Haematology

Question 1

Causes of anaemia

Answer 1

MICROCYTIC (MCV <80fL) - Thalassemia - ACD - IDA - Lead poisoning - Sideroblastic NORMOCYTIC (MCV 80-100fL) - haemorrhage - haemolysis - chronic renal failure - BM failure (infiltration/hypoplasia) - ACD MACROCYTIC (MCV >100fL) - hypothyroid - haemolysis - myelodysplasia - megaloblastic (B12/folate) - liver disease

Question 2

How to differentiate ACD from IDA?

Answer 2

Iron studies !!!!

IDA

• serum Fe ↓
• transferrin ↑
• TIBC ↑
• saturation ↓
• serum ferritin ↓↓↓

ACD

• serum Fe ↓
• transferrin ↓
• TIBC ↓
• saturation ↓
• serum ferritin normal/↑

Question 3

Reed stern-berg cells

Answer 3

Non-Hodgkin’s lymphoma

Question 4

Anisocytosis, pencil poikilocytes

Answer 4

IDA

Question 5

↑ unconjugated bilirubin, ↑ LDH, ↑ reticuloctyes, low haptoglobin

Answer 5

Haemolysis

Question 6

Old, calcium raised, renal impairment, anaemia, bone disease

Answer 6

Myeloma !!!

Question 7

Increased blood volume, viscosity, splenomegaly

Answer 7

Polycythemia vera

Question 8

Philadelphia Chromosome

Answer 8

CML

Question 9

Auer rods

Answer 9

AML

Question 10

CD10 phenotype

Answer 10

ALL

Question 11

What is von Willebrands disease?

Answer 11

• an inherited condition that results when the blood lacks functioning von Willebrand factor, a protein that helps the blood to clot and also carries another clotting protein, factor VIII. - It is usually milder than hemophilia and can affect both males and females

Question 12

What is factor V Leiden?

Answer 12

INCREASED TENDENCY TO FORM CLOTS - Factor V Leiden is the name of a specific gene mutation that results in thrombophilia - People with factor V Leiden thrombophilia have a higher than average risk of developing a DVT - only about 10 percent of individuals with the factor V Leiden mutation ever develop abnormal clots.

Question 13

Answer 13

Chronic kidney disease

• Burr cells/echinocytes
• ↓L-carnitine which is important for normal BM function = suppressed BM

Question 14

Answer 14

Acanthocytes

• seen in liver disease

Question 15

Answer 15

Stomatocyte

• often seen in alcohol induced liver disease

Question 16

Answer 16

Target cells or codocytes

are red cells with central staining with precipitated haemoglobin seen in conditions with abnormal haemoglobin as well as cell membrane

• Sickle cell disease
• thalassaemia
• iron deficiency anaemia
• liver disease

Question 17

Signs + symptoms of subacute combined degeneration of the cord? How to avoid this when treating patients with megaloblastic anaemia?

Answer 17

• dementia + peripheral neuropathy
• lack of vibration sense
• due to B 12 def - megaloblastic anaemia

Treatment

• replenish B12 before giving folate
• might only have a little bit of B12, so if you give folate the BM might use up the last bit of B12 and the patient could get this condition

Question 18

Conditions related to JAK2 mutation?

Answer 18

• polycythemia vera
• primary myelofibrosis
• essential thrombocythemia

Question 19

Myelofibrosis

Answer 19

• bone marrow is replaced by scar tissue (fibrosis)
• because of the fibrosis, the bone marrow cannot produce enough normal blood cells
• Pancytopenia with teardrop cells
• Has the ability to turn into AML over time

Question 20

Answer 20

Shistocytes

• RBC fragments
• due to haemolysis

Question 22

Answer 22

Howell-Jolly bodies - contain nuclear remnants

Causes are:

• Post splenectomy
• Leukaemia
• Megaloblastic anaemia
• Iron deficiency anaemia

Question 24

Causes of high ESR

Answer 24

• Multiple myeloma
• Tuberculosis
• Metastatic malignancy
• Temporal arteritis
• Polymyalgia rheumatica

Question 25

Factors that tend to increase/decrease ESR

Answer 25

**Factors that tend to increase the ESR** * Anaemia (especially macrocytic) * Advanced age * Pregnancy * ↑Fibrinogen level (acute phase response) – infection/inflammation/malignancy etc **Factors that tend to decrease the ESR:** * Polycythaemia (lots of negative charges preventing rouleaux formation) * Leukocytosis (extreme)/hyperviscosity (both interfere with sedimentation of red cells) * Microcytosis (cell mass low so will sediment down the tube more slowly) * Red cell abnormalities e.g. spherocytes/acanthocytes * ↓Plasma proteins especially hypofibrinogenaemia and hypogammaglobulinaemia