Pictures in hematology

Pictures in hematology
‫محمد حارث الساعاتي‬.‫د‬
Pallor of conjunctiva
anemia
Koilonychia ( spoon shape nail)
Causes :
1. Iron deficiency anemia
2. Rarely amino acid deficiency
Angular chelitis
Cracks at the angle of the mouth commonly
occur in iron deficiency anemia
Jaundice
Jaundice with anemia occur in hemolytic anemia
, it is usually mild (lemon colour ) & mainly
indirect hyperbilirubinemia .
Glossitis
Painful red beefy tongue ( with atrophy of
papillae ) occur in
1. Megaloblastic anemia
2. Iron deficiency anemia .
Oral candidiasis ( thrush)
White coated tongue due to candidiasis occur
when there is low immunity due to HIV ,
diabetes , malignancy , steroid use , prolonged
antibiotic therapy .
Should be differentiated from food sticking on
the tongue !
gingival hypertrophy
Causes :
1. AML
2. Phenytoin
3. Rarely calcium channel blockers
Oral ulceration
Causes :
1. Infection : viral , bacterial …
2. Traumatic
3. Autoimmune diseases : SLE , behcet disease ..
4. Malignancy
5. Inflammatory bowel diseases
6. Chemotherapy
Lymphadenopathy
Causes :
Infective
• Bacterial: streptococcal, tuberculosis, brucellosis
• Viral: Epstein–Barr virus (EBV), human immunodeficiency
virus (HIV)
• Protozoal: toxoplasmosis
• Fungal: histoplasmosis, coccidioidomycosis
Neoplastic
• Primary: lymphomas, leukaemias
• Secondary: lung, breast, thyroid, stomach
Connective tissue disorders
• Rheumatoid arthritis
• Systemic lupus erythematosus (SLE)
Sarcoidosis
Amyloidosis
Drugs
• Phenytoin
lymphadenopathy
Bruises & petechia
Signs of bleeding tendency
Causes :
1. Thrombocytopenia
2. Platelets dysfunction
3. Coagulation defect ( mainly cause muscle &
joint bleeding)
4. Side effects of drugs like heparin , warfarin &
aspirin …
Hepatosplenomegally
Causes :
1. Infections : malaria , brucellosis , kala azar,
miliary TB…
2. Hematological diseases : thalassemia,
myelofibrosis ..
3. Leukemias , lymphomas .
4. Amyloidosis
5. Glycogen storage diseases
* See macloid”s clinical examination
Bone marrow study
Include bone marrow aspiration & biopsy
Indications:
1. Bicytopenia or pancytopenia( leukemia , aplastic
anemia …)
2. Suspected lymphoproliferative &
myeloproliferative disorders
3. dx. & staging of lymphoma
4. dx. Of multiple myeloma
5. Part of work up in pyrexia of unknown origin .
& many other indications .
Some drugs used in hematology
Iron sucrose ( venofir) :
Used in iron deficiency anemia , given as slow IV
infusion , may cause hypersensetivity reactions
therefore testing dose before use is indicated
Doxorubicin ( adriamycin)
Part of many chemotherapeutic regimen including ALL ,
AML , LYMPHOMA , & other solid malignancies .
Side effects: bone marrow suppression , stomatitis ,
vomiting , alopecia , cardiotoxicity
Therefore , assessment of cardiac function ( by ECHO
study ) is indicated before starting it .
Risk factor of cardiotoxicity : elderly , preexisting heart
diseases , use of other cardiotoxic agents & chest
radiation .
The drug is photosensetive ( should be protected from
light ) .
Doxorubicin
Methotrexate
Given in hematological malignancies , solid
organ malignancies & other non malignant
conditions like rheumatoid arthritis .
Can be given intrathecally in ALL for CNS
prophylaxis .
Side effects : vomiting , diarrhoea , mucositis ,
bone marrow suppression , liver fibrosis .
Cyclophosphamide ( endoxan)
Used in NHL , breast CA , lupus nephritis &
other malignant diseases .
Side effects : bone marrow supression ,
infertility , hemorrhagic cystitis .
Risk of hemorrhagic cystitis can be reduced by
the use of mesna .
hydroxyurea
Used as cytoreductive agent in CML , essential
thrombocythemia & in sickle cell disease.
Role in sickle cell :
1. Increase Hb F
2. Decrease level of circulating leucocytes .
3. Increase RBC hydration
Thereby decrease sickling
Imatinib ( glivic)
Tyrosin kinase inhibitor , specific for abnormal
BCR-ABL tyrosin kinase produced by
philadelphia chromosome .
Indications :
1. CML
2. ALL ( that is positive for Ph. Chromosome)
3. Hypereosinophilic syndrome
4. Gastrointestinal stromal tumours .
Side effects of imatinib:
1. Edema
2. Neutropenia
3. Muscle cramps
4. Rash
5. Left ventricular dysfunction & congestive heart
failure & may cause QT prolongation .
6. Liver troxicity
7. teratogenic
Cigar shape cells in IDA
Hypersegmented neutrophil in
megaloblastic anemia
Bite & blister cells in G6PD deficiency
Bite cells
Bite cells , G6PD deficiency
blister cells
spherocytes
Causes :
1. Heriditary spherocytosis
2. Autoimmune hemolytic anemia
Deferentiated by coomb”s test ( + in AIHA)
TARGET CELLS
Causes :
1. Thalassemia
2. Liver disease
RBC fragments ( shictocytes)
Causes:
1. Hemolytic uremic syndrome
2. TTP
3. DIC
4. Malignant HT
5. Valve hemolysis
6. Sever eclampsia
Sickle cell
Tear drop cell in myelofibrosis
thalassemia
Dactilitis in sickle cell anemia
Fanconi anemia
Inherited bone marrow failure ( aplastic anemia
) , clinically characterized by short stature ,
developmental delay , café au lait spots , thumb
dysplasia & radial abnormality & hearing defect
.

Download Report