Thalassemia

Question 1

Alpha thalassemia trait blood film

Answer 1

Mild microcytic anaemia
Target cells
RARE- basophilic stippling

Question 2

Differential diagnosis with alpha thalassemia trait

Answer 2

IDA or a comordity with this
Other types of Thalassaemia
ACD
lead poisoning

Question 3

Further tests for Thalassaemia

Answer 3

Hb electrophoresis (acid and alkaline)
PCR
Patient history - genetic counseling
FBC
HPLC

Question 4

Thalassaemia vs IDA with RBC and MCV

Answer 4

Thalassaemia - marked decrease in MCV and RBC is increased
IDA- MCV is decreased. RBC is normal or decreased

Question 5

Hbh disease blood film

Answer 5

Marked microcytosis hypochromic
Poikilocytosis
Target cells
Polychromasia
Bite cells

Question 6

Further tests for HbH disease

Answer 6

PCR
Incubated reticulocyte stain to look for Hbh bodies
ICT
Hb electrophoresis

Question 7

Differential diagnosis for Hbh disease

Answer 7

Alpha Thalassaemia minor

Question 8

What are the reticulocytes like in Hbh disease

Answer 8

Increased

Question 9

What do the Hbh bodies look like

Answer 9

Golf ball inclusions
More symmetrical distribution of clumping than reticulocytes and more spread through the cell

Question 10

What are Hbh bodies made of

Answer 10

Beta 4 complexes

Question 11

What type of stain is the incubated reticulocyte stain

Answer 11

A supra vital stain

Question 12

Beta Thalassaemia trait blood film

Answer 12

Mild microcytosis hypochromic
Target cells
Basophilic stippling
Elliptocytes
Poikilocytosis

Question 13

Platelets in beta Thalassaemia trait/minor

Answer 13

Thrombocytosis

Question 14

Beta Thalassaemia intermedia blood film

Answer 14

NRBCs
Target cells
Poikilocytosis
Polychromasia
Basophilic stippling
Tear drops
Elliptocytes

Question 15

Platelets in beta Thalassaemia intermedia

Answer 15

Marked Thrombocytosis

Question 16

differential diagnosis for beta Thalassaemia intermedia

Answer 16

Beta Thalassaemia major

Question 17

Treatment for severe beta Thalassaemia intermedia

Answer 17

Blood transfusions
Splenectomy

Question 18

Beta Thalassaemia major blood film

Answer 18

Marked microcytic hypochromic anaemia
Poikilocytosis, anisocytosis
TARGET CELLS
Tear drops
Elliptocytes
Fragments
Microspherocytes
Erythroblasts
Basophilic stippling
Alpha chain inclusion bodies
Haemolysis and erythroid hyperplasia

Question 19

Sickle cell blood film

Answer 19

Chronic haemolytic anaemia/normochromic normocytic anaemia
Anisocytosis, polychromisa
Some normal RBC
Targets cells
Sickle cells
Poikilocytosis

Question 20

Reticulocytes in HbS

Answer 20

Increased unless aplastic

Question 21

Infarcted spleen blood film

Answer 21

Marked poikilocytosis
NRBCS
Pappenheimer bodies
Howell jolly Bodies
Spherocytes
Basophilic stippling

Question 22

Differential diagnosis for HbS

Answer 22

HbS with another haemoglobinopathy like HbSC
Beta Thalassaemia + sickle cell

Question 23

Further tests for HbS

Answer 23

Screening tests - solubility tests, sickling tests
Hb electrophoresis (alkaline and acid)
PCR
Family history
Ethnicities - greater in Africa

Question 24

HbE blood film

Answer 24

VERY small MCV (50-70)
Marked microcytic anaemia
TARGET cells
Anisocytosis

Question 25

Further tests for HbE

Answer 25

Same as HbS

Question 26

Differential diagnosis for HbE

Answer 26

Thalassemia IDA

Question 27

Platelets and WBC in HbS

Answer 27

Both increased

Question 28

HbC blood film

Answer 28

Normocytic normochromic anaemia Sometimes microcytic hypochromic Target cells Reticulocytosis Could have NRBC

Question 29

Target cells are seen in

Answer 29

Thalassaemia HbS Liver disease Post splenectomy