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heamatology problems.pptx
1.
2.
3. Sarah is a 4-year-old girl presented with a 2-day
history of widespread bruising. She has also had
two nosebleeds in the preceding 24 hours.
There are no hx of truma , although her mother
says she is quietly febrile, especially when
playing with her younger brother.They both had a
cold and a sore throat 2 weeks previously.
She is otherwise very well.There is no significant
past medical or family history and
she is on no medication
4. Sarah is drawing pictures and is cheerful and
cooperative.
Her height and weight are on the 25th centiles.
There is no jaundice and she is
afebrile. She is pale and clinically anaemic with
a few lymph nodes in the cervical
and inguinal regions.
5. There is widespread bruising mainly on her
limbs but no evidence of active bleeding.
There is no hepatosplenomegaly. Her pulse is
96 beats/min . Examination of the
Other system are normal.
6. Haemoglobin 6.2 g/dL 11.5–15.5 g/dL
White cell count 1.2 109/L 6.0–17.5 109/L
Neutrophils 0.2 109/L 3.0–5.8 109/L
Lymphocytes 0.8 109/L 1.5–3.0 109/L
Platelets 6 109/L 150–400 109/L
Prothrombin time: 12 s 11–15 s
Partial thromboplastin time: 32 s 25–35 s
Blood film :No blasts
8. **Bone marrow failure
• Inherited – fanconi anemia ..
• Acquired
– viral, e.g. hepatitis, herpes, Epstein–Barr
– drugs – idiosyncratic, e.g. chloramphenicol,
anticonvulsants, or predictable,
e.g. chemotherapy; 80 per cent are ‘idiopathic a
plastic anemia’.
**Bone marrow infiltration
• Malignancy, e.g. leukaemia or neuroblastoma.
Rarely myelofibrosis and myelodysplasi
9. • Blood film – detailed morphology of all cell lines
• Red cell indices – the anaemia in AA is
normocytic or mildly macrocytic
• Reticulocytes – 20 109/L suggests severe
aplastic anaemia
• Viral titres – hepatitis, Epstein–Barr, parvovirus)
• Chromosomes for breakage analysis
• BM aspiration – to assess morphology and
cellularity of the cells and to exclude infiltration.
In AA it is hypocellular but the remaining cells
are normal
11. Ahmed is a 2-year-old boy who presents to the
paediatric rapid referral clinic with easy
bruising. His mother states that over the last 2
days bruises have been appearing on his
body spontaneously or with minimal trauma and
that he also had two short nose bleeds
the previous day. He is otherwise well but his
mother says that he had a cold about
2 weeks ago.
12. He has had no previous illnesses but had a
circumcision at 2 months of
age for religious reasons with no excessive
bleeding. He is on no medication.There is no
family history of bleeding disorders
13. He is well, playing and apyrexial.There is no
pallor.
He has widespread purpura and bruising over
the flexor and extensor surfaces of all four
limbs, trunk and face.
There is some blood crusted around his nose.
There is no lymphadenopathy or
hepatosplenomegaly.
There are no respiratory or cardiological signs
and there are no joint abnormalities.
14. Haemoglobin 10.2 g/dL 10.5–14.0 g/dL
White cell count 9.6 109/L 5.0–15.0 109/L
Platelets 6 109/L 150–400 109/L
Clotting factors : Normal
Blood film – large (young) platelets; no blasts seen
*Urine dipstick:
Blood – negative
Protein – negative
Leucocytes – negative
Nitrites – negative
15. • Infections
•Thrombocytopenia secondary to , leukaemia
or chemotherapy
• Henoch–Schِ nlein purpura (HSP) and other
vasculitides
•Trauma
• Clotting disorders
• Drugs, e.g. steroids
16. idiopathic thrombocytopenia
purpura (ITP).
This condition is caused by
antibodies to platelets.The history of a viral
infection 2 weeks prior to the onset of the
ITP is typical, as is the isolated, very low
platelet count in an otherwise well child
18. Rebekah is a 14-year-oldAfro-Caribbean girl
who presents to the ER department
complaining of pain in her chest and back.
Her pain started this morning and has been
worsening throughout the day, despite taking
paracetamol, & ibuprofen.
She is finding it difficult to breath deeply and
the pain is worse on inspiration.
19. She has HbSS sickle cell disease and has been
admitted to hospital three times in
the last month with painful crises.
20. Rebekah’s temperature is 38.8C, her heart rate
is 120 beats/min, blood pressure
135/85 mmHg, respiratory rate 40 breaths/min,
and oxygen saturation 91 per cent in air.
She is in pain and unable to take a deep breath.
There are bronchial breath sounds at
both lung bases. Heart sounds are normal. Her
abdomen is soft and non-tender and her
ears and throat are unremarkable.
25. A 63-year-old woman goes to her general
practitioner (GP) complaining of extreme
tiredness.
She has been increasingly fatigued over the past
year but in recent weeks she has
become breathless on exertion, and complained of
headaches.
Her feet have become numb and she has started
to become unsteady on her feet.
She has had no significant previous medical
illnesses..
26. She is a retired teacher and lives alone. Until
the last 2 years she was active, walking 3 or 4
miles a day. She is a non-smoker and drinks
about 15 units of alcohol per week.
She is taking no regular medication.
Her mother and one of her two sisters have
thyroid problems.
27. Pale & jundice. temperature is 37.8°C. pulse rate
is 96/min regular, and blood pressure 142/72
mmHg.
cardiovascular, respiratory and abdominal systems
is normal.
She has a symmetrical distal weakness
affecting her arms and legs. Knee and ankle jerks
are absent and she has extensor plantar
responses.
She has sensory loss in a glove and stocking
distribution with a particularly
severe loss of joint position sense.
29. • Folate deficiency
• Excessive alcohol consumption
• Hypothyroidism
• Certain drugs, e.g. azathioprine,
methotrexate
• Primary acquired sideroblastic anaemia and
myelodysplastic syndromes
30. This patient has a severe macrocytic anaemia
and neurological signs due to
vitamin B12 deficiency
31. *Serum vitamin B12 and folate levels
*antibodies to intrinsic factor and parietal cells
assay.
*A radioactive B12 absorption test (Schilling
test) distinguishes gastric from intestinal
causes of deficiency
32. Rapid correction of vitamin B12 is essential
using
intramuscular hydroxycobalamin
Inj.
33. Mnal is a 50 years female presented with
generalized fatigability and dragging
abdominal pain ,, also she noticed that her
Wight dramatically reduced over 2 yrs ,, & in
last 2 months lost about (8 kilo)
34. Pale ,, cachexic ,, PR= 90 ,, RR=24 ,, BP=130/90
2 cm hepatomegally with 7 cm splenomegally
Other system clear
35. HB : 9.9 g/dl
WBC : 56 * 109
PLTs : 702 * 109
Blood film : leukocytosis ,, all stages of
granulocytes formation seen
