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Path - Intro to Haematology + Anaemia (i) (intro (Dx (lab tests (FBC (WCC,…
Path - Intro to Haematology + Anaemia (i)
types of anemias
haematinic deficient
Fe
B12
folate
aplastic
rare
BM + haematopoietic stem cells (erythroid + myeloid cells) that reside there are damaged
inability of stem cells to generate mature blood cells
pancytopenia = anemia + leukopenia + thrombocytopenia
or hypoplastic (v few blood cells produced)
can be immune, hereditary, sometimes idiopathic
Haemolytic
due to haemolysis (abnormal breakdown of RBCs) either in blood vessels (intravasc) or elsewhere, usually spleen (extravascular)
congenital or acquired
Lab Morphological classification
based on MCV
macrocytic
RBCs too large - macrocytosis
MCV > 100 fL
causes
megaloblastic anaemia
BM produces large, structurally abnormal, immature RBCs (megaloblasts)
caused by B12/folate deficiency
necessary for DNA synthesis
non-megaloblastic
alcohol/liver disease
hypothyroidism
chemo
microcytic
characterised by small RBCs (microcytes)
MCV < 80 fL
RBCs usually also hypochromic (pale)
causes
Fe deficient
thalassaemia
abnormal Hb production
sideroblastic
presence of ringed sideroblasts (RBC precursors) instead of RBCs
normocytic
normal-sized RBCs, but a low number of them
causes
chronic disease
renal disease
acute blood loss
increased ferritin (BM slightly less cellular)
BM
responds quickly to cell reductions (e.g. blood loss)
involved in immunity
stem cells differentiate via erythropoietin, GFs, CKs
intro
= low Hb due to disorders of globin/heme/supplements
fatigue
hypoxia (only in acute onset, as hasn't had time to adapt to low Hb)
heart failure/angina (esp in elderly/those with already poor cardiac function)
dyspnoea when active
Dx
Hx
clinical exam
lab tests
blood film (shape + colour)
FBC
Hb
Normal = 13-15 g/d
most important
MCV (average size of RBCs)
normal 80-100 fL
WCC
checks for leukaemia + infection
normal = 5-7000
10000+ is abnormal
reticulocyte count (indicates BM activity)
Packed cell vol (PCV, aka haematocrit)
% of blood occupied by RBVs
normal = 40%
detects dehydration
BM aspirate (cells)
BM trephine (tissue)
taken @ iliac crest
unconjugated bilirubin
if high: haemolytic anaemia
= breakdown product of heme
haematinic levels
Coomb's test
detects haemolytic
detects anti-RBC Igs
Pathophysiological classification
blood loss (esp GI bleeding)
nutritional deficiency
BM failure
anaemia of chronic disease
destructive (haemolytic)
Reticulocytosis
abnormally high reticulocytes (immature RBCs) in blood
indicates erythropoiesis
BM trying to compensate for anaemia
indicates BM function is intact