Hematology

Pictures in hematology

د.محمد حارث الساعاتي

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 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 .