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Phase 2A > Full Blood Count Interpretation > Flashcards

Full Blood Count Interpretation Flashcards

1
Q

What do you use in the red cell count to classify anaemia?

A

Main method is by using the mean cell volume

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2
Q

If the reticulocyte count is raised in a patient with anaemia what is the likely cause?

A

blood loss

haemolytic anaemia

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3
Q

what is sideroblastic anaemia?

A

when the body has enough iron but is unable to use it to make haemoglobin

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4
Q

What does Hb show on a red cell count?

A

conc. of Hb within the blood.

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5
Q

What does MCV mean?

A

Mean cell volume of the red blood cells.

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6
Q

What is the reticulocyte count?

A

conc. of immature red blood cells

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7
Q

what is the haematocrit?

A

volume percentage of red blood cells in the blood

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8
Q

What is mean corpuscular haemoglobin

A

mean haemoglobin quantity within the blood cells - affects the colour of the cells.
Most normocytic and macrocytic anaemias are normochromic
Most microcytic anaemias are hypo chromic

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9
Q

If patient has anaemia and an abnormal WCC and platelets, what does this suggest?

A

Bone marrow cause is likely

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10
Q

Name three causes of Microcytic anaemia?

A 
SIT 
Sideroblastic
Iron deficiency
Thalassaemia
Chronic disease
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11
Q

Name three causes of normocytic anaemia

A 
Acute blood loss
Haemolytic anaemia 
Sickle cell 
Chronic disease
Hypothyroidism 
Bone marrow failure
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12
Q

Name two causes of megaloblastic macrocytic anaemia?

A

Decreased B12

Decreased Folate

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13
Q

Name 4 causes of non-megaloblastic macrocytic anaemia?

A

Alcohol
Reticulocytosis
Liver disease
Pregnancy

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14
Q

What tests could you do to find specific causes of anaemia?

A
  1. Haematinics : B12, folate, ferritin
  2. Iron studies
  3. TFTs
  4. Blood film +/- bone marrow biopsy
  5. Hb electrophoresis (if sickle cell or thalassaemia suspected)
  6. Billirubin (raised in haemolysis)
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15
Q

Causes of iron deficient anaemia

A
  1. Chronic blood loss
    - Menstrual bleeding
    - GI tract loss (malignancy, ulcers, varices
    - Urinary tract loss
  2. Increased demand
    - Pregnancy
    - Growth
  3. Decreased absorption
    - Coeliacs
    - gastrectomy
  4. Poor intake
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16
Q

Investigations for iron deficient anaemia if there is no clear cause?

A

Upper GI endoscopy + colonoscopy
Coeliac screen
Urine dipstick

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17
Q

Treatment for iron deficient anaemia

A

Treat the cause
Ferrous sulfate tablets
Transfusion if Hb < 70

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18
Q

What is a common side effect of ferrous sulphate tablets

A

Constipation

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19
Q

what is the physiology of B12

A

vitamin B12 is found in meat and dairy products. The stomach produces intrinsic factor which binds to B12, allowing it to be absorbed in the terminal ileum.

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20
Q

Causes of B12 deficient anaemia?

A

Pernicious anaemia

Malabsorption (e.g after gastrectomy or terminal ileum disease/resection)

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21
Q

Investigations for pernicious anaemia

A

parietal cell antibodies
intrinsic factor antibodies
Schilling’s test (purpose of the test is to determine how well the patient is able to absorb B12 from their intestinal tract.)

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22
Q

What is the treatment for B12 deficient anaemia?

A

treat the cause

hydroxocobalamin injections 3 monthly

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23
Q

Causes of folate deficient anaemia

A

Dietary (alcoholism, neglect)

Increased requirements (pregnancy, haematopoiesis)

Malabsorption (coeliacs, pancreatic insufficiency, gastrectomy, Crohn’s)

Drugs that interfere with metabolism (phenytoin, methotrexate, trimethoprim)

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24
Q

What is classically shown on a FBC of someone with anaemia of chronic disease?

A

Low iron
Low TIBC (total iron binding capacity)
normal ferritin

25
Name three inherited causes of haemolytic anaemia
1. Haemoglobinopathies - sickle cell - thalassaemia 2. Membrane defects - hereditary spherocytosis, elliptocytosis 3. Enzyme defects - G6PD deficiency, pyruvate kinase deficiency
26
Name three acquired causes of haemolytic anaemia
1. Immune mediated - autoimmune haemolytic anaemia - drug-induced haemolytic anaemia 2. Non-immune - DIC - TTP - physical damage (heart valves, toxins e.g lead, malaria)
27
Investigations to confirm haemolytic anaemia
1. Increased Hb breakdown - increased unconjugated bilirubin - increased LDH - increased urinary urobilinogen (on urine dipstick) 2. Increased Hb production - increased reticulocytes 3. Intravascular haemolysis - decreased free haptoglobin - haemoglobinuria
28
Investigations to find cause of haemolytic anaemia
1. Blood film - sickle cells - schistocytes - inclusion bodies (malaria) - spherocytes/elliptocytes (hereditary spherocytosis/elliptocytosis) - Heinz bodies, bite / blister cells (G6PD) - prickle cells (pyruvate kinase deficiency) 2. Coombs' test - autoimmune haemolytic anaemia 3. Hb electrophoresis 4. Enzyme assays
29
what is polycythaemia
increased concentration of red blood cells within the blood
30
what are the causes of polycythaemia
Relative polycythaemia (i.e decreased plasma volume) - acute dehydration - chronic (obesity, HTN, alcohol excess, smoking associated) Absolute (i.e increased RBC mass) - Primary : polycythaemia ruba vera - Secondary : due to increased EPO (renal cell carcinoma) or chronic hypoxia (COPD, high altitudes, congenital cyanotic heart disease)
31
What mutation is associated with polycythaemia ruba vera?
JAK2 mutation
32
what causes polycythaemia ruba vera
malignant proliferation of a clone derived from 1 pluripotent stem cell
33
what is a complication of polycythaemia ruba vera
increased risk of thrombosis/bleeding
34
what is the presentation of polycythaemia ruba vera
may be asymptomatic and picked up on routine blood count May present with vague symptoms related to hyper viscosity e.g headache, dizziness, tinnitus, erythromelalgia)
35
Investigations for polycythaemia
1. WCC and platelets - both raised in primary absolute polycythaemia (polycythaemia ruba vera), but not in secondary absolute polycythaemia 2. 51Cr Red Cell Mass study - normal red cell mass in relative polycythaemia - raised red cell mass in absolute polycythaemia 3. EPO level 4. If polycythaemia ruba vera suspected : bone marrow biopsy
36
Treatment options for polycythaemia ruba vera
Venesection Hydroxycarbamide (don't take if pregnant or planning pregnancy) Interferon Aspirin daily to reduce blood clots
37
Why may neutrophils be high?
- Bacterial infection - Inflammation - Necrosis - Corticosteroids - Malignancy / myeloproliferative disorder - Stress (trauma, surgery, burns)
38
Why may neutrophils be low?
- Post-chemotherapy - Agranulocytosis causing drugs (carbamazepine, clozapine, colchicine, carjimazole) - viral infection - hypersplenism - bone marrow failure (e.g leukaemia)
39
Why may lymphocytes be high?
- Viral infection - chronic infections - CLL/lymphoma
40
Why may lymphocytes be low?
- viral infection - HIV - post-chemotherapy - bone marrow failure (e.g in leukaemia) - whole body radiation
41
Why may monocytes be high?
- bacterial infection - autoimmune disease - leukaemia/Hodgkin's
42
Why may monocyte count be low
acute infections corticosteroids leukaemia
43
why may eosinophils be high?
``` allergy (eczema) parasite infection drug reaction skin diseases malignancy e.g Hodgkin's ```
44
Why may basophils be high?
``` Some leukaemia/lymphomas IgE mediated hypersensitivity Inflammatory disorders Myeloproliferative disorders Viral infection ```
45
on what is thrombocytopenia?
decreased platelets
46
causes of thrombocytopenia (decreased production) ?
bone marrow failure aplastic anaemia megaloblastic anaemia myelosuppresion
47
what is aplastic anaemia
Aplastic anaemia causes a deficiency of all blood cell types: red blood cells, white blood cells, and platelets.
48
what is megaloblastic anaemia
Megaloblastic anemia is a condition in which the bone marrow produces unusually large, structurally abnormal, immature red blood cells
49
Causes of thrombocytopenia (increased destruction/consumption)
Non immune - DIC - TTP - HUS - sequestration in hypersplensim Primary immune - ITP Secondary immune - SLE - CLL - viruses - drugs - alloimmune
50
possible Ix for thrombocytopenia
- Blood film +/- bone marrow biopsy - Infection screen (e.g HIV) - LFTs - LDH - Serum B12 and folate - Coagulation screen - fibrinogen and D-dimer - Acute phase reactants
51
Treatment of thrombocytopenia
Treat the cause - immunosuppressants if autoimmune e.g prednisolone, azathioprine - plasmapheresis for TTP / HUS Platelet concentrate transfusion Splenectomy
52
What is HUS?
Hemolytic–uremic syndrome (HUS) is a group of blood disorders characterized by low red blood cells, acute kidney failure, and low platelets
53
What is thrombocythemia
increased platelets
54
Causes of thrombocythemia
Primary : essential thrombocythemia Secondary : bleeding, inflammation, infection, malignancy, post-splenectomy
55
Investigations for thrombocythemia
- Blood film +/- bone marrow biopsy - Acute phase reactants - JAK2 mutation
56
Treatment of essential thrombocythemia
aspirin | hydroxycarbamide
57
Presentation of essential thrombocythemia
bleeding arterial and venous thrombosis microvascular occlusion (headache, atypical chest pain, light-headedness)
58
what happens to the urea in a GI bleed?
increased in upper GI bleeding

Phase 2A (11 decks)

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