Haematology

Indicates biliary obstruction and hepatic metastasis

Liver and skeletal muscle pathologies

If low, capillary leak

If high, hepatitis

Problem in bile duct

problem in liver

Severe necrosis of liver

Alcoholic cirrhosis

Acute infection, inflammation, acute necrosis

Viral infection, drug reactions

Iron deficiency, thalassaemia (low MCV, raised RBC)

Blood loss, chronic disease, bone marrow failure, renal failure, hypothyroidism, haemolysis, pregnancy

B12/folate deficiency, alcohol excess, reticulocytosis, myelodysplastic syndrome, marrow infiltration, hypothyroidism

Erythropoietin deficiency

DNA nuclear remnants in RBCs. They are normally removed by the spleen and seen in post splenectomy and hyposplenism (sickle cell, coeliac, UC, Crohn's)

Young (therefore large) RBCs signifying active erythropoiesis. Increased in haemolysis and haemorrhage.

Acute viral infections, chronic infections, leukaemias and lymphomas

Epstein-Barr virus infection

Steroid therapy, SLE, Legionnaire's, HIV, post chemo

Drug reactions (erythema multiform), allergies, parasitic infection, skin disease (pemphigus, eczema, psoriasis)

Pernicious anaemia, NOT B12 deficiency

B12 and folate deficiency

Autoimmune substitution of Glu for Val at position 6 of the beta chain

Heterozygote = HbAS = sickle cell trait. Homozygote = HbSS = SCA

Haemolysis, Hb ~ 6-9, Reticulocytes raised by 10-20%, raised bilirubin

Cold, dehydration, infection, hypoxia

Splenic infection therefore susceptibility to infection, poor growth, chronic renal failure, gallstones, retinal disease, iron overload, lung damage.

Hydroxycarbimide if crises are frequent, prophylactic antibiotics, bone marrow transplant

Prompt IV opiates, crossmatch, rehydrate, broad spectrum antibiotics, blood transfusion

Acquired - Anticoagulation with warfarin, liver failure, vitamin K deficiency, dengue fever, leukaemia.

Autoimmune - antiphospholipid syndrome

Genetic - Haemophilia, Von Willebrand's, Bernard-Soulier syndrome

Congenital - Factor V leiden

Acquired - antiphopholipid syndrome, heparin induced thrombocytopenia, paroxysmal nocturnal haemoglobinuria, cancers, nephrotic syndrome, pregnancy, oral contraceptive

DVT, PE, SOB, palpitations, collapse, shock, cardiac arrest, miscarriage (multiple = antiphospholipid syndrome), pre-eclampsia

Petechiae, purpura, melena, haematochezia, bleeding gums

Inactivates thrombin (IIa) and factor Xa at a slow rate. Heparin AT-III can also inactivate factors IX, XI, XII and plasmin

Vitamin K antagonist therefore inactivates Vit K dependent clotting factors (II, VII, IX, X, protein C, protein S)

Caused by damaged surface.

XII -> XIIa
XI -> XIa
IX -> IXa
X -> Xa

Prothrombin (II) -> Thrombin (IIa)

V -> Va

Fibrinogen -> Fibrin

Hence factor V leiden causes hypercoagulability

Trauma

Tissue factor
X -> Xa

Prothrombin (II) -> Thrombin (IIa)

V -> Va

Fibrinogen -> Fibrin

Hence factor V leiden causes hypercoagulability

Addition of thromboplastin to the plasma to test the extrinsic system. It tests for abnormalities in factors I, II, V, VIII, IX, X, XI, XII

Thrombin added to plasma to convert fibrinogen to fibrin. Prolonged by heparin treatment.

10 mins

Use packed RBCs

Use FFP

TRALI, bacterial infection, anaphylaxis, fluid overload, acute haemolytic reactions

Viral infection, graft vs host disease, iron overload, post transfusion pupura

Caused by a massive destruction of cells leading to increased potassium, urate and renal impairment.

Marrow failure: Anaemia, susceptibility to infection, bleeding.

Infiltration: Hepato and splenomegaly, lymphadenopathy, orchidomegaly, cranial nerve palsy

Blast cells on blood film, mediastinal lymphadenopathy on CXR

IV fluids, prophylactic antibiotics, allopurinol (prevent tumour lysis syndrome)

Remission induction via vincristine, prednisolone, L-asparaginase + daunorubicin

CNS prophylaxis - intrathecal methotrexate

Maintenance - mercaptopurine (daily), methotrexate (weekly), vincristine and prednisolone (monthly)

Gum hypertrophy, CNS involvement is rare

Presence of the Philadelphia chromosome. Features of gout due to purine breakdown. WCC raised across the spectrum.

CLL

0 = Lymphocytosis alone = 13 yr

1= LCT + lymphadenopathy = 8yr

2- LCT + splen/hepat meg = 5yr

3= LCT + anaemia = 2yr

4 = LCT + platelets < 100 = 1yr

Enlarged, rubbery, tender nodes. Hepatosplenomegaly

High lymphocytes. Low Hb, neutrophils and platelets

Fludarabine + cyclophosphamide

Imatinib

Reed-Sternberg cells

Enlarged, rubbery PAINLESS cervical nodes (painful in CLL), alcohol induced lymph node pain,

Is via the Ann Arbor system

1. Confined to single lymph node region

2. Two or more nodal areas on same side of diaphragm

3. Nodes on both sides of diaphragm

4. Spread beyond lymph nodes (liver or bone)

ABVD - Adriamycin, bleomycin, vinblastine, dacarbazine

No Reed-Sternberg cells featured

Disease of the oropharyngeal lymphoid tissue (Waldeyer's ring) = difficulty breathing + sore throat.

R-CHOP regimen: Rituximab, Cyclophosphamide, Hydroxydaunorubicin, Oncovin (trade name of vincristine) and Prednisolone

RBCs = polycythaemia rubra vera

WBCs = chronic myeloid leukaemia

Platelets = Essential thrombocytopenia

Fibroblasts = Myelofibrosis

headaches, dizziness, tinnitus, itchy after hot bath, burning sensation in peripheries, visual disturbances, gout due to raised urate from RBC turnover

Monoclonal band (2/3 IgG, 1/3 IgA). Urine often contains Bence-Jones protein. Increased blast cells on bone marrow biopsy.

Osteolytic pain, pathological fractures and hypercalcaemia (increased osteoclasts), anaemia, neutropenia, thrombocytopenia, recurrent bacterial infections, renal failure

A+, A-, O+, O-

A-, O-

B+, B-, O+, O-

B-, O-

Anything

Anything negative

O-, O+

O-