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Lab Results for Haematological Disorders
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Iron Deficiency Anaemia Megaloblastic Anaemias and Vitamin B12 Deficiency Folic Acid Anaemia of Chronic Disease
Anaemia of Chronic Renal Insufficiency Anaemia of Hypometabolism Hereditary Spherocytosis Glucose-6-Phosphate
Pyruvate Kinase deficiency The Thallasemias Sickle Cell Disease Haemoglobin C Disease
Autoimmune Haemolytic Anaemia Drug Induced Immune Haemolysis Haemolytic-Uraemic Syndrome Paroxysmal Nocturnal Haematuria
Haemolytic Disease of the Newborn Aplastic Anaemia Sideroblastic Anaemia Anaemia of Marrow Infiltration
Haemophilia A Von Willebrands Disease Haemophilia B Disseminated Intravascular Coagulation
Ideopathetic Thrombocytopenic Purpura Chronic Granulomatous Disease Myelofibrosis With Myeloid Metaplasia Polycythaemia Vera
Essential Thrombocytopenia Acute Leukaemia Chronic Myelocytic Leukaemia Chronic Lymphocytic Leukaemia
Malignant/Non-Hodgkin's Lymphomas Hodgkins Disease Immunoproliferative Disorders Leukaemic Reticuloendotheliosis
Multiple Myelomas Macroglobulinaemia Heavy Chain Disease .
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Autoimmune Haemolytic Anaemias
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LABORATORY FINDINGS

Findings of Haemolysis

Peripheral Blood Bone Marrow Direct Antiglobulin (Coombs') Test

A positive direct Coombs' test indicates that an antibody is attached to the surface of the patient's RBC.  This will be indicated by broad-spectrum antiglobulin reagents.  Using monospecific Coombs' reagents, warm AIHA will react maximally at 37 degrees C with anti-human IgG serum along (30% - 40% of patients) or with both anti-IgG and anticompolement sera (40% - 50% of patients).  When only IgG is detected, it is usually an antibody reacting with Rh antigenic sites.  These sites are separated so that two IgG molecules will not be close enough to activate the complement system.  When IgG and complement are both detected, the antibody is usually directed against non-Rh antigens that are spaced so that two IgG molecules can fix complement.

Cold AIHA reacts maximally at 4 degrees C and reacts only with anti-complement serum.  The IgM antibody is rarely detected it quickly separates from RBC, especially on warming.  The bound complement may be detected at 37 degrees C.

Indirect Antiglobulin (Coombs1) Test

The indirect Coombs' test indicates the presence of free autoantibody in the patient's serum, which occurs when there are large amounts of autoantibody and low RBC binding affinity.  Warm autoantibodies are usually IgG, they agglutinate test cells at 37 degrees C, and they show no increase in reactivity at 4 degrees C.  Cold autoantibodies are IgM, they strongly agglutinate test cells at 4 degrees C, but they may sometimes react at up to 33 degrees C.  This indicates a wide thermal range of reactivity.

Eluates of RBC

In warm AIHA, antibody eluted from the RBC surface is usually the same as that identified in the patient's serum in the indirect Coombs' test.  In cold AIHA, no antibody can be eluted from RBC surface because the antibody usually has already eluted spontaneously.

Cold Agglutinin Titre

See Table 8-1 for examples of conditions showing increased cold agglutinin titers.

Other Laboratory findings
 


 
Table 8-1.  Conditions Showing Increased Cold Agglutinin Titres* 
DISORDER USUAL TITRE
Idiopathic cold AIHA >1:256
Mycoplasmal pneumonia 1 :1000 - 1:8000
Cold agglutinin disease > 1 : 10,000
*The haemolytic activity of the serum correlates more closely with the thermal amplitude of the antibody than with the titre.  Thermal amplitude refers to the extent of temperature range of activity, even up to 33 degrees C.

Drug Induced Immune Haemolysis
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LABORATORY FINDINGS


Haemolytic-Uraemic Syndrome
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LABORATORY FINDINGS

Peripheral Blood

Other laboratory Findings
Paroxysmal Nocturnal Haemoglobinuria
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LABORATORY FINDINGS

Peripheral Blood

Bone Marrow Other laboratory Findings Diagnostic Tests
Haemolytic Disease of the Newborn
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LABORATORY FINDINGS

Rh Incompatibility

ABO Incompatibility
Aplastic Anaemia
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LABORATORY FINDINGS

Peripheral Blood

Bone Marrow Other Laboratory Findings

Sideroblastic Anaemia
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LABORATORY FINDINGS

Peripheral Blood

Bone Marrow Other Laboratory Findings

Non-heme iron accumulates in RBC mitochondria surrounding the nucleus instead of cytoplasmic ferritin. A ring of iron is seen as opposed to the normal situation where only a few (less than 4) small aggregates of iron (ferritin) are present

Anaemia of Marrow Infiltration
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LABORATORY FINDINGS

Peripheral Blood

Bone Marrow Laboratory Findings of Underlying Disease
Haemophilia A
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LABORATORY FINDINGS


Von Willebrands Disease
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Normal / Von Willebrands

LABORATORY FINDINGS

  • Decreased AHF (6% - 60% of normal levels) - occurs in less than 50% of patients
  • Marked increase in AHF following transfusion of normal plasma.
  • Decreased von Willebrand's factor (factor VIII related antigen) - characteristic finding
  • Prolonged bleeding time reflects level of von Willebrand's factor.
  • Decreased platelet retention by glass bead columns
  • Decreased or absent ristocetin - induced platelet agglutination - characteristic finding.  In the presence of normal plasma, the patient's platelets aggregate with ristocetin;  the patient's plasma impairs agglutination of normal platelets in the presence of ristocetin.
  • Normal platelet agglutination with adenosine diphosphate (ADP), epinephrine, and collagen
  • Abnormal activated partial thromboplastin time if AHF is less than 25% - 30% of normal level
  • Normal prothrombin time, fibrinogen, thrombin time, platelet count, and clot retraction

Haemophilia B
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LABORATORY FINDINGS


Disseminated Intravascular Coagulation

LABORATORY FINDINGS

Additional findings in severe acute DIC:

DIC - Click on image for link to source
Click on Images for links to case study and image souce
The patient is a 20-year-old college student who presented to the emergency room at an outside hospital with general malaise, low-grade fever, and purplish discoloration on his face. The facial discoloration developed rapidly during the time from when he left his house to the time he arrived at the emergency room. Blood cultures were drawn and he was admitted to the intensive care unit. He was begun on imipenem-cilastatin and given fresh frozen plasma, cryoprecipitate, fluid resuscitation and dopamine. He was transferred to the University of Pittsburgh Medical Center with fever, disseminated intravascular coagulation and hypotension. Final Diagnosis -- Meningococcemia and Disseminated Intravascular Coagulation (Fever, Purpura and Hypotension)
.

Ideopathetic Thrombocytopenic Purpura
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Link to image source

LABORATORY FINDINGS

Peripheral Blood

  • Decreased platelets (<20,000/ul in the acute form;  10,000/ul - 80,000/ul in the chronic form) - thrombocytopenia is due to shortened platelet survival (1-2 days versus 10 days).  Platelets are coated by an IgG antibody and removed from the circulation, primarily by the spleen but also by the liver and other reticuloendothelial organs.
  • Large platelets are seen on smear - the early release of large immature platelets and megakaryocytic fragments from the bone marrow reflect an increased rate of platelet production.
Bone Marrow
  • Increased numbers of megakaryocytes that are less granular, smoother in contour, and more basophilic than normal megakaryocytes;  immature large megakaryocytes with increased numbers of nuclei;  absence of attached platelets indicate rapid release from the marrow
Other Laboratory Findings
  • Increased bleeding time and impaired clot retraction - reflect effect of thrombocytopenia
  • Findings due to bleeding;  anaemia, reticulocytosis, leukocytosis

Chronic Granulomatous Disease
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What is chronic granulomatous disease?
The human immune system, which protects us from disease, is made up of a complex network of highly specialized cells and organs. When any part of this network is faulty, it interrupts the smooth functioning of the immune response and can result in an immulogic disorder. Chronic granulomatous disease (CGD) is actually a group of rare, inherited disorders of the immune system that are caused by defects in the immune system cells called phagocytes. These defects leave patients vulnerable to severe recurrent bacterial and fungal infections and chronic inflammatory conditions such as gingivitis (swollen inflamed gums), enlarged lymph glands, or tumor-like masses called granulomas. While not malignant, granulomas can cause serious problems by obstructing passage of food through the esophagus, stomach, and intestines as well as blocking urine flow from the kidneys and bladder.

CGD is an inherited disease, which means that one or both parents pass on a defective gene to their child, even though the parents may be perfectly healhty. In the case of CGD, the genetic defect interferes with the child's ability to fight off certain diseases. It is estimated that one in one million babies is born with CGD, although symptoms of the disorder may not appear until after 3 months of age.

Two-thirds of people with CGD inherit the disease as a sex-linked characteristic, that is, as a defect in a recessive gene found on the X chromosome passed on to a child by its mother. A male has one X chromosome, a female has two. If a woman carries the faulty geneon only one of her X chromosome, she may not be affected by the disorder if normal phagocytes are generated by the other X chromosome. Her sons will have a 50 percent chance of inheriting the defective gene. her daughters might be carriers of the defective gene but won't develop CGD. However, carriers of the CGD gene appear to be prone to mouth ulcers and certain skin rashes.

Sometimes the normal X chromosomes in a female CGD carrier becomes inactivated early in the development of the embryo. This allows some cases of X-linked CGD to occur in females, aof X-linked CGD to occur in females, although it is much rarer than in males.

Faulty genes lodged on chromosomes other than the X chromosome can also cause CGD. The autosomal recessive form of CGD results when an abnormal gene is inherited from each parent. Both males and females are affected equally by this form of CGD. If only one abnormal gene is present, then the person carries the gene but does not develop the disease. Reference to source document Transposed from:
Chronic Granulomatous Disease
"A Guide for CGD Patients and Their Families"

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
National Institute of Health

National Institute of Allergy and Infectonal Institute of Allergy and Infectious Diseases
Division of Intramural Research
Prepared by the NIAID
Office of Communications

Link to source

LABORATORY FINDINGS

Peripheral Blood

Bone Marrow Other Laboratory Findings Laboratory Findings of Underlying Disorders

*These findings help in differentiating seconary erythrocytosis from polycythemia vera.


Myelofibrosis With Myeloid Metaplasia
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LABORATORY FINDINGS

Peripheral Blood*

Bone Marrow Other Laboratory Findings


*The combination in the peripheral blood of immature RBC, WBC, and platelets is known as leukoerythroblastosis and is characteristic of myelofibrosis with myeloid metaplasia.  These morphologic abnormalities may be a consequence of damage to the normal cellular release system of the marrow, of extramedullary blood-cell formation, or of both.


Click here for link to source

Reticulin Stain
Agnogenic myeloid metaplasia with myelofibrosis. These low-power bone marrow biopsies clearly show the fibrosis associated with this disease. (L) This H&E stained preparation shows virtual replacement of the marrow cavity with light pink-staining fibrotic tissue. A reticulin stain (R) demonstrates the fibrosis as well.

Polycythemia Vera
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LABORATORY FINDINGS

Peripheral Blood

Bone Marrow Other Laboratory Findings Diagnostic Criteria of the Polycythaemia Vera Study Group*

Category A

1.    Increased RBC mass
2.    Normal arterial O2 saturation
3.    Splenomegaly

Category B

1.    Thrombocytosis
2.    Leukocytosis
3.    Elevated leukocyte alkaline phosphatase score
4.    Elevated serum vitamin B12 or unsaturated B12 binding capacity


Click on image for link to source
Hypercellular marrow, with both erythroid and myeloid hyperplasia in this section (Giemsa, 400x)

Essential Thrombocythaemia

LABORATORY FINDINGS

Peripheral Blood*

Bone Marrow Other Laboratory Findings *This combination of laboratory findings is characteristic of essential thrombocythemia.
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