The Full blood count Flashcards
What is Anaemia?
Low Haemoglobin (Hb)
What is Polycythaemia/ Erythrocytosis?
High Hb & haematocrit
What is Leukopenia?
Low white cell count (WCC)
What is Leucocytosis?
High WCC
What is Thrombocytopenia?
low platelets (plts)
What is Thrombocytosis/ thrombocythaemia?
High plts
Generally we see low values of a cell if…
- Increased destruction (e.g. splenomegaly)
- Decreased production (e.g. cancer in bone marrow)
- Relative loss affecting concentration (e.g. post IV fluids)
What is Pancytopenia?
Low Hb & WCC & plts
Generally we see high values of a cell if…
- Reactive to inflammatory/ infective process (e.g. sepsis)
- Increased production by a cancer (lymphoma/ leukemia/ myeloma/ polycythemia vera/ essential throbocythemia)
- Relative increase if fluid loss (e.g. if dehydrated)
What are the 7 symptoms of anaemia?
Fatigue
Weakness
Pallor
Dizziness
Fainting
Shortness of breath (SOB)
Chest pain
What are the 3 main types of anaemia?
Microcytic
Normocytic
Macrocytic
What is Microcytic anaemia?
MCV= low
red blood cell is small
What is Normocytic anaemia?
MCV normal, normal RBC size
- Reticulocytes present
- Reticulocytes absent
What are reticulocytes?
- Immature RBCs
- Presence show the bone marrow is physically able to make red cells and has had the time to make red cells
What is Macrocytic anaemia?
MCV= high, large RBC
Megaloblasts present
Megaloblasts absent
What are megaloblasts?
Large RBCs
Haven’t been able to complete cell division
What is Microcytic anaemia caused by?
- Iron deficiency (often due to chronic bleeding)
- Thalassemia
- May have cancer or problem with menstrual cycle
What is the cause of Normocytic anaemia when reticulocytes absent?
Aplastic anaemia (affects the bone marrow= not working properly)
Acute bleeding (sometimes retics increased)
Anaemia of chronic disease (sometimes microcytic)
What is the cause of Normocytic anaemia when reticulocytes present?
Haemolysis (heart valves, spherocytosis)
Sickle cell
G6PD deficiency
What is G6PD?
enzyme you need to make glutathione which makes strong RBCs
Deficiency means you have weak RBCs
What is the cause of Macrocytic anaemia when Megaloblasts are present?
- B12 deficiency (can’t complete cell division)
- Folate (B9) deficiency (both of which can be caused by alcohol)
What is the cause of Macrocytic anaemia when Megaloblasts are absent?
- Myelodysplastic syndrome
- Liver disease (inc caused by alcohol- excess cell membrane due to defective cholesterol esterification)
What is the treatment for anaemia?
FIX THE CAUSE
- Diet
- Vitamin replacement (Fe/B12/folate)
- EPO injection
- Blood transfusion
What are the causes of Polycythaemia?
-Relative
- Absolute
Primary
Polycythemia Vera (JAK2 gene)= blood cancer
Secondary
Renal cell carcinoma
Exogenous EPO (EPO made in kidneys, could be caused by kidney cancer)
What are the causes of Leukopenia? (5)
- Cancer (esp those affecting bone marrow)
- Cancer treatment (chem/ radiotherapy)
- Other drugs (antipsychotics, carbimazole)
- Viral infection (HIV)
- Autoimmune conditions
What are the 4 causes of Leukocytosis?
Raised neutrophils
Raised eosinophils
Raised lymphocytes
Very Raised lymphocytes
In what cases should you be worried about Leukopenia?
Neutropenia (neutrophils very low)
Agranulocytosis (neutrophils very very low)
What do raised neutrophils indicate?
Think bacterial infection
What do raised eosinophils indicate?
Think allergy
What do raised lymphocytes indicate?
Think viral infection
What do very raised lymphocytes indicate?
Think malignancy
What are the 3 cancers of white cells?
Leukemias
Lymphomas
Myeloma
What are Leukemias?
- Commonly present with raised WBC
- Acute (AML, ALL)
- Chronic (CML, CLL)
What are Lymphomas?
- Commonly presents with raised WBC
- Hodgkin’s (presence of cells down microscope)
- Non-Hodgkins
What are Myelomas?
Solid tumour in the bone marrow
What are the 4 causes of Thrombocytopenia?
- Decreased production by marrow
- Increased platelet sequestration
- Dilutional
- Increased platelet destruction
What is decreased production by marrow caused by?
Malignancy
Myelofibrosis/ myelodysplasia
Nutritional deficiency
What is increased platelet sequestration caused by?
Splenomegaly (portal hypertension due to cirrhosis)
What is dilutional caused by?
Post blood transfusion
Pregnancy
What is increased platelet destruction caused by?
Immune thrombocytopenic purpura (ITP)
Disseminated intravascular coagulation (DIC)
Thrombotic thrombocytopenic purpura (TTP) (ADAMTS13 gene)
Drug related (Chemo, quinine, NSAIDS, penicillin & anticonvulsants)
What is Thrombocytosis/ thrombocythemia?
Raised platelets
What are the causes of thrombocytosis?
Primary
- Essential thrombocythaemia (cancer)
Secondary/ reactive (>80%)
- Inflammation (autoimmune or infection)
- Drugs
- Surgery/ other trauma
- Haemolysis
- Iron deficiency
What are the 3 key causes of Pancytopenia?
Reduced production
Increased destruction
Sequestration
Why does reduced production cause Pancytopenia?
- Replacement of marrow by fibrosis (myelofibrosis)
- Replacement of marrow by tumour
- Aplastic anaemia (often non cause found)
Why does increased destruction cause Pancytopenia?
Sepsis
Why does sequestration cause Pancytopenia?
Splenomegaly
