haematology - powerpoint presentation
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Haematology
FBC
• Red Cells: Hb, MCV• WBC: cell type and presence of abnormal or
immature forms• Platelets
Anaemia
• Hb• MCV
Microcytic Normocytic MacrocyticIron defThalessaemiaACD
Acute blood lossHaemolyticMarrow infiltrationACD
B12FolateAlcoholReticulocytosisHypothyroid
Haematinics• Deficiencies can cause anaemia:
IronB12Folate
Duodenum
Terminal ileum
Duo and jej
Iron absorption
Iron deficiency
Intake vs Utilisation
PubertyDiet
Malabsorption not common
• Blood loss
• Atrophic tongue!
IDA vs ACD
Iron parameter IDA ACD
Serum iron
TIBC
Serum ferritin
Serum sTfR N
B12 absorption
B12 deficiency
• Pernicious anaemia – autoantibodies• Neurological problems• Beefy tongue!• Schilling test – radioactive; im. With IF
Not commonDiet RARE
Small bowel diseaseReduction in IF
Intake vs Utilisation
Folate defiency
Intake vs Utilisation
• Neural tube defects• NO neuropathy
PregnancyLactationAdolescence
Excess turnover of cells:Haemolysis, malignancy
Diet COMMON
Coeliac diseaseAntifolate drugs
Haemolytic anaemia
• Intravascular vs Extravascular : bilirubin, LDH• Polychromasia, reticulocytosis
Hereditory spherocytosisThalassaemiaSickle cell anaemiaG6PD deficiencyPyruvate kinase deficiency
Damage to red cell membraneMalariaOxidant damage
Aquired vs Inherited
G6PD deficiency
• X-linked • Inability to detoxify oxidising agents • Heinz bodies, spherocytosis
Polycythaemia
True Apparent
Primary:
PRV
Secondary
Hypoxia: chronic smoking
high altitude lung disease
Excess erythropoietin
Dehydration
Production byBone marrow
Cell loss/destruction
Polycythemia
1. Haematinic deficiency2. BM infiltration/failure
• Haemopoietic cancer• Metastatic cancer• Aplasia
Shortened survival bleeding haemolysis
•Acquired (environment)•Immune•Microangiopathic•Malaria•**PNH
• Inherited •Haemoglobin•Enzyme•Membrane
RBC
Reduced cell counts
Three cell lines reduced/involved• Think bone marrow failure/infiltration (but don’t forget Vit B12/folate deficiency)
One cell line reduced• Think increased destruction/loss (but don’t forget iron deficiency in low RBC/Hb)
PlateletsProduction byBone marrow
Cell loss/destruction
Primary: CMLSecondary: infection, inflammation, pregnancy, post-splenectomy
1. Drug induced2. BM infiltration/failure
• Haemopoietic cancer• Metastatic cancer• Aplasia
Immune mediatedHypersplenismDisseminated intravascular coagulation
• AML vs CML• ALL vs CLL
ALL• Clinical features:
- bone pain- hepatomegaly- splenomegaly- lymphadenopathy- thymic enlargement- testicular enlargemenrs- fatigue, lethargy, pallor, breathlessness (anaemia –
normocytic, normochromic)- fever and infection features (neutropenia)- bruising, petechia, bleeding (thrombocytopenia)
• Replacement of normal bone marrow by lymphoblasts
Bleeding disorders
Coagulation screen
What do you get?
Prothrombin time (± INR)Activated partial thromboplastin time (APTT)Thrombin time (TT)
Haemostasis screeningINR (Prothrombin Time)Measuresextrinsic & common pathwayCommon abnormalitywarfarinliver diseaseDIC
APTTMeasuresintrinsic and common pathwayCommon abnormalityheparinliver diseaseDIC haemophiliaTT (thrombin time)
Measuresfibrinogen&thrombin inhibitionCommon abnormalityDIC heparin
What you need to know• normal ranges for WBC, Hb, MCV, platelet count in
adults• If the WBC is abnormally high or abnormally low we
expect you to be able to work out whether it is the count of neutrophils, lymphocytes or eosinophils that is causing the abnormality in the total WBC
• We expect you know that there are variations in haematological normal ranges related to gender, age and ethnic origin
Questions
SBA
• What event is this?• When is it?• When are you getting
tickets?
White cells
• Neutrophilia: bacterial infections, inflammation, malignancy, necrosis, treatment with corticosteroids?
• Neutropenia: post-chemo, viral, adverse drug reactions eg. carbimazole
• Lymphocytosis: viral, lymphomas, chronic infections eg TB, chronic lymphocytic leukaemia
• Eosinophilia: parasite infection, atopic allergic, Hodgkin
EMQ• A Anaemia• B Lymphocytosis• C Lymphopenia• D Neutropenia• E Neutrophilia• F Pancytopenia• G Polycythaemia• H Reticulocytosis• I Thrombocytopenia• J Thrombocytosis
1. A patient with infectious mononucleosis.
2. A patient who has just started treatment with B12 and folatefor megaloblastic anaemia.
3. A patient with chronic renal failure.
4. A patient with chronic obstructive pulmonary disease.
5. A patient with disseminated intravascular coagulation.
SBA• A 61-year-old woman with pancytopenia, mild jaundice, and peripheral
neuropathy is found to have decreased serum levels of vitamin B12. Which of the abnormal cell morphologies listed below is most likely to be present in a smear made from her peripheral blood?
• A. Hypersegmented PMNs
• B. Large granular lymphocytes
• C. Oval microcytes
• D. Pelger-Huet neutrophils
• E. Plasmacytoid lymphocytes
SQA• A 16-year-old girl has a sore throat, enlarged tender cervical
lymph nodes, and low-grade fever for 3 days. In addition to erythematous pharyngeal mucosa and cervical lymphadenopathy, physical examination reveals mild splenomegaly. A complete blood count (CBC) shows an increased number of white blood cells with a lymphocytosis and many reactive lymphocytes.
• What is the most likely diagnosis?
• What laboratory tests would be helpful in confirming the diagnosis?
SQA• 3 year old girl referred with failure to thrive. • Hepatosplenomegaly. • Hb 5.1 (13.0-16.5)• MCV 58 (80-100)• WCC 9.1 x 109 (4-11 x 109)• Platelets 317 x 109 (150-400 x 109)• Bilirubin 38 (1-22) • AST (19-48)
SQA• 63 year old man presents with a left-sided TIA • Similar episode 1 week earlier. Results of FBC: • Hb 21.2 (13.0-16.5)• Haematocrit 0.61• WCC 15.3 x 109 (4-11 x 109)• Increased neutrophils and eosinophils• Platelets 897 x 109 (150-400 x 109)• Bilirubin 8 (1-22) • AST 30 (19-48)• Cholesterol 3.6 (0.1-1.6)
SQA
• 78 year old man• Hepatolsplenomegaly• Hb 10.1 (13.0-16.5)• WCC 227 x 109 (4-11 x 109)• Platelets 741 x 109 (150-400 x 109)• Uric acid 490 (110-420)
SQA
• 58 year old woman with pallor, decreased sensation in both legs below the knee, absent ankle jerk
• Hb 8.2 (13.0-16.5)• MCV 124 (80-100)• WCC 2.4 x 109 (4-11 x 109)• Platelets 102 x 109 (150-400 x 109)