Becky & Shef

What is haematopoiesis?

The production of mature blood cells

What three processes have to occur?

Proliferation (mitosis)

Differentiation

Maturation

Where is EPO released from? What does it do?Released from the Kidneys in response to hypoxia

EPO interacts with the EPO receptor on the surface of RBCs, resulting in proliferation and differentiation of erythroid precursor cells as well as the prevention of these cells

Increases the rate of mitoses

Decreases the maturation time

What is erythropoiesis? What 4 constituents are needed?EPO

Iron

Folic acid

Vitamin B12

How long does it take for a erythrocyte to mature? How long do they circulate for?

7 days to mature

Circulate for 120 days – Why is this significant?*

What changes does a committed stem cell undergo in order to become an erythrocyte? (6)

Decrease in cell sizeHb productionLoss of organellesAcquisition of eosinophilic cytoplasmExtrusion of nucleusAcquisition of biconcave disc shape

What is anaemia?

Fewer red blood cells than normal OR less haemoglobin than normal in each red blood cell.

How do we assess erythrocytes?

Size (MCV) & Colour (MCH)

Affected by:Iron

Deficiency leads to microcytic, hypochromic anaemiaVitamin B12

Deficiency leads to macrocytic anaemiaFolic acid

Deficiency leads to macrocytic anaemia

Full Blood CountHbHaematocritMCVMCHMCHCRDWWBC

(See notes below for definitions)

#1 Clinical Presentation

A 42yo male presents to his GP reporting several episodes of epistaxis (nose bleeds) for the past two weeks.

Following examination, the GP noticed blood filled bullae in their mouth along with numerous petechiae on their upper & lower limbs.

 

HAEMATOLOGY 

Name:  William JenkinsDate of Birth: 11/10/1972 Address: 29 Humphrey Road, Birmingham

GP/Requesting Clinician: NHS No./Hospital No. 396 946 3948

Clinical Details Provided:                           Epistaxis, petechiae on upper & lower limbs, blood-filled oral bullae 

  Value Reference Range

Hb (g/L) 140 Male 130-175Female 115-165

PCV/haematocrit (L/L) 0.52 Male 0.4-0.54Female 0.37-0.50

RCC (1012/L) 5.50 Male 4.5-6.0Female 3.9-5.0

MCV(fL) 90 80-96MCH (pg) 29 27-33MCHC (g/dL) 34 32-35RDW  (%) 14 11-15WBC (109/L) 8 3.0-10.0Platelets (109/L) 40 150-400   

Answer: Thrombocytopenia

Low platelets (45; Normal 150-400)

FBC otherwise normal

Causes of thrombocytopenia Impaired production (in the bone marrow)

Viral infections eg rubella Thiazide medication Alcohol toxicity Leukaemias

Increased destruction/consumption Medicines eg some antibiotics, digoxin, heparin Sepsis Trauma Burns Pregnancy

Splenic sequestration Liver cirrhosis

#2 Clinical PresentationA 34yo female has come to see you and is complaining of abdominal pain which she localises to her lower right lower quadrant (right iliac fossa). She also reports prolonged diarrhoea and has informed you that she has unintentionally lost ‘a few kilos’ over the past fortnight.

She describes her stool as slimy and occasionally she notices a small amount of bright red blood.

Following investigations, it is noted that she has raised CRP.

 

HAEMATOLOGY 

Name: 

 

Date of Birth: 04/07/1980 Address: 233 Highland Avenue,, Hull

GP/Requesting Clinician: NHS No./Hospital No. 435 546 3985

Clinical Details Provided: 

  Value Reference Range

Hb (g/L) 140 Male 130-175Female 115-165

PCV/haematocrit (L/L) 0.42 Male 0.4-0.54Female 0.37-0.50

RCC (1012/L) 4.4 Male 4.5-6.0Female 3.9-5.0

MCV(fL) 114 80-96MCH (pg) 32 27-33MCHC (g/dL) 34 32-35RDW  (%) 15 11-15WBC (109/L) 7.8 3.0-10.0Platelets (109/L) 340 150-400      

Answer: Folate deficiency / B12 deficiency Macrocytic (Megaloblastic) anaemia (MCV =

114; 80-96)

Normochromic (MHC within normal range)

Presentation suggestive of Crohn’s Terminal ileum commonly affected Think absorption!

CausesVitamin B12 deficiencyConditions affecting the small intestine (particularly the terminal ileum as often seen in Crohn’s disease)Iatrogenic (For example gastectomy, medications (eg PPIs))Autoimmune (Most common causes of B12 deficiency in the UK is pernicious anaemia)Diet (Fish & dairy products are a good source )

Folate deficiencyDiet (Sources include broccoli, Brussels sprouts, asparagus, peas, chickpeas and brown rice)Malabsorption (eg Coeliac disease)Medication (eg anticonvulsants)Excessive urination

#3 Clinical PresentationA 47yo woman presents to her GP with fatigue and breast tenderness. She reports that she has been getting heavier periods (menorrhagia) than usual and experiences episodes of hot flushes.

Examination findings show that she has a pale conjunctiva.

 

HAEMATOLOGY 

Name: 

 

Date of Birth: Address

GP/Requesting Clinician: NHS No./Hospital No.

Clinical Details Provided: 

  Value Reference Range

Hb (g/L) 135 Male 130-175Female 115-165

PCV/haematocrit (L/L) 0.28 Male 0.4-0.54Female 0.37-0.50

RCC (1012/L) 3.7 Male 4.5-6.0Female 3.9-5.0

MCV(fL) 62 80-96MCH (pg) 20 27-33MCHC (g/dL) 34 32-35RDW  (%) 17 11-15WBC (109/L) 7.2 3.0-10.0Platelets (109/L) 380 150-400      

Answer: Iron deficiency anaemia

Microcytic (MCV = 62)

Hypochromic (MCH = 20)

What investigation can you carry out to confirm iron deficiency?

Serum ferritin measurement

Less frequently used:Transferrin saturation indexTIBC (total iron binding capacity; increased in

anaemia)Serum iron

CausesPregnancy (Increased demand)MenorrhagiaGI blood loss

NSAIDsStomach ulcersGI cancer

Chronic kidney diseaseTrauma

#4 Clinical PresentationA 57yo male diagnosed with colon cancer has been receiving chemotherapy for the passed three months. He has bruises, bleeding gums, fatigue and suffers from frequent infections.

 

HAEMATOLOGY 

Name: Ben Franklin

 

Date of Birth: 05/02/1957 Address

GP/Requesting Clinician: NHS No./Hospital No. 435 483 0932

Clinical Details Provided: Bruising, bleeding gums, recurrent infections 

  Value Reference Range 

Hb (g/L) 80 Male 130-175Female 115-165

PCV/haematocrit (L/L) 0.20 Male 0.4-0.54Female 0.37-0.50

RCC (1012/L) 2.5 Male 4.5-6.0Female 3.9-5.0

MCV(fL) 85 80-96

MCH (pg) 31 27-33

MCHC (g/dL) 33 32-35

RDW (%) 13 11-15

WBC (109/L) 1.9 3.0-10.0

Platelets (109/L) 55 150-400

      

Answer: PancytopeniaAnaemia - Low haemoglobin (Hb = 80)

Thrombocytopenia (Platelets = 55)

Neutropenia (WBC = 1.9)

CausesAplastic anaemia

ChemotherapyAutoimmuneViral hepatitis

LeukaemiaHypersplenismSevere Folate or vitamin B12 deficiencySystemic lupus erythematosus

#5 Clinical Presentation

Ryan brooks was diagnosed with rheumatoid arthritis 3 years ago. He gets easily fatigued and sometimes feels short of breath. An FBC is carried out.

 

HAEMATOLOGY 

Name: Ryan Brooks

 

Date of Birth: Address

GP/Requesting Clinician: NHS No./Hospital No.

Clinical Details Provided: 

  Value Reference Range 

Hb (g/L) 110 Male 130-175Female 115-165

PCV/haematocrit (L/L) 0.32 Male 0.4-0.54Female 0.37-0.50

RCC (1012/L) 4.0 Male 4.5-6.0Female 3.9-5.0

MCV(fL) 90 80-96

MCH (pg) 30 27-33

MCHC (g/dL) 34 32-35

RDW (%) 14 11-15

WBC (109/L) 9.0 3.0-10.0

Platelets (109/L) 375 150-400

      

Answer: Anaemia of chronic disease

Normocytic

Normochromic