The Full blood count

Question 1

What is Anaemia?

Answer 1

Low Haemoglobin (Hb)

Question 2

What is Polycythaemia/ Erythrocytosis?

Answer 2

High Hb & haematocrit

Question 3

What is Leukopenia?

Answer 3

Low white cell count (WCC)

Question 4

What is Leucocytosis?

Answer 4

High WCC

Question 5

What is Thrombocytopenia?

Answer 5

low platelets (plts)

Question 6

What is Thrombocytosis/ thrombocythaemia?

Answer 6

High plts

Question 7

Generally we see low values of a cell if…

Answer 7

• Increased destruction (e.g. splenomegaly)
• Decreased production (e.g. cancer in bone marrow)
• Relative loss affecting concentration (e.g. post IV fluids)

Question 7

What is Pancytopenia?

Answer 7

Low Hb & WCC & plts

Question 8

Generally we see high values of a cell if…

Answer 8

• Reactive to inflammatory/ infective process (e.g. sepsis)
• Increased production by a cancer (lymphoma/ leukemia/ myeloma/ polycythemia vera/ essential throbocythemia)
• Relative increase if fluid loss (e.g. if dehydrated)

Question 9

What are the 7 symptoms of anaemia?

Answer 9

Fatigue
Weakness
Pallor
Dizziness
Fainting
Shortness of breath (SOB)
Chest pain

Question 10

What are the 3 main types of anaemia?

Answer 10

Microcytic
Normocytic
Macrocytic

Question 11

What is Microcytic anaemia?

Answer 11

MCV= low
red blood cell is small

Question 12

What is Normocytic anaemia?

Answer 12

MCV normal, normal RBC size
- Reticulocytes present
- Reticulocytes absent

Question 13

What are reticulocytes?

Answer 13

• Immature RBCs
• Presence show the bone marrow is physically able to make red cells and has had the time to make red cells

Question 14

What is Macrocytic anaemia?

Answer 14

MCV= high, large RBC
Megaloblasts present
Megaloblasts absent

Question 15

What are megaloblasts?

Answer 15

Large RBCs
Haven’t been able to complete cell division

Question 16

What is Microcytic anaemia caused by?

Answer 16

• Iron deficiency (often due to chronic bleeding)
• Thalassemia
• May have cancer or problem with menstrual cycle

Question 17

What is the cause of Normocytic anaemia when reticulocytes absent?

Answer 17

Aplastic anaemia (affects the bone marrow= not working properly)
Acute bleeding (sometimes retics increased)
Anaemia of chronic disease (sometimes microcytic)

Question 18

What is the cause of Normocytic anaemia when reticulocytes present?

Answer 18

Haemolysis (heart valves, spherocytosis)
Sickle cell
G6PD deficiency

Question 19

What is G6PD?

Answer 19

enzyme you need to make glutathione which makes strong RBCs
Deficiency means you have weak RBCs

Question 20

What is the cause of Macrocytic anaemia when Megaloblasts are present?

Answer 20

• B12 deficiency (can’t complete cell division)
• Folate (B9) deficiency (both of which can be caused by alcohol)

Question 21

What is the cause of Macrocytic anaemia when Megaloblasts are absent?

Answer 21

• Myelodysplastic syndrome
• Liver disease (inc caused by alcohol- excess cell membrane due to defective cholesterol esterification)

Question 22

What is the treatment for anaemia?

Answer 22

FIX THE CAUSE
- Diet
- Vitamin replacement (Fe/B12/folate)
- EPO injection
- Blood transfusion

Question 23

What are the causes of Polycythaemia?

Answer 23

-Relative
- Absolute
Primary
Polycythemia Vera (JAK2 gene)= blood cancer
Secondary
Renal cell carcinoma
Exogenous EPO (EPO made in kidneys, could be caused by kidney cancer)

Question 24

What are the causes of Leukopenia? (5)

Answer 24

- Cancer (esp those affecting bone marrow) - Cancer treatment (chem/ radiotherapy) - Other drugs (antipsychotics, carbimazole) - Viral infection (HIV) - Autoimmune conditions

Question 25

What are the 4 causes of Leukocytosis?

Answer 25

Raised neutrophils Raised eosinophils Raised lymphocytes Very Raised lymphocytes

Question 25

In what cases should you be worried about Leukopenia?

Answer 25

Neutropenia (neutrophils very low) Agranulocytosis (neutrophils very very low)

Question 26

What do raised neutrophils indicate?

Answer 26

Think bacterial infection

Question 27

What do raised eosinophils indicate?

Answer 27

Think allergy

Question 28

What do raised lymphocytes indicate?

Answer 28

Think viral infection

Question 29

What do very raised lymphocytes indicate?

Answer 29

Think malignancy

Question 30

What are the 3 cancers of white cells?

Answer 30

Leukemias Lymphomas Myeloma

Question 31

What are Leukemias?

Answer 31

- Commonly present with raised WBC - Acute (AML, ALL) - Chronic (CML, CLL)

Question 32

What are Lymphomas?

Answer 32

- Commonly presents with raised WBC - Hodgkin's (presence of cells down microscope) - Non-Hodgkins

Question 33

What are Myelomas?

Answer 33

Solid tumour in the bone marrow

Question 34

What are the 4 causes of Thrombocytopenia?

Answer 34

- Decreased production by marrow - Increased platelet sequestration - Dilutional - Increased platelet destruction

Question 35

What is decreased production by marrow caused by?

Answer 35

Malignancy Myelofibrosis/ myelodysplasia Nutritional deficiency

Question 36

What is increased platelet sequestration caused by?

Answer 36

Splenomegaly (portal hypertension due to cirrhosis)

Question 37

What is dilutional caused by?

Answer 37

Post blood transfusion Pregnancy

Question 38

What is increased platelet destruction caused by?

Answer 38

Immune thrombocytopenic purpura (ITP) Disseminated intravascular coagulation (DIC) Thrombotic thrombocytopenic purpura (TTP) (ADAMTS13 gene) Drug related (Chemo, quinine, NSAIDS, penicillin & anticonvulsants)

Question 39

What is Thrombocytosis/ thrombocythemia?

Answer 39

Raised platelets

Question 40

What are the causes of thrombocytosis?

Answer 40

Primary - Essential thrombocythaemia (cancer) Secondary/ reactive (>80%) - Inflammation (autoimmune or infection) - Drugs - Surgery/ other trauma - Haemolysis - Iron deficiency

Question 41

What are the 3 key causes of Pancytopenia?

Answer 41

Reduced production Increased destruction Sequestration

Question 42

Why does reduced production cause Pancytopenia?

Answer 42

- Replacement of marrow by fibrosis (myelofibrosis) - Replacement of marrow by tumour - Aplastic anaemia (often non cause found)

Question 43

Why does increased destruction cause Pancytopenia?

Answer 43

Sepsis

Question 44

Why does sequestration cause Pancytopenia?

Answer 44

Splenomegaly