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PathY5 > Interactive case hx in haematology > Flashcards

Interactive case hx in haematology Flashcards

1
Q

Which of the following is the most convincing indication of iron deficiency? Please rank:

Anaemia and low MCV
Jaundice
Pencil cells on the blood film
Low transferrin saturation plus low serum iron
Fatigue

A

?

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2
Q

Give 2 symptoms and 2 signs of anaemia

A

weakness/ lethargy
Breathlessness

Pallor
Tachycardia + cardiomegaly

extra signs: koilynychia, glossitis, jaundice

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3
Q

Scenario A&E
Age 36
Sex Female
History 2years SOBOE
FBC Hb 32 g/l (116-150g/dl)
WBC 7 x 109/l (2-10.5 x 109/l)
platelets 452 x 109/l (150-400 x 109/l)
MCV 54fl ( 80-100fl)

What are the 3 most likely causes of this anaemia ?

A

Iron Deficiency Anaemia
Thalassaemia
ACD

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4
Q

What further investigations would be useful?

A

Reticulocyte count
- Haemoglobin electrophoresis
Iron studies..e.g. ferritin, transferrin saturation
Blood film

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5
Q

When is reticulocytosis absent?

A

Inadequate haematinics

Bone marrow failure (e.g. infiltration)

Acute major haemorrhage…reticulocyte response within 6 hours which increases over 6-10 days

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6
Q

What is on a blood film in IDA?

A

Iron deficiency

  1. Pencil cells
  2. Anisocytosis
  3. Poilkilocytosis
  4. Hypochromic
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7
Q

What does this show?

A
  1. Pencil cells
  2. Anisocytosis
  3. Poilkilocytosis
  4. Hypochromic
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8
Q

What causes IDA?

A

Uterine blood loss

GI loss

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9
Q

Hb 60 g/l (135-175g/l)

WBC 0.1 x 109/l (2-10.5 x 109/l)

Platelets 4 x 109/l (150-400 x 109/l)

What is abnormal about this blood count?

A
  1. Hb is LOW
  2. WBC is LOW
  3. Platelets LOW
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10
Q

What could cause this combination of abnormalities?

GIVE THREE POSSIBILITIES

A
  1. Aplastic anaemia
  2. Leukemia
  3. Infiltration e.g.Lymphoma, carcinoma
  4. Drugs e.g. chemotherapy
  5. B12/folate deficiency
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11
Q

Give 2 useful further investigations

A
  1. Blood film
  2. Vitamin B12
  3. Folic acid
  4. bone marrow
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12
Q

Suggest one diagnosis

A

ACUTE MYELOID LEUKAEMIA

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13
Q

What are the likely clinical problems going to be?

A

AML

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14
Q

What are the principles of managing this condition?

A

Supportive

  1. Red cell transfusions
  2. Platelet transfusions
  3. Nurse in isolation; prompt antibiotics

Disease related management

Consider chemotherapy

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15
Q

Hb 120g/l (135-175g/l)

WBC 10 x 109/l (2-10.5 x 109/l)

Platelets 28 x 109/l (150-400 x 109/l)

What is abnormal about this blood count?

A

Anemia

Thrombocytopenia

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16
Q

What are the causes of the MAIN abnormality on this FBC ?

A

NOT MAKING PLATELETS

  • drugs e.g. chemotherapy, thiazides,
  • bone marrow disorders e.g. leukemia, aplastic, myelodysplasia, myeloma, infiltration with carcinoma

PREMATURE DESTRUCTION OF PLTS

  • ITP (auto-immune)
  • Disseminated intravascular coagulation
  • heparin
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17
Q

What further investigations could you do? GIVE 3 POSSIBILITIES

A
  1. Coagulation screen
  2. Blood film
  3. Bone marrow aspirate/trephine
  4. ANA/RAPA
  5. HIV
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18
Q

COAGULATION SCREEN

  • APTT 54 seconds (control 40s)
  • INR 2.1

What is abnormal about this coagulation screen?

A
  • Prolonged APTT
  • INR increased
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19
Q

What further investigations would be useful now?

A
  1. Blood film
  2. D-dimers/FDPs
  3. fibrinogen
  4. Blood cultures/CSR/MSU (Septic screen)
  5. Liver function tests
20
Q

What is the diagnosis?

A

Disseminated intravascular coagulation

21
Q

What is the management of DIC?

A

LIAISE WITH HAEMATOLOGY TEAM AND THE HAEM LAB

  • Antibiotics
  • Blood products….Red cells, platelets, cryoprecipitate, FFP
  • Regular blood tests to assess response to products
22
Q

What can alter myeloblasts?

A

<5% in BM is normal

5-10% is myelodysplasia

>20% is AML

If in peripheral blood, may be AML or leukoerythroblastic anaemia

Auer Rods

23
Q

What can alter lymphoblasts?

A

<5% is normal in BM

>20% = ALL

TdT positive (NO AUER RODS)

24
Q

What are the B cell markers?

A

CD19 and 20

25
Q

What are the T cell markers?

A

CD3

CD4

CD8

CD5

26
Q

What are the lymphocyte makrers of maturity?

A

TdT = immature T/B lymphoblasts

Surface Ig = mature B/ plasma cells

27
Q
A

Hereditary spherocytosis

28
Q

Spherocytes: Auto Immune or Inherited. One test to confirm acquired ?

Hb elctrophoresis

DAT (direct antiglobulin)

Sickle solubility

Unconjugated hyperbilirubinaemia

A

DAT (direct antiglobulin)

29
Q

What is the difference between inherited and acquired haemolytic anaemias?

A

Inherited = inherited defect of cell

Acquired = environment causes damage

30
Q
A

MAHA

Malaria

Snake bites

Aortic stenosis

31
Q

Woman with SLE and menorrhagia

A

ACD

32
Q

Why does ACD happen?

A
33
Q

What causes isolated single lineage cytpaenia with otherwise normal FBC?

A
34
Q
A

B12 deficiency

35
Q
A

Leukoerythroblastic anaemia- Metastatic prostate cancer

36
Q

What causes pancytopaenia?

A
37
Q

Single most useful haematological test

DAT

Immunophenotyping for CD19/CD5/CD3 expression

HTLV1 serology

BCR ABL1 RT-PCR assay

JAK2V617F mutation analysis

Factor V Leiden screen

A

BCR ABL1 RT-PCR assay

38
Q

What is the clinical picture of someone with CML?

A
39
Q

How do leukaemia markers correlate with levels of residual leukaemia in the body?

A
40
Q
A

Tyrosine Kinase Inhibitor- Imatinib/ dasatinib

41
Q
A

Blast crisis

42
Q
A

JAK2V617F mutation analysis

43
Q
A

Immunophenotyping for CD19/CD5/CD3 expression (for CLL)

44
Q

What is CLL?

A
45
Q
A

Ibrutinib

46
Q
A

Multiple Myeloma

47
Q
A

Cast Nephropathy

PathY5 (98 decks)

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