Interactive case hx in haematology Flashcards
(47 cards)
Which of the following is the most convincing indication of iron deficiency? Please rank:
Anaemia and low MCV
Jaundice
Pencil cells on the blood film
Low transferrin saturation plus low serum iron
Fatigue
?
Give 2 symptoms and 2 signs of anaemia
weakness/ lethargy
Breathlessness
Pallor
Tachycardia + cardiomegaly
extra signs: koilynychia, glossitis, jaundice
Scenario A&E
Age 36
Sex Female
History 2years SOBOE
FBC Hb 32 g/l (116-150g/dl)
WBC 7 x 109/l (2-10.5 x 109/l)
platelets 452 x 109/l (150-400 x 109/l)
MCV 54fl ( 80-100fl)
What are the 3 most likely causes of this anaemia ?
Iron Deficiency Anaemia
Thalassaemia
ACD
What further investigations would be useful?
Reticulocyte count
- Haemoglobin electrophoresis
Iron studies..e.g. ferritin, transferrin saturation
Blood film
When is reticulocytosis absent?
Inadequate haematinics
Bone marrow failure (e.g. infiltration)
Acute major haemorrhage…reticulocyte response within 6 hours which increases over 6-10 days
What is on a blood film in IDA?
Iron deficiency
- Pencil cells
- Anisocytosis
- Poilkilocytosis
- Hypochromic
What does this show?
- Pencil cells
- Anisocytosis
- Poilkilocytosis
- Hypochromic
What causes IDA?
Uterine blood loss
GI loss
Hb 60 g/l (135-175g/l)
WBC 0.1 x 109/l (2-10.5 x 109/l)
Platelets 4 x 109/l (150-400 x 109/l)
What is abnormal about this blood count?
- Hb is LOW
- WBC is LOW
- Platelets LOW
What could cause this combination of abnormalities?
GIVE THREE POSSIBILITIES
- Aplastic anaemia
- Leukemia
- Infiltration e.g.Lymphoma, carcinoma
- Drugs e.g. chemotherapy
- B12/folate deficiency
Give 2 useful further investigations
- Blood film
- Vitamin B12
- Folic acid
- bone marrow
Suggest one diagnosis
ACUTE MYELOID LEUKAEMIA
What are the likely clinical problems going to be?
AML
What are the principles of managing this condition?
Supportive
- Red cell transfusions
- Platelet transfusions
- Nurse in isolation; prompt antibiotics
Disease related management
Consider chemotherapy
Hb 120g/l (135-175g/l)
WBC 10 x 109/l (2-10.5 x 109/l)
Platelets 28 x 109/l (150-400 x 109/l)
What is abnormal about this blood count?
Anemia
Thrombocytopenia
What are the causes of the MAIN abnormality on this FBC ?
NOT MAKING PLATELETS
- drugs e.g. chemotherapy, thiazides,
- bone marrow disorders e.g. leukemia, aplastic, myelodysplasia, myeloma, infiltration with carcinoma
PREMATURE DESTRUCTION OF PLTS
- ITP (auto-immune)
- Disseminated intravascular coagulation
- heparin
What further investigations could you do? GIVE 3 POSSIBILITIES
- Coagulation screen
- Blood film
- Bone marrow aspirate/trephine
- ANA/RAPA
- HIV
COAGULATION SCREEN
- APTT 54 seconds (control 40s)
- INR 2.1
What is abnormal about this coagulation screen?
- Prolonged APTT
- INR increased
What further investigations would be useful now?
- Blood film
- D-dimers/FDPs
- fibrinogen
- Blood cultures/CSR/MSU (Septic screen)
- Liver function tests
What is the diagnosis?
Disseminated intravascular coagulation
What is the management of DIC?
LIAISE WITH HAEMATOLOGY TEAM AND THE HAEM LAB
- Antibiotics
- Blood products….Red cells, platelets, cryoprecipitate, FFP
- Regular blood tests to assess response to products
What can alter myeloblasts?
<5% in BM is normal
5-10% is myelodysplasia
>20% is AML
If in peripheral blood, may be AML or leukoerythroblastic anaemia
Auer Rods
What can alter lymphoblasts?
<5% is normal in BM
>20% = ALL
TdT positive (NO AUER RODS)
What are the B cell markers?
CD19 and 20
