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Haematological Hx

Haematological System Hx, Ex and Ix

Unusual tiredness, lethargy or fatigue Anaemia, malignancy, sleep problems, depression
Frequent infections, problems recovering from infections Immunosuppression, leukaemia, age, diabetes, HIV.
Chronic high fevers and sweats High grade aggressive lymphomas
Fever CMV and EBV
Faint, widespread non-itchy rash EBV
Jaundice Haemolytic anaemia
Plethoric face and conjunctiva Polycythaemia
Parasthesiae and neurological deficits B12 deficiency
Abnormal bleeding and ecchymoses Trauma, thrombocytopenia, coagulation disorders, age, Cushing’s syndrome
Petechiae/purpura Thrombocytopenia, platelet dysfunction (chronic liver disease, aspirin, MPD), septicaemia, scurvy
Petechiae < 3mm
Pupura 0.3-1cm
Ecchymoses >1cm
Bone pain (primary disease) Acute leukaemia with rapid expansions
Bone pain (secondary disease) Secondary metastases of lung, breast or prostate cancer
Leg swelling and pain DVT
Pruritis Polycythaemia, lymphoma, myeloproliferative disease
Postural hypotension Anaemia and dehydration
Koilonychia Dry, brittle, spoon-shaped nails seen in anaemia
Epitrochlear lymph node enlargement Hodgkin's lymphoma, local infection, syphilis
Hypertrophy of gums Acute monocytic leukaemia
Atrophic glossitis Megaloblatic anaemia or iron deficiency anaemia
Rubbery and firm lymph nodes Lymphoma
Solid lymph nodes Metastases from tumours
Fixed nodule Cancerous lymph node
Hepatomegaly EBV, malaria, myeloma, leukaemia, lymphoma, haemolytic anaemia, alcoholism.
Splenomegaly EBV, malignancy, polycytheamia, sypihilis, portal hypertension
Low serum iron with low TIBC Anaemia of chronic disease
Low serum iron with high TIBC Iron deficiency anaemia
Sideroblastic anaemia Microcytic anaemia, X-linked inheritance. Deposits of iron around a primitive red cell nucleus
Target cells Liver disease, thalassemia, post-splenectomy
Inheriting 3 abnormal alpha thalassemia genes HbH disease
Inheriting 2 abnormal alpha thalassemia genes Decreased MCV with slight decrease in Hb
Inheriting 1 abnormal alpha thalassemia genes Decreased MCV
Spherocyte Hereditary spherocytosis, autoimmune haemolytic anaemia, burns.
Tear drop cell Myelofibrosis, thalassemia
Pencil cells Iron deficiency anaemia, megaloblastic anaemia, hereditary elliptocytosis
Acanthocytes (irregular spicules) Alcoholic liver disease, post-splenectomy
Stomatocytes (slit like region of central pallor) Alcoholic liver disease, obstructive jaundice, herediatary stomatocytosis
Sickle cell Genetic mutation of beta haemoglobin chain, sickle-shaped cells, auto-agglutination at low O2
Schistocyte (fragmented RBC) Microangiopathic anaemia (disseminated intravascular coagulation, thrombotic thrombocytopenic purpura, pre-eclampsia)
Rouleux formation Multiple myeloma, temporal arteritis
Auto-agglutination Warm or cold type auto-agglutinins, incompatible blood transfusion.
Neutrophilia Infection, inflammation, corticosteroid therapy, MPNs (CML), pregnancy, treatmetn with GC-CSF.
Neutropenia Cytotoxic chemotherapy, megalobalstic anaemia, infections.
Toxic granulation Bacterial infections, sepsis
Elevated neutrophils over lymphocytes Bacterial infection
Elevated lymphocytes over neutrophils Viral infection
Dohle bodies (blue patches in cytoplasm) Severe sepsis
Hypersegmented neutrophils (>5 segs) Megaloblastic anaemia, myelodysplasia, methotrexate
Neutrophil left shift Bacterial infections, chronic myeloid leukaemia
Blasts Acute leukaemia
Eosinophilia Allergic conditions, parasites, drug hypersensitivity
Basophilia (least numerous of all blood cells) Myeloproliferative disorders (CML), allergic reactions
Monocytosis Bacterial infections, myelodysplasia, chronic infection (TB, syphilis) or chronic inflammation (rheumatoid arthritis)
Lymphocytosis Infections, CLL, pertussis infection, hairy cell leukaemia
Lymphocytes that smear on blood film CLL
Reactive lymphocytes Acute viral infection (hep, EBV, CMV), drugs, allergic reactions
Mild thrombocytopenia 100-150
Moderate thrombocytopenia 30-100
Severe thrombocytopenia <30
Thrombocytosis ET, iron deficiency anaemia and blood loss, chronic infection, malignancy
The most common leukaemia in children Acute lymphoblastic leukaemia
Auer rods Acute Promyelocytic Leukaemia
Chronic leukaemias Pallor, gout, massive splenomegaly, mild hepatomegaly
Multiple myeloma Normocytic, normochromic anaemia, purpura, infection, skin changes, spinal cord compression (bony infiltration)
Immune thrombocytopenic purpura Bruising, wet purpura, petechial rash with no abnormalities on bone marrow
Burkitt's lymphoma Type of non-Hodgkin's lymphoma, B memory cell neoplasm. Associated with MYC up-regulated oncogene t(8:14)
Follicular lymphoma B cell lymphoma involving the decreased expression of BCL2 tumour suppressor gene.
Hodkgin's lymphoma Reed-Sternberg cell, painless, rubbery lymph node enlargement, weight loss, eveer, infiltration of lungs, bones and spinal cord
Non-Hodgkin's lymphoma Multiple lymph nodes involved, hepatosplenomegaly, extranodal spread, less common to have systemic signs
Multiple Myeloma CRABS (cord compression, renal failure, anaemia, bleeding, skin changes)and Bence-Jones proteins in urine
Prevalence of JAK2 mutations in polycytheamia rubra vera 97%
Prevalence of JAK2 mutations in essential thrombocytosis and primary myelofibrosis 50%
Howell-Jolly body Basophilic nuclear remnants in RBC. Splenic dysfunction (splenectomy, Coeliac disease, trauma, sickle cell anaemia, haemolytic anaemia, hereditary sphero, MDS)
Coombs test Autoimmune haemolytic anaemia
Heinz body Small inclusions in RBC - chronic liver disease, NAPDH deficiency, G6PDH deficiency, alpha thal)
Massive splenomegaly Myelofibrosis
Bence Jones Proteins on serum electrophoresis Multiple myeloma
Death in patients with impaired white cell function Gram negative septicaemia
Created by: Epoot