Unexpected haematology results

Dr Ifraz Hamid Consultant Haematologist Royal Bournemouth Hospital Outline

▪ Abnormal FBC results

▪ Blood film interpretation

▪ Interpreting Immunoglobulins Abnormal blood counts

▪ Malignant vs reactive causes

▪ Review historic results

▪ Symptoms - night sweats, weight loss, pruritus, rashes

▪ Reactive causes - smoking, infection, inflammation, malignancy

▪ Blood film

▪ Repeat tests/trends Polycythaemia

▪ When to investigate - Male - HCT >0.52 , female - HCT > 0.48

▪ Secondary causes - Smoking, lung pathology, OSA, CO, dehydration, hormones, drugs

▪ Helpful hints - Blood film, other blood counts

▪ Concerning symptoms - B symptoms, aquagenic pruritus, stroke, VTE

▪ Erythropoetin

▪ Molecular tests - JAK 2, JAK 2 exon 12

▪ USS abdomen

▪ When to refer

▪ Treatment options and indications for treatment

▪ Haematocrit targets Thrombocytosis

▪ Sustained platelet count >450 x10*9

▪ Common secondary causes - infection, inflammatory, post surgery, iron deficiency, malignancy

▪ Helpful hints - blood film, other counts, iron, inflammatory markers, Hyperkalaemia

▪ Duration

▪ B Symptoms

▪ Molecular tests - JAK 2, JAK 2 exon 12, CAL R, MPL

▪ Treatment options and indications for treatment Macrocytosis

▪ Causes - medication, alcohol, haematinic deficiency, haemolysis, myelodysplasia

▪ Investigations - haemolysis screen, haematincs, LFT, TFTs, immunoglobulins,

▪ Cytopenias

▪ Blood film

AIHA -polychromasia

Low B12/Folate - hypersegmented neutrophils

MDS - dysplasia

▪ Myelodysplasia - BM required for diagnosis

▪ Monocytosis - Chronic myelomonocytic leukaemia (CMML) Myelodysplasia

• Treatment options - Palliative to High dose chemotherapy and allogeneic stem cell transplantation Neutropenia

▪ Mild 1.0-2.0, moderate 0.5-1.0, severe <0.5 x10*9

▪ Common causes -viral infection, inflammation, medication, autoimmune, ethnic,

▪ Symptoms

▪ Historic results

▪ Other cytopenias

▪ Blood film -

Reactive - left shift, toxic granulation

Dysplastic - hypersegmented, hypogranular

B12 deficiency- Hypersegmented neutrophils

Leucoerythroblastic Thrombocytopenia

▪ Causes - infection, medication, immune, malignancy, spurious, DIC

▪ Symptoms

▪ Immune thrombocytopenia

▪ Other immune conditions

▪ Blood film features -

Immune- Large/giant platelets

MDS - Dysplastic features

Infection - reactive features eg reactive lymphocytes

Spurious - plt clumps

Infiltration - leucoerythroblastic

DIC - fragmented RBCs

▪ When to treat - Non immune/immune

▪ ITP Treatment options Lymphocytosis

▪ Duration

▪ Reactive causes - viral infection, inflammation, smoking, splenectomy

▪ Symptoms - lymph nodes, B symptoms

▪ Haematological causes - LPD eg CLL, lymphoma

▪ Blood film - reactive, mature, monomorphic

▪ Flow cytometry Immunoglobulins

• Reactive vs malignant

• Helpful hints - Monoclonal or Polyclonal, Immuneparesis, Hypogammaglobuinaemia, comment

• MGUS vs Myeloma

• CRAB criteria

• Serum free light chains Serum free light chains

• Kappa and Lambda

• Ratio

• Renal impairment

• Bence Jones proteins Conclusion

• Blood films provide important information

• Consider reactive causes

• Duration of abnormality

• Symptoms

• Discuss with haematologist if unsure! Thank you

Any questions