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Haematological Hx
Haematological System Hx, Ex and Ix
| Term | Definition |
|---|---|
| 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 |
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