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4 - Y5 a Path lectures 2021/22 > Haem 1: Systemic disease & intro to haematopathology > Flashcards

Haem 1: Systemic disease & intro to haematopathology Flashcards

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1
Q

• Patient with new Dx of lymphoma on biopsy of neck node has new onset: Jaundice, Anaemia, Raised LDH

What are the DDx?

A
  • Lymphoma with pathological nodes compressing bile duct, anaemia of inflammation (post-hepatic)
  • Lymphoma Stage 4 with BM and liver infiltration (hepatic)
  • Lymphoma Stage 1 and AIHA (pre-hepatic)
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2
Q

What are the principles of haematological disorder?

A
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3
Q

Give some examples of primary haematological disorders

A
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4
Q

Give some examples of secondary haematological disorders

A
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5
Q

Name some haematological changes caused by systemic disease

A
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6
Q

Name some different types of anaemia

A
  • iron deficiency,
  • leucoerythroblastic,
  • microangiopathic,
  • auto-immune haemolytic
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7
Q

What may anaemia be the first presentation of?

A
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8
Q

Can anaemia result from chronic inflammation?

A

yes

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9
Q

What is seen on bloods and blood film in anaemia?

A
  • microcytic hypochromic anaemia,
  • reduced ferritin & TF saturation,
  • raised TIBC
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10
Q

What is anaemia indicative of until proven otherwise?

A

bleeding (find cause!!)

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11
Q

Where might the occult blood loss be from in anaemia?

A
  • GI cancers – gastric, colorectal
  • Urinary tract cancers (less commonly) – Renal cell carcinoma (physician’s tumour), Bladder cancer
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12
Q

What might the bleeding in anaemia be due to?

A
  • Menorrhagia in pre-menopausal women
  • GI blood loss in men and post-menopausal women
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13
Q

What is Leucoerythroblastic anaemia?

A
  • Red and white cell precursor anaemia
  • variable degree of anaemia
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14
Q

What are the morphological features of Leucoerythroblastic anaemia on blood film?

A

Morphology on peripheral blood film

  • Teardrop RBCs – aniso and poikilocytosis
  • Nucleated (normal in BM) RBCs (left purple cell)
  • Immature myeloid cells (right purple cell)
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15
Q

What does this show?

A

normal peripheral blood film

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16
Q

What does this show?

A
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17
Q

What does a Leucoerythroblastic blood film usually indicate?

A

bone marrow infiltration

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18
Q

What are the causes of a Leucoerythroblastic blood film?

A
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19
Q

What is Haemolytic anaemia?

A

shortened RBC survival → low Hb

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20
Q

What are some common lab features of all haemolytic anaemias?

A
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21
Q

What are the 2 groups of haemolytic anaemias?

A
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22
Q

Which test is used to identify Immune-mediated haemolytic anaemia?

A

DAT positive (direct antiglobulin/Coomb’s test)

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23
Q

Which test is used to identify Non-immune-mediated haemolytic anaemia?

A

DAT negative (acquired haemolytic anaemia)

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24
Q

What is immune-mediated haemolytic anaemia associated with?

A
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25
What does the arrow show?
spherocytes (seen in immune-mediated haemolytic anaemia)
26
What are the 2 types of AIHA?
27
Compare warm AIHA vs cold AIHA
28
Compare the direct vs indirect Coombs tests
29
What are the classic features of Non-immune-mediated haemolytic anaemia
* RBC fragments (schistocytes), * Thrombocytopenia, * DAT-negative
30
What are the causes of Non-immune-mediated anaemia?
31
what are the causes of Micro-angiopathic haemolytic anaemia (MAHA)?
32
what are the causes of Micro-angiopathic haemolytic anaemia (MAHA)?
33
Compare peripheral blood with bone marrow
34
How do you Investigate an abnormal WBC
35
What are the Causes of neutrophilia
36
What do these images show?
37
What is the difference seen between reactive infection/malignancy in neutrophilia
38
What are the two types of Eosinophilia
X
39
When is Monocytosis seen?
rare, seen in some chronic infections and primary haematological disorders
40
Summarise an increased phagocyte count (infection, inflammation, neoplasia, myeloproliferative)
41
What is Lymphocytosis?
HIGH WCC
42
What are the causes of Lymphocytosis?
* EBV, CMV, Toxoplasma * Infectious hepatitis, rubella, herpes. infections * Autoimmune disorder * Sarcoidosis
43
What is Lymphopenia?
LOW WCC
44
What are the causes of lymphopenia?
* HIV * Autoimmune disorders * Inherited immune deficiency syndromes * Drugs(chemotherapy)
45
How is Lymphocytosis morphology evaluated?
46
What is Clonality in a B-cell lymphocytosis?
light chain restriction
47
What is the difference between polyclonal and monoclonal?
Polyclonal= kappa and lambda (reactive) Monoclonal (kappa ONLY or lambda ONLY (malignant)
48
How is leukaemia classified and evaluated?
49
Describe the difference between normal myeloid differentiation and acute myeloid leukaemia differentiation
50
Which Acquired somatic mutations can cause leukaemia and lymphoma?
51
What is the point of a tissue biopsy is ?lymphoma and leukaemia?
52
What does this show?
B-cell acute lymphoblastic lymphoma
53
What does this show?
Multiple myeloma
54
Describe B-cell acute lymphoblastic lymphoma
* TdT +ve (indicates immature cells; used in. VDJ rearrangement) * CD19 +ve (indicates B-cell lineage) * SurfaceIg- ve(abnormal)
55
Describe Multiple myeloma
* TdT -ve(normal) * Surface Ig +ve(normal) * CD138 +ve(abnormal)
56
What is Precise classification is used for in leukaemia/lymphoma
57
What are some associated clinical problems in lymphoma/leukamia
58
see q
59
What is the explanation for the anaemia?
* IDA * *would not expect jaundice* * *would not give nucleated red cells in PB* * Anaemia of chronic disease * BM mets from breast Ca * MAHA * *Not get leucoerythroblastic problems in blood as BM is healthy* * AIHA * *AIHA is DAT-positive*
60
What is the likely Dx?

4 - Y5 a Path lectures 2021/22 (37 decks)

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