Clinical and Laboratory assessment in Haematology(haematology)

Question 1

What symptoms do we look for in abnormal RBCs? (4)

Answer 1

-Polycythaemia, anaemia, tachycardia, shortness of breath etc.

Question 2

What symptoms do we look for in abnormal WBCs? (6)

Answer 2

-Early satiety, infections, recurrent accounts, night sweats, malaise vs malignancy.

Question 3

What symptoms do we look for in abnormal platelets? (6)

Answer 3

• Neurological symptoms, bleeding, mucosal bleed vs blood clots, swollen legs, chest pains.

Question 4

What symptoms do we look for in abnormal coagulation factors? (6)

Answer 4

-Bleeding, joint and muscle bleeding vs blood clots, swollen legs, chest pains, neurological symptoms.

Question 5

What type of questions are asked in a case of bleeding? (6)

Answer 5

-Type of bleeding
-Severity of bleed
-Single or recurrent event
-Cause of bleeding
-Medical history for bleeding
-Alcohol, drugs or medication ingestion.

Question 6

How do you then examine the bleeding patient?

Answer 6

•Take vitals: BP, Heart rate, temperature and sugar levels, oxygen saturation.
•CAJCOLD: Cyanosis, Anaemia, Jaundice, Clubbing, Oedema, Lymphadenopathy, Dehydration.
•Systems which includes:
-Neurological system
-Cardiothoracic system
-Abdominal
-Ear, nose and throat
-Ophthalmology
-Lymphatic

Question 7

What are the red cell indices we test for?

Answer 7

Red cell count
Haemoglobin-Anaemia or polycythaemia
Haematocrit
Mean cell volume- Type of anaemia and cause
Mean cell haemoglobin-Type of anaemia
Mean cell haemoglobin concentration-Type of anaemia
RDW%- variability in cell sizes.
Reticulocyte count-measures bone marrow response.

Question 8

What are the causes of deranged platelet counts? (2)

Answer 8

Thrombocytopenia: Decreased production, increased destruction, hypersplenism, dilutional.
Thrombocytosis: Reactive such as post-splenectomy, chronic infections, acute haemorrhage.
Endogenous such as myeloproliferative disorders.

Question 9

What causes neutrophil leucocytosis? (5)

Answer 9

-Bacterial infection
-Pregnancy
-Tissue necrosis
-Drugs
-Acute haemorrhage or haemolysis

Question 10

What causes neutropenia?

Answer 10

•Decreased production
-Aplastic anaemia, acute haemolysis.
-Congenital, drug induced.

•Increased destruction
-Hypersplenism
-Immune mediated destruction

Question 11

What are the causes of:
1. Basophilia
2. Eosinophilia
3. Monocytosis

Answer 11

1. It is associated with myeloproliferative malignancy, usually seen in diseases like chicken pox, small pox, myxoedema etc.
2. Parasitic diseases, allergic diseases, Recovery from an acute infection and certain skin diseases.
3. Chronic bacterial infections, chronic neutrophilia, protozoan infections and connective tissue diseases.

Question 12

What can a full blood count tell you about a patient’s possible differential diagnosis?

A. Type of bleeding disorder.
B. Nutritional deficiency
C. Bone marrow function
D. Allergic reaction

Answer 12

Nutritional deficiency

Question 13

What is the erythrocyte sedimentary rate?

Answer 13

Measures the rate of fall of a column of red cells in plasma in 1 hour.

Question 14

What are the differences between aspirate and trephine? (6)

Answer 14

ASPIRATE
-Bone marrow fluid is taken using syringe.
-Smear of the fluid are made on glass slide.
-Morphology of cells is assessed.

TREPHINE
-Core biopsy of the bone marrow is taken.
-Processes in sections and examined.
-Better to look for the bone marrow architecture.

Question 15

What is immunophenotyping used for?

Answer 15

It helps to distinguish between myeloid and lymphoid cells.

Question 16

What are the genetic tests taken for haematology abnormalities? (3)

Answer 16

-DNA sequencing
-Fluorescent in situ hybridisation
-Karyotyping

Question 17

What is the indication for a bone marrow investigation?

Answer 17

Leukemia diagnosis