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