Haematology
FBC
• Red Cells: Hb, MCV
• WBC: cell type and presence of abnormal or
immature forms
• Platelets
Anaemia
• Hb
• MCV
Microcytic Normocytic Macrocytic
Iron def
Thalessaemia
ACD
Acute blood loss
Haemolytic
Marrow infiltrat...
Haematinics
• Deficiencies can cause anaemia:
Iron
B12
Folate
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 – radioactiv...
Folate defiency
Intake vs Utilisation
• Neural tube defects
• NO neuropathy
Pregnancy
Lactation
Adolescence
Excess turnove...
Haemolytic anaemia
• Intravascular vs Extravascular : bilirubin, LDH
• Polychromasia, reticulocytosis
Hereditory spherocyt...
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 erythropoiet...
Production by
Bone marrow
Cell loss/
destruction
Polycythemia
1. Haematinic deficiency
2. BM infiltration/failure
• Haemop...
Reduced cell counts
Three cell lines reduced/involved
• Think bone marrow failure/infiltration
(but don’t forget Vit B12/f...
PlateletsProduction by
Bone marrow
Cell loss/
destruction
Primary: CML
Secondary: infection,
inflammation, pregnancy,
post...
• AML vs CML
• ALL vs CLL
ALL
• Clinical features:
- bone pain
- hepatomegaly
- splenomegaly
- lymphadenopathy
- thymic enlargement
- testicular enl...
Bleeding disorders
Coagulation screen
What do you get?
Prothrombin time (± INR)
Activated partial thromboplastin time (APTT)
Thrombin time (T...
Haemostasis screening
INR (Prothrombin Time)
Measures
extrinsic & common pathway
Common abnormality
warfarin
liver disease...
What you need to know
• normal ranges for WBC, Hb, MCV, platelet count in
adults
• If the WBC is abnormally high or abnorm...
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?
• Ne...
EMQ
• A Anaemia
• B Lymphocytosis
• C Lymphopenia
• D Neutropenia
• E Neutrophilia
• F Pancytopenia
• G Polycythaemia
• H ...
SBA
• A 61-year-old woman with pancytopenia, mild jaundice, and peripheral
neuropathy is found to have decreased serum lev...
SQA
• A 16-year-old girl has a sore throat, enlarged tender cervical
lymph nodes, and low-grade fever for 3 days. In addit...
SQA
• 3 year old girl referred with failure to thrive.
• Hepatosplenomegaly.
• Hb 5.1 (13.0-16.5)
• MCV 58 (80-100)
• WCC ...
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....
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...
SQA
• 58 year old woman with pallor, decreased
sensation in both legs below the knee, absent
ankle jerk
• Hb 8.2 (13.0-16....
Haematology - PowerPoint Presentation
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Haematology - PowerPoint Presentation

  1. 1. Haematology
  2. 2. FBC • Red Cells: Hb, MCV • WBC: cell type and presence of abnormal or immature forms • Platelets
  3. 3. Anaemia • Hb • MCV Microcytic Normocytic Macrocytic Iron def Thalessaemia ACD Acute blood loss Haemolytic Marrow infiltration ACD B12 Folate Alcohol Reticulocytosis Hypothyroid
  4. 4. Haematinics • Deficiencies can cause anaemia: Iron B12 Folate Duodenum Terminal ileum Duo and jej
  5. 5. Iron absorption
  6. 6. Iron deficiency Intake vs Utilisation PubertyDiet Malabsorption not common • Blood loss • Atrophic tongue!
  7. 7. IDA vs ACD Iron parameter IDA ACD Serum iron TIBC Serum ferritin Serum sTfR N
  8. 8. B12 absorption
  9. 9. B12 deficiency • Pernicious anaemia – autoantibodies • Neurological problems • Beefy tongue! • Schilling test – radioactive; im. With IF Not common Diet RARE Small bowel disease Reduction in IF Intake vs Utilisation
  10. 10. Folate defiency Intake vs Utilisation • Neural tube defects • NO neuropathy Pregnancy Lactation Adolescence Excess turnover of cells: Haemolysis, malignancy Diet COMMON Coeliac disease Antifolate drugs
  11. 11. Haemolytic anaemia • Intravascular vs Extravascular : bilirubin, LDH • Polychromasia, reticulocytosis Hereditory spherocytosis Thalassaemia Sickle cell anaemia G6PD deficiency Pyruvate kinase deficiency Damage to red cell membrane Malaria Oxidant damage Aquired vs Inherited
  12. 12. G6PD deficiency • X-linked • Inability to detoxify oxidising agents • Heinz bodies, spherocytosis
  13. 13. Polycythaemia True Apparent Primary: PRV Secondary Hypoxia: chronic smoking high altitude lung disease Excess erythropoietin Dehydration
  14. 14. Production by Bone marrow Cell loss/ destruction Polycythemia 1. Haematinic deficiency 2. BM infiltration/failure • Haemopoietic cancer • Metastatic cancer • Aplasia Shortened survival bleeding haemolysis •Acquired (environment) •Immune •Microangiopathic •Malaria •**PNH • Inherited •Haemoglobin •Enzyme •Membrane RBC
  15. 15. 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)
  16. 16. PlateletsProduction by Bone marrow Cell loss/ destruction Primary: CML Secondary: infection, inflammation, pregnancy, post-splenectomy 1. Drug induced 2. BM infiltration/failure • Haemopoietic cancer • Metastatic cancer • Aplasia Immune mediated Hypersplenism Disseminated intravascular coagulation
  17. 17. • AML vs CML • ALL vs CLL
  18. 18. 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
  19. 19. Bleeding disorders
  20. 20. Coagulation screen What do you get? Prothrombin time (± INR) Activated partial thromboplastin time (APTT) Thrombin time (TT)
  21. 21. Haemostasis screening INR (Prothrombin Time) Measures extrinsic & common pathway Common abnormality warfarin liver disease DIC APTT Measures intrinsic and common pathway Common abnormality heparin liver disease DIC haemophiliaTT (thrombin time) Measures fibrinogen&thrombin inhibition Common abnormality DIC heparin
  22. 22. 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
  23. 23. Questions
  24. 24. SBA • What event is this? • When is it? • When are you getting tickets?
  25. 25. 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
  26. 26. 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 folate for megaloblastic anaemia. 3. A patient with chronic renal failure. 4. A patient with chronic obstructive pulmonary disease. 5. A patient with disseminated intravascular coagulation.
  27. 27. 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
  28. 28. 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?
  29. 29. 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)
  30. 30. 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)
  31. 31. 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)
  32. 32. 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 )

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