Week 10: General blood disorders Flashcards
What does a low ferritin saturation indicate
Iron deficiency (confirmed)
What does a high ferritin saturation indicate
Inflammation (acute phase protein)
-inflammation can cause high ferritin levels even in an iron deficient patient
What does a low transferrin saturation indicate
- Iron deficiency
- It’s been a while since eating (eg after sleeping)
Transferrin is very variable according to mealtimes
What does a high transferrin saturation indicate
- Just eaten
2. Haemochromatosis
Relationship between transferrin saturation and Total Iron Binding Capacity (TIBC)
Inverse relationship.
Low transferrin saturation means a high TIBC
What transferrin and ferritin saturations indicate haemochromatosis
Transferrin saturation >50%
High ferritin
Apart from transferrin and ferritin,
what other tests can be used to diagnose haemochromatosis
- HFE gene test
- PEARL liver scan (to see amount of iron in liver)
- Liver USS
What gene is associated with haemachromatosis
HFE gene
What 4 conditions are associated with haemachromatosis
- Diabetes
- Liver failure
- Chondrocalcinosis in knees
- Heart failure
Causes of microcytic anaemia
- Iron deficiency
2. Thalassaemia
Causes of macrocytic anaemia
- Low B12/folate
- Pregnancy
- Thyrotoxicosis
- Myelodysplasia (blood cancer)
Symptoms of B12 vs folate deficiency
B12 deficiency causes neuropathy
Folate deficiency is usually asymptomatic (except during pregnancy)
Causes of low reticulocytes (baby RBC)
Bone marrow problem (inability to make RBC)
Causes of high reticulocytes (baby RBC)
Haemolysis
Results in Bone Marrow releasing immature RBC earlier, to try to combat anaemia
Causes of low WBC
- Drugs
- Very bad sepsis
- Late stage leukaemia
Causes of high WBC
- Inflammation
- Infection
- Leukaemia (usually very very high)
Which virus and bacteria are particularly associated with raised lymphocytes
- EBV virus
2. Pertussis bacteria
Causes of low platelets due to decreased production
- Low B12/ folate
- Blood cancers (myeloproliferative neoplasms, leukaemia)
- Splenomegaly
Causes of low platelets due to increased consumption
- Sepsis
- DIC
- Immune mediated conditions (idiopathic thrombocytopenic purpura)
1st line management in someone whose test has come back with low platelets
REPEAT THE TEST
Platelet clumping on blood film is a normal occurrence in the lab and will cause decreased levels
Causes of high platelets
- Active bleed
- Inflammation
- Post-splenectomy (nowhere to store the platelets)
Causes of polycythaemia (high haematocrit)
- Smoking
- Alcohol (depletes plasma volume)
- Dehydration (low plasma volume)
- Steroid
- Epo-secreting tumour
How does smoking cause polycythaemia
CO from smoke binds to Hb. Leads to chronic cyanosis
Kidneys make more haemoglobin to make up for it
Which are myeloid cells
- Macrophages
- Neutrophils, basophils, eosinophils
amongst others
