anaemia of ch disease
Serum ferritin
Is normal or increased
Confirmatory diag of sideroblastic an
Bone marrow exam with prussian blue stain
Ringed sideroblasts are seen
Prussian blue helps us see excess iron accumulation
Causes of normoblastic macrocytic anaemia
Hemolytic anaemia
Post haemorrhagic anaemia
Alcholism
Liver disease
Aplastic anaemiascurvy
Megaloblastic anaemia
Rbc macrocytosis oval macrocytes
Megaloblasts with howell jolly bodies
Wbc hypersegmented neutrophils
Biochemical ldh is invariably high
Special tests
Serum Vit b12 assay
Radioactive vit b 12 absorption test - schilling test
Folate def
Serum folate assay
Red cell folate assay
Hypersegmented neutrophils
When more than 5% of neutrophils have 5 lobes or atleast 1 6 lobed cell.
It is early sign of vit b12 or folate deficiency
Other conditions
Megaloblastic anaemia
Iron def anaemia
Myeloproliferative disorders
Chronic renal failure
Pernicious anaemia most specific test
Anti intrinsic factor ab
Schilling test
Megaloblastic anaemia lab diagnosis
Blood picture
Hb% reduced
Mcv inc
Mch inc
PBF
Rbc macrocystosis with anisocytosis and poikilocytosis
Megaloblasts and howell jolly bodies may be present
Wbc hyperseg neutrophils are present
Platelets thrombocytopenia
Bone marrow exam
Cellularity inc
M/e ratio is dec
Erythropoiesis hyperactive
Granulopoiesis abnormal resulting in giant stab
Megalaryopoiesis normal or inc
Biochemical serum iron and ferritin inc
Serum bilirubin inc
Plasma Ldh invariably inc
Serum haptoglobin reduced
Special tests
Schilling test
Serum vit b 12 assay
Serum folate assay
Causes of megaloblastic erythropoeiss
Vit b 12 def
Folate def
Combined b 12 and folate def
Abnormalities in b 12 and folate metabolism
Other defects of dna synthesis
Megaloblastic erythropoiesis
Megaloblastic erythropoiesosMegaloblastic Erythropoiesis refers to the production of abnormally large, immature red blood cell precursors (megaloblasts) in the bone marrow due to defective DNA synthesis. This defect leads to ineffective erythropoiesis, meaning many developing red cells die before maturing, causing anemia.
Causes:
Megaloblastic erythropoiesis primarily results from deficiencies in:
Vitamin B12 (Cobalamin) deficiency – e.g., pernicious anemia, malabsorption disorders
Folic acid deficiency – e.g., dietary deficiency, pregnancy, alcoholism
Causes of pancytopenia
Aplastic anaemia
Megaloblastic anaemia
Subleukemic acute leukemia
Hypersplenism
Sle
Radiotherapy
General evidence of hemolysis
1.Evidence of increased hb breakdown
Reduced blood hb level
Reduced plasma haptoglobin and haemopexin level
Reduced glycosylated hb level
Increased plasma ldh level
Haemoglobinemia
Haemoglobinurea
Methhamoglobinemia
Haemo sidenurea
2.Evidence of compensatory erythroid hyperplasia
Reticulocytosis
Macrocytosis and polychromasia
Erythroid hyperplasia of bone marrow
Radiological changes in skull and tubular bones
3.Evidence of damage to rbc
Fragmemtation of rbc
Spherocytosis
Heinz bodies
- Shortened rbc life span
Classify haemolytic anaemia
- Haemolytic anaemia due to intra corpuscular mechanism
2……. due to extracorpuscular mechanism
Due intracorpuscular defects
- Congenital
A.Memb defects: heriditary spherocytosis
Heriditary eliptocytosis
Heriditary xerocytosis
B.hb defects:
Haemoglobinopathies(Sickle cell anaemia
Hb c hb e hb d)
Thalasemia
C. Enzyme defects: pyruvate kinase deficiency
Glucose 6 phosphate deficiency
2.Acquired.
Paroxysmal nocturnal hburea
Extracorpuscular defects
- Immune mechanism
Autoimmune acquired haemolytic anaemia
Haemolytic disease of new born
2.non immune mechanism
Cardiac haemolytic anaemia
March haemoglobinurea - Miscellaneous
Lead poisoning
Causes of neutropenia
Viral inf
Bacterial inf
Protozoal inf
Aplastic anaemia
Megaloblastic anaemia
Hyperspenism
Sle
Types of leukemia
1.Acute leukemia
Aml
Undiff aml
Myekoblastic leukemia without maturation
Myeloblastic leukemia with maturation
Hypergranular promyelocytic leukemia
Myelomonocytic leukemia
Monocytic leukemia
Erythroleukemia
Megakaryoblastic leukemia
All
Small homogenous lymphoblast
Heterogeneous lymphoblast
Large homogenous lymphoblast
Chronic leukemia
Cml
Cll
2.Chronic leukemia
Erythroleukemia
It is a type of leukemia that involves both erythroid and myeloid precursors in bone marrow
Confirmatory of leukemia
Peripheral blood film
Rbc nn with aniso poikilo
Mild polychromasia
Presence of blast cells.
Leukocytosis most cells are lymphoblastic
Smear cells are present
Thrombocytopenia
Peripheral blood film of cml
Rbc.. nn
Polychromasia
Basophilic stippling
Wbc
Leukocytosis
Segmented neutrophils are present
Neutrophil
Myelocytes 10-50%
Myeloblastupto 10%
Eosinophil and basophil inc
Platelet inc in chronic phase
Later dec
Cml diagnostic
Philadelphia chromosome
Ie abnormal chromosome 22
