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ICM Revision > HAEM/ONCO > Flashcards

HAEM/ONCO Flashcards

1
Q

What information does FBC provide?

A

overview of bone marrow function
infection state
anaemia

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2
Q

What type of blood sample is an FBC?

A

venous - EDTA sample

purple top

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3
Q

How are Haemoglobin levels interpretation?

A

High Hb = erythrocytosis - due to dehydration, EPO elevation and chronic hypoxia

Low Hb = Aneamia - check MCV

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4
Q

How to interpret MCV in anaemia?

A

High MCV >100fL = macrocytosis
- due to vitB12/Folate def, alcoholism, medications, liver disease

Low MCV <80fL = microcytosis
- due to iron def, sickle cell, thalassemia, chronic disease

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5
Q

What role do platelets have?

A

Formation of blood clots

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6
Q

Causes of thrombocytopenia?

A 
bone marrow dysfunction 
acute blood loss 
heparin induced 
liver disease
autoimmune - SLE/ITP 
infections 
hypersplenism
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7
Q

Thrombocytosis can be divided into…..

A

Primary
- essential thrombocythemia, polycythemia vera, CML and myelofibrosis

Secondary

  • infections/inflammatory conditions
  • splenectomy
  • acute bleed/malignancy
  • iron deficiency
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8
Q

How is WCC interpreted?

A 
>11 = leucocytosis 
<4 = leucopenia

> 50 - consider the possibility of hyperviscosity

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9
Q

How are Neutrophils interpreted?

A 
<2 = neutropenia
>7.5 = neutrophillia
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10
Q

Causes of neutrophillia?

A 
vomiting
infection 
dehydration, trauma and burns 
HAEMTOLOGICAL MALIGNANCIES 
drugs 
surgery 
labour
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11
Q

Causes of neutropenia?

A 
HAMAETOLOGICAL MALIGNANCIES 
viral infections 
bacterial sepsis
splenomagely 
chemo/drugs 
SLE
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12
Q

How to interpret Lymphocytes?

A

> 4.5 lymphocytosis

<1.5 lymphocytopenia

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13
Q

Causes of Lymphocytosis?

A

viral infections
lymphomas/leukaemia
splenectomy
B-thalassemia

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14
Q

Causes of Lymphocytopenia?

consideration in chronic lymphocytopenia?

A

acute phase of viral/bacterial infections
HIV/COVID
chemo or Bone marrow trasnsplant

chronic lymphocytopenia consider opportunistic infections

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15
Q

How to interpret monocytes?

A

> 0.8 = monocytosis

<0.2 - monocytopenia

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16
Q

Causes of monocytosis?

A

infectious disease = Malaria, TB, typhoid
infective endocarditis
AML, hodgkins lymphoma

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17
Q

Causes of Eosinophilia?

A 
drugs - erythema multiforme, steven johnson syndrome 
parasitic infection 
allergy/atopy 
pemphigus 
sarcoidosis 
hodgkins, AML, esophillic leukaemia 
RA, SLE and polyarterits nodosa
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18
Q

What is the Hematocrit?

A

Measure of RBC in serum sample as percentage

MCV x proportion of sedimented cells in centrifuged sample

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19
Q

How is Basophil level interpreted?

A 
>0.1 = basophillia 
<0.1 = basopenia
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20
Q

Causes of Basophillia?

A 
IgE mediated hypersensitivity
hypothyroid 
drugs 
AML/CML 
Polycythemia rubra/vera
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21
Q

Causes of Basopenia?

A 
leucocytosis 
thyroxicosis 
haemorrhage 
cushing's 
allergic reaction 
drugs
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22
Q

What can RBC do?

A

help to identify any haemoglobinopathy

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23
Q

What type is the Blood film sample?

How is it done?

A

taken from EDTA bottle (purple top)
Small drop of blood placed onto slide and spread thinly
revied by Haem SpR/consultant

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24
Q

What does anisocytosis mean? when is it seen?

A

variation of RBC sizes

seen in myelodysplastic syndrome
some forms of anaemia

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25
Q

Target cells seen in…

A

Iron deficiency anaemia

post-splenectomy

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26
Q

What are Heinz bodies?

When are they seen?

A

denatured globin

seen in….
G6PD and a-thalassemia

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27
Q

Howell Jolly Bodies are…

seen in…

A

blobs of DNA in RBC

post-splenectomy
severe anaemia

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28
Q

Reticulocytes are…

seen in…

A

immature RBC

seen in
haemolytic anaemia

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29
Q

Schistocytes are…

seen in…

A

fragments of FBC

seen in...
haemolytic uraemic syndrome 
DIC 
TTP
Metallic heart valves 
haemolytic anameia
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30
Q

Sideroblasts are…

what does it indicate?

A

Immature RBCs with blobs of iron

indicates…
myelodysplastic sydrome

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31
Q

What are smudge cells?

seen in….

A

ruptured WBCs

seen in chronic lymphocytic leukaemia

32
Q

sphreocytes

A

spherical RBCs - not normal bi-concave disc

indicative of…
hereditary spherocytosis
autoimmune haemolytic anaemia

33
Q

What is tumour lysis syndrome?

A

metabolic abnormalities resulting from rapid cell death in the treatment of haematological disease

34
Q

What are findings suggestive of TLS?

A 
hyperkalaemia 
hyperuriciamia 
hyperphosphataemia 
hypocalcaemia 
AKI (raised creatinine and urea)
35
Q

What type of sample is the clotting profile?

A

Citrate sample (light blue)

citrate sequesters Ca2+ - preventing clotting

36
Q

What results are included in the clotting profile?

A

PT
APTT
Thrombin time
INR

37
Q

What is PT?

prolonged when?

A

Time take for sample to clot once calcium and tissue factor is introduced - normal ia 11-14 secs

prolonged in vitK def, warfarin use, DIC, Liver disease and factor 7 deficiency

38
Q

What is APTT?

Prolonged when?

A

time taken for sample to clot when Calcium and contact factor are introduced
- normally 32-38 seconds

prolonged when
vit K def, warfarin use, DIC, liver disease,
hemophilias, Unfractionated heparin and factor 12 deficiency

39
Q

What is thrombin time?

prolonged when?

A

time taken for sample to clot when thrombin is introduced

prolonged when
unfractionated heparin
DIC
thrombolysis

40
Q

What is INR?

A

value calculated to asses the anticoagulant effect of warfarin
on warfarin the target range is 2-3

41
Q

What is D-Dimer?

What do the values mean?

A

bi-product molecule of fibrinolysis
orginally developed to detect and monitor DIC but now more used as an aid to rule out possible thrombus

under 50s = <230ng/l D-dimer units

over 50s = adjusted value

42
Q

Raised D-dimer?

A 
DIC, thrombosis 
aortic dissection 
malignancy 
infection 
pregnancy 
inflammation
43
Q

How is d-dimer interpretated?

A

negative d-dimer can helpt to rule out a thrombosis
- potential cause of PE and DVT

negative d-dimers may be due to the embolism being made up of another substance = air, fat or amniotic fluid

However positive D-dimer is not diagnostic
- calculate Wells score

44
Q

What is Haemophilia?

What tests results are suggestive of it?

A

x-linked recessive disorder of coagulation

Blood tests - Prolonged APTT

bleeding, thrombin and PT are all normal

45
Q

What is the thrombophilia screen designed for?

A

provide evidence of inherited deficiencies for naturally occuring anticoagulants

these include:
antithrombin
protein S
protein C

46
Q

What does transfusion reaction usually present with?

A

flushing, chills, dyspnoea, fever

presence of RFs

  • ABO incompatibility
  • pregnancy or transfusion
  • transplantation or immunocompromised
  • IgA deficiency
  • prior hx of transfusion recation
47
Q

What are haematinics?

what does the sample test for?

A

Haematinics are nutrients required for the formation of blood cells.

Ferritin
transferrin/TIBC
serum iron
B12
Folate
48
Q

What type of sample is haematinics?

A

Serum seperating tube (SST) - yellow/gold tube

49
Q

What is ESR?

A

ESR is erythrocyte sedimentation rate

used to asses possible inflammation or ‘acute phase’

50
Q

When is ESR raised?

A

infection, inflammatory disease, anaemia, pregnancy, paraproteinemias, neoplastic conditions and sickle cell crisis

51
Q

When is there decreased ESR ?

A

polycythemia
hyperviscosity
spherocytosis
sickle cell disease

52
Q

How is sickle cell/haemoglobinopathies screened/tested for?

A

EDTA (purple) bottle

  • HPLC (chromatography), electrophoresis and PCR are done
  • if first time screen - check ferritin levels to rule out anaemia
53
Q

Confirmatory/definitive test for Sickle cell disease?

A

HB electrophoresis/HPLC

  • HBS (80-90%)
  • some patients may have raised HbF
54
Q

Tests done for Thalassemias?

A

HPLC electrophoresis

exact genotypes established with PCR

55
Q

What does urine bence jones protein test involve?

What are the indications?

A

Involves a clean catch urine sample being sent to lab - check for immunoglobulin light chains aka bence jones proteins

56
Q

Most accurate method to detect bence jones proteins?

A

immunoelectrophoresis

57
Q

Reasons for abnormal results in bence jones urine test

A

amyloidosis - buildup of protein in tissue/organ

CLL /Lymphoma
MGUS - build up of m-protein

chronic renal failure

58
Q

What is serum electrophoresis used for?

What does the sample involve?

A

Primarily used to screen/detect/assess/monitor paraproteinaemia

59
Q

Uses of urinary electrophoresis?

A

typically performed in worsening kidney disease

Bence Jones protein

60
Q

Mprotein/paraprotein spikes found in gammaglobulin region of electrophoresis can indicate…

A 
multiple myeloma
lymphoma 
CLL
amylodoisis
MGUS
Walderstorms macroglobulinaemia 
RA, SLE, liver cirrhosis and chronic infections
61
Q

Indications of Reticulocyte count?

A

help distinguish between anaemia from either…

  • acute blood loss
  • due to destruction of RBCs
  • decreased RBC production

monitor bone marrow response to chemo, bone marrow transplant, Follow-up after iron def anaemia tx

62
Q

What sample type is reticulocyte count?

A

EDTA sample (purple)

63
Q

What is the direct antibody test?

What is it commonly known as?

A

Test for immunoglobulins targeting against RBCs

aka Direct coombs test

64
Q

When is the direct antibody test done?

A

Investigation of
- autoimmune haemolytic anaemia

  • acute haemolytic transfusion reaction
65
Q

What type of sample is the direct antibody test?

A

EDTA sample

66
Q

What Ix done in Acute lymphocytic leukaemia?

Findings?

A

FBC - neutropenia, anaemia and thrombocytopenia

Blood film - blast cells

flow cytometry done to check lineage affected - b lymphocytes

67
Q

What Ix done Chronic lymphocytic leukaemia?

Findings?

A

FBC - lymphocytosis and anaemia

Blood film - smudge/smear cells

immunophenotyping to confirm type of leukaemia - well differentiated B lymphocytes

68
Q

What Ix done in Acute Myeloid leukaemia?

Findings?

A

Blood film - blast cells (auer rods)

69
Q

What Ix done in Chronic Myeloid Leukaemia?

Findings?

A

Blood film - granulocytes of varying stages in maturation

- thrombocytosis can be present also

70
Q

What Ix done in Hodgkin’s lymphoma?

Findings?

A

Blood film - reed sternberg cells

Bloods - normocytic anaemia, eosinophillia and raised ldh

71
Q

Staging in Hodgkin’s lymphoma?

A

Staging - Ann-Arbour staging

1 = single lymph node

2 = 2+ lymph nodes - same side of diaphragm

3 = nodes on both sides of diaphargm affected

4 = spread beyond lymph nodes

72
Q

What Ix done in burkitt’s lymphoma?

Findings?

A

excisional lymph node biopsy
- starry sky appearance

Bloods - normocytic anaemia

ESR/LDH measured for prognostic purposes

CT CAP = staging purposes

73
Q

What Ix done in Multiple myeloma?

Findings?

A

Bloods - low WCC, elevated ESR/calcium and plasma viscosity
Urea and creatinine raised

Bence-jones protein in urine or monoclonal proteins in blood

Bone marrow aspirate - confirms diagnosis

Whole body MRI - check for bone lesions

blood film = roleaux formaton

Skull XR - lytic lesions aka raindrop skull

74
Q

What is Waldenstrom’s macroglobulinaemia?

What Ixs are done? findings?

A

condition affecting older men involving the secretion of a monoclonal IgM paraprotein

Biospy of bone marrow
FBC
low complement (esp. C4)
high ESR

75
Q

What Ix done in Haemophillia? Findings?

A

clotting profile

  • prolonged APTT
  • bleeding time, thrombin time, prothrombin time normal
76
Q

Describing procedure of Bone marrow aspiration

A
  1. slides - blood assessed under microscope by senior hematologist
  2. Immunophenotype - identifying cell lineage as well as confirming diagnosis, classifying and monitoring response to tx
  3. cytogenetic = chromosomal sequencing - check for genetic disease
  4. trephine = ‘coring’ biopsy - more detailed identification of the degree of infiltration - if malignancy

ICM Revision (19 decks)

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