Systemic diseases Haem

Question 1

Lab findings IDA

Answer 1

microcytic hypochromic anaemia, reduced ferritin & TF saturation, raised TIBC

Question 2

Likely diagnoses of IDA

Answer 2

Bleeding until proven otherwise
Menorrhagia in pre- menopausal
GI cancers

Question 3

Leucoerythroblastic anaemia fiindings

Answer 3

o Teardrop RBCs – aniso and poikilocytosis
o Nucleated RBCs
o Immature myeloid cells

Question 4

Cause of Leucoerythroblastic anaemia

Answer 4

o Malignant

o Severe infection

o Myelofibrosis

Question 5

Common lab features of all haemolytic anaemias

Answer 5

o Anaemia – may be compensated
o Reticulocytosis
o Unconjugated bilirubin raised – pre-hepatic
o LDH raised

Question 6

Types of inherited Haem anaemia

Answer 6

Membrane – hereditary spherocytosis
Cytoplasm/enzyme – G6PD deficiency
Haemoglobin – SCD (structural) or thalassemia (quantitative)

Question 7

Types of acquired Immune-mediated anaemia

Answer 7

o Warm AIHA (80-90%) IgG, extravascular haemolysis – lymphoma, CLL, drug allergy, SLE, idiopathic

o Cold AIHA (10-15%) IgM (or IgG), intravascular haemolysis – M. pneumoniae, EBV, CMV

Question 8

Types of Non-immune-mediated acquired anaemia

Answer 8

Infection- malaria
Paroxysmal nocturnal haemoglobinuria (Ham’s test +ve)
Micro-angiopathic haemolytic anaemia (MAHA)- adenocarcinoma, HUS, TTP (ADAMTS13 mutation, high vWF)

Question 9

Causes of a neutrophilia

Answer 9

 Corticosteroids
 Underlying neoplasia
 Tissue inflammation  colitis or pancreatitis
 Myeloproliferative or leukemic disorders
 PYOGENIC INFECTION (most likely)

Question 10

Infections that don’t produce a neutrophilia:

Answer 10

o Brucella
o Typhoid
o Viral infections

Question 11

Malignant neutrophilia picture

Answer 11

• Neutrophilia/basophilia + immature cells (myelocytes) + splenomegaly = CML
• Neutropenia + myeloblasts = AML

Question 12

Reactive eosinophilia causes

Answer 12

 Parasitic infection
 Allergic diseases  asthma, rheumatoid, polyarteritis, pulmonary eosinophilia
 Underlying neoplasms  Hodgkin’s, T-cell NHL
 Drugs  reaction erythema multiforme

Question 13

Chronic eosinophilic leukaemia gene fusion

Answer 13

 Eosinophils part of clone

 FIP1L1-PDGFRa fusion gene

Question 14

Causes of monocytosis

Answer 14

TB, brucella, typhoid
o Viral, CMV, varicella zoster
o Sarcoidosis
o Chronic myelomonocytic leukaemia (CMML, myelodysplastic syndrome)

Question 15

Atypical lymphocyte morphology causes

Answer 15

Mature lymphocytes (PB)
•	Reactive/atypical lymphocytes (IM)
•	Small lymphocytes and smear cells (CLL/NHL)
Immature lymphoid cells in PB
•	Lymphoblasts (ALL)

Question 16

Clonality in a B-cell lymphocytosis

Answer 16

Polyclonal = kappa and lambda (reactive)

Monoclonal (kappa ONLY or lambda ONLY (malignant)

Question 17

B-cell acute lymphoblastic lymphoma morphology and immunology picture

Answer 17

 TdT +ve (indicates immature cells; used in VDJ rearrangement)
 CD19 +ve (indicates B-cell lineage)
 Surface Ig -ve (abnormal)

Question 18

What you test malignant cells for

Answer 18

Morphology Immunophenotype

Cytogenetics Molecular Genetics