Diagnostic Haematology

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<ul><li><p>CLINICAL PATHOLOGY DEPARTMENT*ANAEMIAS</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>CLINICAL PATHOLOGY DEPARTMENT*Objectives:By the end of this lesson, the students will be able to:Differentiate between different types of anaemia. Choose the proper laboratory tests to diagnose different types of anaemia. Interpret laboratory test results of a case of anaemia. </p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>CLINICAL PATHOLOGY DEPARTMENT*How to approach a case of anaemia? A case of anaemia is diagnosed first by complete blood count with special stress on the indices RBC morphology Reticulocyte count Leukemia must be excluded.</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>CLINICAL PATHOLOGY DEPARTMENT*Hypochromic microcytic anaemia MCV &lt; 75 fl, MCH &lt; 26 pg Iron deficiency anaemiaAnaemia of chronic diseaseSideroblastic anaemiaThalassaemia (, )</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>CLINICAL PATHOLOGY DEPARTMENT*Lab diagnosis of hypochromic microcytic anaemia</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>CLINICAL PATHOLOGY DEPARTMENT*Iron deficiency anaemiaThalassemia</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>CLINICAL PATHOLOGY DEPARTMENT*Sideroblastic AnaemiaRinged SideroblastsPB in a case of Sideroblastic anaemia</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>CLINICAL PATHOLOGY DEPARTMENT*Macrocytic AnaemiaA-Macrocytic Anaemia with reticulocytosis1-Acute bleeding2-Haemolytic anaemiasB-Macrocytic Anaemia without reticulocytosisMegaloblastic anaemia (B12 or folate def.)MyelodysplasiaAplastic anaemiaLiver diseaseThyroid disease</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>CLINICAL PATHOLOGY DEPARTMENT*Megaloblastic Anaemia A group of anaemias in which the erythroblasts in the bone marrow show asynchronous maturation of nucleus &amp; cytoplasm i.e. the nucleus maturation is delayed due to DNA synthesis . It is due to vit. B12 or folate deficiency (commonest folate )</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>CLINICAL PATHOLOGY DEPARTMENT*Lab tests for B12 &amp; folate deficiencyComplete blood picture: Macrocytic anaemia MCV&gt;100 fl Leucopenia, neutrophil hypersegmentation ThrombocytopeniaB.M. examination: Hypercellular, with megaloblasts, giant metamyelocytes. Other tests:Serum B12 Serum folate, Red cell folateAnti-parietal Ab &amp; anti-intrinsic factor Ab.</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>CLINICAL PATHOLOGY DEPARTMENT*Megaloblastic features in the BM:</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>Lab Approach to Haemolytic AnaemiaScreening tests </p><p> Increased reticulocyte count Increased urine urobilinogenIncreased indirect bilirubin</p><p>CLINICAL PATHOLOGY DEPARTMENT*</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>Lab Approach to Haemolytic Anaemia</p><p>Specific tests: Hemoglobin Electrophoresis to detect abnormal hemoglobins.Osmotic fragility test for heriditary spherocytosisCoombs test for immune hemolytic anaemiasG-6-PD assay for favismRed cell morphologyB.M. examination.</p><p>*</p></li><li><p>Two Types of Haemolysis1-Extravascular (in RES e.g spleen)2-Intravascular (inside vessels)Main cause : ?????? Specific tests include : HemoglobinaemiaHemoglobinuriaDecreased haptoglobinCLINICAL PATHOLOGY DEPARTMENT*</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>CLINICAL PATHOLOGY DEPARTMENT*Normochromic Normocytic anaemiaNormal MCV , MCH &amp; MCHCHaemolytic anaemias other than thalassemia Ex :sickle cell , hereditary spherocytosis, G6PD deficiency.Acute bleedingAcute systemic disease</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>CLINICAL PATHOLOGY DEPARTMENT*Normochromic, normocytic anaemia in a case of anaemia of chronic disease</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>CLINICAL PATHOLOGY DEPARTMENT*Hereditary ElliptocytosisG6PD deficiencySickle cell AnaemiaSickle cell Anaemia</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>CLINICAL PATHOLOGY DEPARTMENT*Hereditary Spherocytosis Red cell membrane defectDiagnostic criteria:1-Normochromic Normocytic anaemia with increased MCHC2-Blood film show micro-spherocytes3-Reticulocytosis 4-Increased Saline Osmotic Fragility </p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>CLINICAL PATHOLOGY DEPARTMENT*Hereditary SpherocytosisSaline Osmotic Fragility TestControlTestSpherocytes in blood filmSpherocytes in blood film</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>CLINICAL PATHOLOGY DEPARTMENT*Immune haemolytic anaemia</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>CLINICAL PATHOLOGY DEPARTMENT*RBCs fragments in haemolytic anaemiaCold Agglutinins</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>CLINICAL PATHOLOGY DEPARTMENT*Aplastic anaemia &amp; BM failureDefinition:Pancytopenia resulting from aplasia of the bone marrow.</p><p>Classification:Primary: Congenital (Fanconi, non Fanconi types) and acquired (idiopathic)Secondary: Ionizing radiation, drugs, chemicals &amp; infections.</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>CLINICAL PATHOLOGY DEPARTMENT*Laboratory findings of aplastic anemia:</p><p>Normochromic normocytic anaemia with low reticulocyte count.LeucopeniaThrombocytopeniaNo abnormal cells are seen in blood films.Hypocellular bone marrow with replacement of haemopoietic tissue by fat spaces. Aplastic anaemia</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>CLINICAL PATHOLOGY DEPARTMENT*Haemostasis</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>*CLINICAL PATHOLOGY DEPARTMENTBleeding disordersBleeding disorders may be due to abnormalities of the vascular system, platelets, coagulation system or fibrinolytic system.</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>Lab tests for bleeding disordersSCREENING TESTS:BTCTPT /INR to standardize PT results among different labsPTTTT*CLINICAL PATHOLOGY DEPARTMENT</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>*CLINICAL PATHOLOGY DEPARTMENTLab diagnosis of vascular causesBT: prolongedCT : normalHess test: &gt; 5 purpuric spotsPlatelet count : normalPlatelet function: normal</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>PROLONGED BLEEDING TIMECBC to diagnose thrombocytopeniaPT normal &amp; PTT prolonged..? VWD??BM for thrombocytopeniaPlatelet function tests (aggregometer) to diagnose qualitative platelet disorders.eg. Glanzman disease *CLINICAL PATHOLOGY DEPARTMENT</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>*CLINICAL PATHOLOGY DEPARTMENTClotting cascade</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>Prolonged PTTWITH NORMAL PT: DEFECT IN INTRINSIC SYSTEMFACTOR VIII &amp;IX ASSAY (factor VIII deficiency=hemophilia A )(factor IX deficiency=hemophilia B)</p><p>PROLONGED PT &amp;PTTDefect in the common pathway: factor X,II,I</p><p> *CLINICAL PATHOLOGY DEPARTMENT</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>PROLONGED PTWith normal PTTHereditary:DEFECT IN extrinsic pathway: factor VII deficiencyAcquired:Hemorrhagic disease of the newborn due to vit K deficiencyLiver disease (synthetic function of the liver)*CLINICAL PATHOLOGY DEPARTMENT</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>Prolonged thrombin timeIn cases of fibrinogen defects : dysfibrinogenemia, afibrinogenemia, DIC*CLINICAL PATHOLOGY DEPARTMENT</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>Monitoring of patients on anticoagulant therapyHeparin therapy by PTTOral anticoagulant therapy by PTLMWH (CLEXAN) by anti factor X*CLINICAL PATHOLOGY DEPARTMENT</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>LAB INVESTIGATIONS OF DICAll screening tests are prolonged: BT,CT PT PTTTHROMBOCYTOPENIAD-DIMER /FDPS positiveFactor assay : decreased activity*CLINICAL PATHOLOGY DEPARTMENT</p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li><li><p>*CLINICAL PATHOLOGY DEPARTMENTInterpretation Of Lab Tests Prolonged PTDefeciency in any factor of the extrinsic or common pathway:7,10,2,1Vit K defeciencyLiver diseaseOral anticoagulant therapy Prolonged PTTdefeciency of any factor in the intrinsic or common pathways: most common VIII, VW, IXHeparin therapy Presence of inhibitors </p><p>CLINICAL PATHOLOGY DEPARTMENT</p></li></ul>