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Clinical Haematology

Diagnosis & Treatment
Blood Cancers

Lymphoma

Lymphoma is a group of blood cancers that develop from lymphocytes (a type of white blood cell). The name often refers to just the cancerous versions rather than all such tumors.

Signs and symptoms may include enlarged lymph nodes, fever, drenching sweats, unintended weight loss, itching, and constantly feeling tired.

The enlarged lymph nodes are usually painless. The sweats are most common at night.

There are dozens of subtypes of lymphomas. The two main categories of lymphomas are Hodgkin's lymphomas (HL) and the non-Hodgkin lymphomas (NHL). About 90% of lymphomas are non-Hodgkin lymphomas.

Lymphomas and leukemias are a part of the broader group of tumors of the hematopoietic and lymphoid tissues.

Links

Leukaemia Foundation
Lymphoma Australia
Leukaemia & Lymphoma Research (UK)
Lymphoma Association (UK)
Leukemia and Lymphoma Society (USA)

Leukemia

Leukemia, also spelled leukaemia, is a group of cancers that usually begin in the bone marrow and result in high numbers of abnormal white blood cells.

There are chronic leukemias such as chronic lymphocytic leukemia and chronic myeloid leukemia.

There are acute leukemias like acute myeloid leukemia and acute lymphoblastic leukemia. These white blood cells are not fully developed.

Often there are be no symptoms. In some cases there may be bleeding and bruising problems, feeling tired, fever, and an increased risk of infections.

These symptoms occur due to a lack of normal blood cells.

Diagnosis is typically made by blood tests or bone marrow biopsy.

Links

Leukaemia Foundation
CLL Forum (US)
CLL Topics (US)
CML Support (UK)
International CML Foundation
Leukaemia & Lymphoma Research (UK)
Leukemia and Lymphoma Society (USA)</a

Multiple Myeloma

Multiple myeloma, also known as plasma cell myeloma, is a cancer of plasma cells, a type of white blood cell normally responsible for producing antibodies.

Often, no symptoms are noticed initially. When advanced, bone pain, bleeding, frequent infections, and anemia may occur.

Complications may include amyloidosis.

Links

Leukaemia Foundation
Myeloma Foundation of Australia
International Myeloma Foundation (USA)
Multiple Myeloma Research Foundation
Myeloma UK
Myeloma Euronet

Myeloproliferative Neoplasms

The myeloproliferative neoplasms (MPNs), previously myeloproliferative diseases (MPDs), are a group of diseases of the bone marrow in which excess cells are produced.

They are related to, and may evolve into, myelodysplastic syndrome and acute myeloid leukemia, although the myeloproliferative diseases on the whole have a much better prognosis than these conditions.

Links

Leukaemia Foundation
MPN Education Foundation (USA)
MPN Research Foundation (USA)

Image Source - Wiki Pathologica

Myelodysplastic Syndromes

Myelodysplastic syndromes (MDS) are a group of cancers in which immature blood cells in the bone marrow do not mature and therefore do not become healthy blood cells.

Early on there are typically no symptoms. Later symptoms may include feeling tired, shortness of breath, easy bleeding, or frequent infections. Some types may develop into acute myeloid leukemia.

Links

Leukaemia Foundation
Aplastic Anaemia and MDS International Foundation
MDS Foundation (USA)

General Haematology

Anaemia

Anaemia or anemia is a decrease in the total amount of red blood cells (RBCs) or hemoglobin in the blood, or a lowered ability of the blood to carry oxygen.

When anemia comes on slowly, the symptoms are often vague and may include feeling tired, weakness, shortness of breath or a poor ability to exercise.

Anemia that comes on quickly often has greater symptoms, which may include confusion, feeling like one is going to pass out, loss of consciousness, or increased thirst. Anemia must be significant before a person becomes noticeably pale.

Additional symptoms may occur depending on the underlying cause.

The three main types of anemia are due to blood loss, decreased red blood cell production, and increased red blood cell breakdown.

Causes of blood loss include trauma and gastrointestinal bleeding, among others.

Causes of decreased production include iron deficiency, a lack of vitamin B12, thalassemia, and a number of neoplasms of the bone marrow.

Causes of increased breakdown include a number of genetic conditions such as sickle cell anemia, infections like malaria, and certain autoimmune diseases.

Low White Blood Cells

Low white blood cells usually neutropenia meaning low neutrophil count.

Leucopenia (from Greek leucos, meaning 'white', and pe (penia), meaning 'deficiency') is a decrease in the number of white blood cells (leucocytes) found in the blood, which places individuals at increased risk of infection.

Neutropenia, a subtype of leucopenia, refers to a decrease in the number of circulating neutrophil granulocytes, the most abundant white blood cells. The terms leucopenia and neutropenia may occasionally be used interchangeably, as the neutrophil count is the most important indicator of infection risk. This should not be confused with agranulocytosis.

Low white cell count may be due to acute viral infections, such as a cold or influenza. It has been associated with chemotherapy, radiation therapy, myelofibrosis, aplastic anemia (failure of white cell, red cell and platelet production), stem cell transplant, bone marrow transplant, HIV, AIDS, and steroid use.

Many medications can cause neutropenia.

Low Platelets

Thrombocytopenia or low platelet count is a condition characterized by abnormally low levels of thrombocytes, also known as platelets, in the blood.

A normal human platelet count ranges from 150 to 450 platelets per litre of blood. These limits are determined by the 2.5th lower and upper percentile, so values outside this range do not necessarily indicate disease.

One common definition of thrombocytopenia requiring emergency treatment is a platelet count below 50 per litre.

Thrombocytopenia usually has no symptoms and is picked up on a routine full blood count.

Some individuals with thrombocytopenia may experience external bleeding such as nosebleeds, and/or bleeding gums.

Some women may have heavier or longer periods or breakthrough bleeding.

Bruising, particularly purpura in the forearms and petechiae in the feet, legs, and mucous membranes, may be caused by spontaneous bleeding under the skin.

The most common is immune thrombocytopenic purpura or idiopathic thrombcytopenic purpura (ITP).

Many drugs can cause thrombocytopenia.

Thrombosis & Embolism

 

Deep Vein Thrombosis (DVT)

Deep vein thrombosis (DVT), is the formation of a blood clot in a deep vein, most commonly the legs.

Symptoms may include pain, swelling, redness, or warmth of the affected area.

About half of cases have no symptoms.

Complications may include pulmonary embolism, as a result of detachment of a clot which travels to the lungs, and post-thrombotic syndrome.

Risk factors include recent surgery, cancer, trauma, lack of movement, obesity, smoking, hormonal birth control, pregnancy and the period following birth, antiphospholipid syndrome, and certain genetic conditions. Genetic factors include deficiencies of antithrombin, protein C, and protein S, and factor V Leiden mutation.

The underlying mechanism typically involves some combination of decreased blood flow rate, increased tendency to clot, and injury to the blood vessel wall.

Individuals suspected of having DVT may be assessed using a clinical prediction rule such as the Wells score. A D-dimer test may also be used to assist with excluding the diagnosis or to signal a need for further testing.

Diagnosis is most commonly confirmed by ultrasound of the suspected veins. Together, DVT and pulmonary embolism are known as venous thromboembolism (VTE).

Anticoagulation (blood thinners) is the standard treatment. Typical medications include low-molecular-weight heparin, warfarin, or a direct oral anticoagulant.

Wearing graduated compression stockings may reduce the risk of post-thrombotic syndrome.

Prevention may include early and frequent walking, calf exercises, aspirin, anticoagulants, graduated compression stockings, or intermittent pneumatic compression.

The rate of DVTs increases from childhood to old age; in adulthood, about one in 1000 adults are affected per year. About 5% of people are affected by a VTE at some point in time.

 

Pulmonary embolism (PE)

Pulmonary embolism (PE) is a blockage of an artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream (embolism).

Symptoms of a PE may include shortness of breath, chest pain particularly upon breathing in, and coughing up blood.

Symptoms of a blood clot in the leg may also be present such as a red, warm, swollen, and painful leg.

Signs of a PE include low blood oxygen levels, rapid breathing, rapid heart rate, and sometimes a mild fever. Severe cases can lead to passing out, abnormally low blood pressure, and sudden death.

PE usually results from a blood clot in the leg that travels to the lung.

The risk of blood clots is increased by cancer, prolonged bed rest, smoking, stroke, certain genetic conditions, estrogen-based medication, pregnancy, obesity, and after some types of surgery.

A small proportion of cases are due to the embolization of air, fat, or amniotic fluid.

Diagnosis is based on signs and symptoms in combination with test results.

If the risk is low a blood test known as a D-dimer will rule out the condition. Otherwise a CT pulmonary angiography, lung ventilation/perfusion scan, or ultrasound of the legs may confirm the diagnosis.

Together deep vein thrombosis and PE are known as venous thromboembolism (VTE).