Haem: Systemic Disease Flashcards
(30 cards)
What are the 4 common anaemia types relevant to haematology?
Iron deficiency anaemia
Leucoerythroblastic anaemia
microangiopathic anaemia
Heamolytic aneamia
What are the causes and lab findings of Iron deficiency aneamia?
Most common -blood loss (occult or not)
-GI, Gastric, Lung, Ovarian, Urinary tract cancers (renal/bladder)
Mennoraghia
IDA is caused by bleeding until proven otherwise -always act on low FE
Lab findings:
FBC- low heam, low RBC, Low MCV
heamtinics -Low ferritin, transferring. Increased TIBC
Blood film - microcytic, Hypochromic aneamia
What are the blood film findings of an iron deficiency anaemia?
Microcytic, hypochromic aneamia
Why is anemia relevant to heamatological cancers
Common first manifestation of heam disease-
as a result of low FE,
as a result of impaired heamopoesis
as a result of systemic inflammation
What is leucoerythroblastic anaemia? what is it often a sign of?
Aneamia where both RED and WHITE cells are low
“red and white cell PRECURSOR anaemia”
usually the 1st manifestation of bone marrow infiltration -
3 main BM infiltration causes:
cancer, myelofibrosis and infections
what are the 3 main causes of leucoerythroblastic anaemia?
usually the 1st manifestation of bone marrow infiltration -
3 main BM infiltration causes:
1) cancer -
heamatopoetic (leukemia/lumphoma/myeloma)
Non-heamatopoetic (secondary tumours -breast, prostate, bronchus)
2) Non malignant /Myelofibrosis
3) Severe infection -
military TB, severe Fungal infections
what are the blood film features of leucoerythroblastic anaemia?
Tear drop cells - poikocytosis
Nucleated RBC (immature) in Peripheral blood Myelocytes (neutrophil precursors) These are a result of the destruction of the barrier preventing precursor exit from the BM
What is haemolytic anaemia? Recall the 2 groups of aetiology and a few of their components
Heamolytic aneamia - shortnened red cell survival
aetiologies are either :
1) Inherited (defects of the RBC):
a) Membrane: Hereditary sphrocytosis
b) Cytoplasm/enzyme: G6PD deficiency
c) Haemoglobin: sickle cell, thalassemia
2) Aquired (increased breakdown due to environement)
a) Immune mediated
b) Non-immune mediated
What are laboratory features of all haemolytic anemias?
Not all might be present but these tend to be seen in haemolytic anaemias:
Anaemia Reticulocytosis (BM is healthy so trying to replace) Raised unconjugated Bilirubin Raised LDH Reduced haptoglobins
What are the lab features of an auto-immune mediated anaemia
Coombs /DAT test POSITIVE
Raised LDH
Reticulocytosis
AIHA :spherocytes on a film
what are the causes of autoimmune mediated haemolytic aneamia
Can often be idiopathic
Associated with systemic immune disease:
e.g.: SLE, CLL, Drug allergies, Mycoplasma infections
What are the lab features of non-immune mediated haemolytic anaemia?
DAT/Coombs negative
Thrombocytopenia
film: Shistocytes (RBC fragments)
What are causes of non-immune mediated haemolytic anaemia?
Most common worldwide is Malaria
Paroxysmal nocturnal haemoglobinuria (Ham’s test +ve)
Microangiopathic haemolytic anaemia (MAHA)
Adenocarninoma release toxic granules
HUS (e.coli)-triad of MAHA, Thrombocytopenia, AKI)
TTP (autoimmune)- pentad of MAHA, Thrombocytopenia, AKI, neuro issues and fever
What are 5 causes of neutrophillia?
1) corticosteroids
2) Underlying neoplasia
3) tissue inflammation (e.g. pancreatitis)
4) Myeloproliferative or leukaemic disorder
5) Pyogenic infection (MOST COMMON)
a few (viral, brucella, typhoid) dont
How can you use a blood film to assess a neutrophillia?
Neutrophillia can either be reactive (normal) or malignant
reactive -Neutrophilia
no immature cells, toxic granulation,
Malignant -
incredibly raised neutrophil count
Immature myelocytes, basophilia = AML
What are the main causes of easonophilia
1) Reactive-
allergies, parasites, underlying neoplasms
2) Primary (very rare)-
eosinophilic leukemia
What are the main causes of raised basophils?
reactive-Poxvirus
malignant -CML
What are the main causes of raised monocytes/monocytosis?
quite rare but:
Chronic infection such as TB, brucella
some viral: CMV
Sarcoidosis
Chronic myelomonocytic leukemia
What are the causes of Lymphocytosis? and lymphopenia
Lymphocytosis -
Secondary (reactive): infection (EBV, CMV, Hepatitis, rubella, etc)
Autoimmune disorder
Sarcoidosis
Primary -Monoclonal proliferation (CLL, NHL, MM, ALL)
Lymphopenia -
HIV, autoimmune, Drugs (chemo), inherited
How can a blood film help identify causes of lymphopenia
Want to take a film of peripheral blood in any lymphocytosis -
identify if cells are MATURE or IMMATURE
mature can be caused by:
Reactive/atypical -normal
Small and smear cells -CML
or IMMATURE - lymphoblast-probably ALL
How do antibodies change depending on the cause of the lymphocytosis
Only valid for B-cells
But reactive lymphocytosis will be POLYclonal -kappa and lambda chains present
malignant - only kappa or lambda chains present
What are some ways to classify leukemias?
Can be complicated because a long chain of cells can go cancerous .
this flash card TRIES to summarise it a bit maybe HELP
Can either be ; MYELOID or LYMPHOID
And if Lymphoid-either B or T cell related
then an important split is - is a precursor growing (e.g.: ALL) out of control or a mature cell (Multiple myeloma)
usually chronic and acute mean
Chronic - increased proliferation but NORMAL differentiation - gives many mature cells
Acute -proliferation increased and differentiation broken -many immature cells
what methods are available to identify leukemias? Why bother?
From a biopsy, a lot can be found:
1) Morphology -
malignant/reactive, mature/immature,
2) Immunophenotyping
(use Cluster of differentiation of cells to identify what they are) -
Lymphoid/myeloid, T or B cell, mature/immature, stage of maturation
3)cytogenetics - look at DNA
identify translocations (Philadelphia Chr in CML
4) Molecular genetics-
identify individual mutations (e.g.: JAK2)
why?
can identify the actual disease
can help treatment -eg Philadelphia chr,
Help prognosis
What is true polycythemia? and relative?
what are some causes of relative polycythemia
Polycythemia is defined as abnormally high heamatocrit -
relative - normal amount of RBC but lower plasma volume- raise the ration
causes: Diuretics, alcohol, obesity
true-normal amount of plasma but increased RBC -also raising the ration
