Verfügbarkeit: Diagnostic hematology

Diagnostic hematology:

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Bibliographische Detailangaben
1. Verfasser:	Beck, Norman (VerfasserIn)
Format:	Buch
Sprache:	English
Veröffentlicht:	London Springer 2009
Schlagworte:	Blood > Diseases > Diagnosis Hematologic Diseases > diagnosis Hematology Blutuntersuchung
Online-Zugang:	Inhaltsverzeichnis
Beschreibung:	XXX, 488 S. Ill., graph. Darst.
ISBN:	1848002823 9781848002821

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245	1	0	\|a Diagnostic hematology \|c Norman Beck
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300			\|a XXX, 488 S. \|b Ill., graph. Darst.
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Datensatz im Suchindex

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adam_text	Contents 1 Preliminary Concepts ........................................................................................... 1 Modern Hematology in Context ......................................................................... 1 The Broad Types of Hematological Disease and Their Tests .............................. 3 Blood Diseases Characterized Essentially by Changes in the FBC ................. 3 Diseases Characterized Essentially by Changes in the Hemostatic Screen ...... 4 Problems and Limitations Found in Practice ...................................................... 4 Nomenclature ...................................................................................................... 5 Basophilia ....................................................................................................... 5 Polycythemia and Erythrocytosis ................................................................... 6 Pancytopenia .................................................................................................. 7 Conventions Adopted ......................................................................................... 7 A Brief Overview of the Contents ....................................................................... 8 Further Reading .................................................................................................. 8 2 Blood Diseases and Their Diagnosis (1)................................................................ 9 The Nature of the Blood System ......................................................................... 9 The Hematological System Is a Balanced System ......................................... 12 The Basic Pathology of the Hematological System ........................................... 14 The Pathology of the Blood Cell Sub-system (Clinical View) ....................... 15 Types of Pathological Abnormality Affecting the Blood Cell Sub-system ........ 15 Disorders of the Plasma ................................................................................ 15 Quantitative Disorders of Production of Blood Cells ................................... 15 Qualitative Disorders of Blood Cells ............................................................ 17 Disorders of Circulating Blood Cells ............................................................ 18 Disorders of Hemoglobin ............................................................................. 20 The Nature of the First-Line Tests in Hematology ........................................... 21 A Brief Look at Laboratory Tests, with Particular Reference to the First-Line Tests in Hematology .............................................................. 21 The First-Line Tests .......................................................................................... 22 Understanding the FBC ................................................................................ 22 The Constituents of the FBC and Their Clinical Significance ....................... 23 The Red Cells ............................................................................................... 23 The White Cell Series ........................................................................................ 24 The Platelets ...................................................................................................... 24 The Role of Blood Film Morphology ............................................................... 24 Case#l .............................................................................................................. 25 The Subcomponent Red Cell Circulations ........................................................ 27 Essential Nutrients Required by the Blood System ....................................... 27 Contents A Word of Warning Regarding Some Serum Levels ......................................... 29 Hemostasis and the Hemostatic Screen ............................................................. 30 The Three Anatomical Elements (or Groups of Elements) ........................... 32 The Three Procoagulant Processes .................................................................... 33 The Initiation of Hemostasis ......................................................................... 33 The Control of Local Thrombin Levels ........................................................ 36 Destruction of Fibrin and Clotting Factors Outside the Area of Injury ....... 37 Clot Retraction and Dissolution ................................................................... 37 Thrombin Production and Its Control .............................................................. 38 An Integrated View of Hemostasis .................................................................... 39 The Role of the Flow of Blood in Hemostasis ................................................... 41 The Hemostatic Screen ...................................................................................... 41 The Components of the Hemostatic Screen .................................................. 42 The Bleeding Time and the Platelet Count ........................................................ 42 The PT and PTT ........................................................................................... 43 The Thrombin Time ..................................................................................... 44 Fibrinogen .................................................................................................... 44 The Pathology of the Hemostatic System (Clinical View) ................................. 44 The Functional Outline of the Hemostatic System ....................................... 44 Types of Pathological Abnormality Affecting the Hemostatic Sub-system .................................................................................................... 44 The Pathogenesis of Disorders of Hemostasis ................................................... 45 Pathological Bleeding ........................................................................................ 45 Defects in the Procoagulant Mechanisms .......................................................... 45 Defects in Mechanisms Controlling Hemostasis ............................................... 47 Pathological Thrombosis .................................................................................. 47 Summary ........................................................................................................... 48 Exercise 2.1 A Quick Self-Test ...................................................................... 49 Exercise 2.2................................................................................................... 49 Answers ........................................................................................................ 50 Further Reading ................................................................................................ 50 References ......................................................................................................... 50 Blood Diseases and Their Diagnosis (2).............................................................. 51 The Nature and Value of Laboratory Tests in Hematology .............................. 51 Normal and Normal Ranges ...................................................................... 53 Variation, Uncertainty of Measurement, Reliability, and Quality Control ....... 54 Specimen Management ..................................................................................... 55 Environmental and Physiological Causes of Pre-analytic Variation ............. 57 Analytic (Laboratory) Variation ....................................................................... 58 Limitations of Tests: Clinical Epidemiology ..................................................... 60 The Operating Characteristics of Tests ............................................................. 61 Positive and Negative Predictive Values and Likelihoods ............................. 63 Deciding on the Normality / Abnormality of a Result ................................. 65 The Single Isolated Abnormal Result ........................................................ 65 The Single Isolated Normal Result ............................................................ 66 One Abnormal Result in a Set of Tests Done at (More or Less) the Same Time .............................................................................................. 67 More Than One Abnormal Result in a Set of Tests .................................. 67 Normal and Abnormal Results of Analytes at Different Times ............. 67 Algorithms ........................................................................................................ 68 Discussion of Fig. 3.5 with Critical Comments ............................................. 69 The Logical Generation of the Provisional Diagnosis ....................................... 70 Probability and Inference .................................................................................. 70 Case #2.............................................................................................................. 71 Contents Common Methods of Generating Pre-test Hypotheses ..................................... 72 The Use of Heuristics in Generating Pre-test Hypotheses ............................. 72 The Final Diagnosis .......................................................................................... 74 Evidence-Based Medicine (EBM) ...................................................................... 74 Summary ........................................................................................................... 76 Exercise 2.1................................................................................................... 78 Exercise 2.2................................................................................................... 78 References ......................................................................................................... 79 Further Reading ................................................................................................ 79 4 Clinical Interactions Between the Blood and the Other Systems .......................... 81 The Physiological Response to Acute Hemorrhage and the Effects ontheFBC ........................................................................................................ 81 Thrombocytosis ............................................................................................ 82 Neutrophilia ................................................................................................. 82 Anemia ......................................................................................................... 83 Reticulocytosis .............................................................................................. 83 The Physiological Response to Hypoxia and the Effects on the Full Blood Count .............................................................................................. 83 The Raised Hematocrit ..................................................................................... 84 Splenectomy and Hyposplenism ........................................................................ 85 Hyposplenism ............................................................................................... 85 Clinical Interactions with Other Systems .......................................................... 86 The Immune System, Infections, and Blood Diseases ....................................... 86 Immunohematology ...................................................................................... 87 The Basis of the Antiglobulin Test (Coombs) ............................................... 88 The Autoimmune Hemolytic Anemias (AIHA) ............................................ 88 Drug-Induced Hemolytic Disease ................................................................. 88 Autoimmune Diseases and the Blood: Other Aspects ................................... 88 HIV/AIDS, Primarily from the Hematological Perspective .......................... 89 Other Infectious Diseases and the Blood ...................................................... 90 The Cardiovascular System and Blood Diseases ............................................... 92 The Gastro-intestinal Tract (GIT) and Blood Disease ...................................... 92 Bleeding ........................................................................................................ 93 Diverticular Disease ...................................................................................... 94 Gastro -intestinal Surgery and Its Complications .............................................. 94 Gastric Surgery ............................................................................................. 94 Intestinal Surgery .......................................................................................... 95 Functional Deficiencies ................................................................................. 95 Liver and Biliary Disease .............................................................................. 95 The Pancreas ................................................................................................. 97 Malabsorption and the Malabsorption Syndromes ...................................... 97 Miscellaneous Conditions ........................................................................... 102 The Skin and Blood Diseases .......................................................................... 103 The Genito-urinary System and Blood Diseases ............................................. 107 Pregnancy and Changes in the Blood .............................................................. 107 The Musculo-skeletal System and Blood Diseases .......................................... 109 The Endocrine System and Blood Diseases ..................................................... 110 The Nervous System and Blood Diseases ........................................................ Ill The Respiratory System and Blood Diseases .................................................. Ill The Respiratory Gas Path at Rest and at Sea Level ................................... 112 The Nature of the Flow of Blood and Its Relevance to Tissue Oxygénation ..................................................................................... 114 The Diffusion of Oxygen from the Hemoglobin Molecule Through the Endothelium ............................................................................................... 116 Contents Diffusion from the Endothelium Through the Interstitium to the Tissue Cell ................................................................................................... П7 Oxygen Carriage and Transport ................................................................. 118 Other Lung Conditions of Relevance to Blood Disease .................................. 123 The Hematology of Malignant Disease ........................................................... 123 Blood Loss in Malignant Disease ............................................................... 123 Metastatic Spread to Bones ........................................................................ 123 Microangiopathic Hemolysis ...................................................................... 123 Disseminated Intravascular Coagulation (DIC) ......................................... 124 Hypercoagulable States ............................................................................... 124 The Erythrocyte Sedimentation Rate (ESR) ................................................... 124 Other Activity Tests ........................................................................................ 125 Summary ......................................................................................................... 125 General Pathophysiological Processes ........................................................ 125 Clinical Interactions of the Blood with Other Systems ............................... 126 A Final Word! ................................................................................................. 126 Exercise 4.1................................................................................................. 127 Exercise 4.2................................................................................................. 127 Answers ...................................................................................................... 127 Further Reading .............................................................................................. 128 References ....................................................................................................... 128 5 The Principles of Diagnosis and the Clinical Examination ................................ 129 The Nature of Traditional Clinical Diagnosis ................................................. 129 The Pathological Diagnosis in Blood Diseases ................................................ 132 The General Pathology Diagnosis .............................................................. 133 The Special Pathology Diagnosis ................................................................ 134 Statistical Methods of Diagnosis: Bayes Theorem ..................................... 135 A Note About Testing in Hematology .................................................... 137 How to Suspect that a Patient Has a Blood Disease ....................................... 137 Symptoms Volunteered by or Elicited from the Patient that Suggest a Blood Disease ............................................................................. 137 Signs Found on Inspection that Suggest a Blood Disease ........................... 138 The Clinical History ........................................................................................ 138 Constitutional and General ........................................................................ 139 Neurological, Mental, and Psychological Symptoms .................................. 139 Cardiovascular, Respiratory, and Performance Status ............................... 140 Skin, Bone, Muscles, and Joints .................................................................. 141 Gastrointestinal and Nutritional History .................................................... 141 Previous Medical and Surgical History ....................................................... 143 Ethnic, Geographical, and Travel History .................................................. 144 Family History ............................................................................................ 145 Drugs, Previous Therapies, Habits ............................................................. 145 Occupational History .................................................................................. 146 Bleeding and Thrombosis ........................................................................... 146 The Clinical Examination ................................................................................ 147 The General Examination ............................................................................... 148 Hands and Wrists ....................................................................................... 151 Upper Arm, Axilla ...................................................................................... 152 Head and Neck ........................................................................................... 152 Face, Mouth, and Eyes ............................................................................... 154 The Thorax ................................................................................................. 155 The Abdomen and Pelvis ............................................................................ 155 The Lower Limbs ........................................................................................ 156 The Nervous System ................................................................................... 156 Contents The Assessment of Lymphadenopathy ............................................................ 157 Clinical Evaluation of Enlarged Lymph Nodes .......................................... 157 The Clinical Examination in the Bleeding Disorders ....................................... 158 What Features Can Suggest that Bleeding Is Pathological? ........................ 159 Hemarthrosis .............................................................................................. 160 The Acute, Very Painful Swollen Joint (Essentially a Monoarthritis) ......... 160 Acute on Chronic Hemarthrosis ................................................................. 161 Massive Bruising After Inappropriately Small Trauma .............................. 161 Acute Muscle and Soft Tissue Bleeds .......................................................... 161 Raccoon Eyes (Periorbital Bleeding) ........................................................... 161 Laceration of the Frenum of the Tongue or Lower Lip .............................. 161 Multiple Hemangiomata ............................................................................. 161 Liver Disease .............................................................................................. 161 Disseminated Intravascular Coagulation (DIC) ......................................... 162 Other Hematological Diseases with Bleeding .............................................. 162 Miscellaneous Presentations ....................................................................... 162 Other Characteristic Clinical Features ........................................................ 163 Common Clinical Patterns in Blood Diseases ............................................. 163 An Application of the Epidemiological Approach .......................................... 165 The Operating Characteristics of the Hb Test ............................................. 166 Summary ......................................................................................................... 167 A Final Word .................................................................................................. 167 Exercise 5.1................................................................................................. 168 Exercise 5.2................................................................................................. 168 Answers ...................................................................................................... 168 References ....................................................................................................... 168 Further Reading .............................................................................................. 169 A Practical Approach to the FBC and Hemostatic Screen ................................ 171 The Full Blood Count: Summary of the Approach ......................................... 171 How to Make the Anatomical Diagnosis .................................................... 172 Making the General Pathology Diagnosis ....................................................... 173 The Master-set of General Pathology Causes of Anatomical Diagnoses Made from the FBC Findings ................................................... 174 Making the General Pathology Diagnosis: an Example .............................. 174 Clinical Input in Diagnosis (of the FBC) Summarized .................................... 177 Making the Specific Diagnosis .................................................................... 178 The Final Diagnosis .................................................................................... 178 The Integrated Assessment .............................................................................. 178 A Note on Morphology Comments ................................................................ 182 The Report May Be a Semi-quantitative List of Certain Observations Made Microscopically ..................................................................................... 184 A Note on the Use of Elements of the FBC in Isolation ............................. 184 The Hemostatic Screen in Practice .................................................................. 185 How to Make the First-Stage Diagnosis ..................................................... 185 The General Pathology Diagnosis ................................................................... 186 The Master-set of General Pathology Causes of First-Stage Diagnoses in the Bleeding Disorders ............................................................................ 186 Deficient/Defective Procoagulant Production (Platelet Numbers) .............. 186 Deficient/Defective Procoagulant Production (Platelet Defect) .................. 187 Deficient/Defective Procoagulant Production (Vitamin K-Dependent Coagulation Factors) .................................................................................. 187 Deficient/Defective Procoagulant Production (Other Coagulation Factors) ..........................................-........................................................... 187 Deficients Defective Procoagulant Production (Combinations) ................... 187 Contents Abnormal Consumption of Procoagulant Factors ...................................... 187 Defects in Vascular Structure or Function .................................................. 187 The Special Pathology (Specific) Diagnosis ..................................................... 187 Case #8 (Tables 6.5 and 6.6)............................................................................ 188 The Bone Marrow Aspiration and Report ...................................................... 190 The Peripheral Blood Concentration of Cells ............................................. 191 Case #10.......................................................................................................... 193 Case #11.......................................................................................................... 194 Case #12.......................................................................................................... 194 A Summary of Indications and Contra-Indications to Marrow Studies .......... 195 Indications for bone marrow aspiration and/or trephine biopsy. (Adapted from EBMG database еЬтООЗОб/Оіб.ООІ.) ................................ 195 Exercise 6.1................................................................................................. 197 Exercise 6.2................................................................................................. 197 Answers ...................................................................................................... 197 Further Reading .............................................................................................. 197 Anemia: General Considerations ...................................................................... 199 The Classification of the Anemias ................................................................... 200 The Epidemiology of Anemia ......................................................................... 201 Diagnostic Problems and Presentations in Anemia ......................................... 201 The Clinical Examination in Cases of Suspected Anemia or Obvious Pallor .. 201 Differentiating Clinical Features ..................................................................... 202 The Assessment of the Severity of Anemia ...................................................... 203 Anemia, Hypoxia, and Cyanosis ..................................................................... 203 Bone Marrow Failure and Anemia ................................................................. 203 Clinical Aspects of the Laboratory Diagnosis of Anemia ............................... 204 Using the Average Cell Size (i.e., MCV) Diagnostically .................................. 205 Anisocytosis and the Raised RDW ................................................................. 205 The Effect of Developing Iron Deficiency on the RDW, MCV, and Hb .... 205 The Effect of Developing Folate Deficiency on the RDW, MCV, andHb ........................................................................................................ 206 Other Causes of a Rise in RDW ................................................................. 206 Case #13. Examine Table 7.4.......................................................................... 206 The Physiological Response to Anemia and the Effects on the Full Blood Count .............................................................................................................. 206 The Response of the Micro-circulation to Anemia ..................................... 207 The Response of the Heart to Anemia ........................................................ 207 The Response of the Lungs to Anemia ....................................................... 208 The Response of the Bone Marrow to Anemia ........................................... 208 An Introduction to the Operating Characteristics of Tests in Patients with Anemia or Pallor ..................................................................................... 210 The Diagnosis of Anemia ........................................................................... 211 The Characterization of the Type of Anemia .............................................. 211 Screening for Certain Common Hereditary Blood Diseases ....................... 212 Confirmatory Tests in Cases of Anemia ..................................................... 212 Exercise 7.1................................................................................................. 213 Exercise?^ ................................................................................................. 213 Answers ...................................................................................................... 213 Optional Advanced Reading ........................................................................... 213 Further Notes on the MCV, MCH, MCHC, RDW, and Anisocytosis ....... 213 A Dynamic, Risk-Aware View of Blood Diseases, Primarily the Anemias ............................................................................................... 217 References ....................................................................................................... 218 Further Reading .............................................................................................. 218 Contents xix 8 Microcytosis: The Microcytìc Anemias ............................................................ 219 Defining Microcytosis ..................................................................................... 219 The General Pathology Causes of Microcytosis .............................................. 219 Deficient Uptake of Iron into the Developing Normoblasts Required for the Formation of Heme ......................................................... 219 FBC Features of Hb-Deficient Red Cells .................................................... 220 Features in Other Laboratory Tests ............................................................ 220 Common Clinical Features ......................................................................... 220 Specific Causes of Microcytosis ...................................................................... 220 Iron Deficiency ........................................................................................... 221 Anemia of Chronic Disorders (ACD) ......................................................... 223 Thalassemia ................................................................................................ 224 Making the Diagnosis ..................................................................................... 225 Clinically Obvious or Suggestive Cases ....................................................... 226 Clinically Undefined Cases ......................................................................... 226 Combined Iron Deficiency and Anemia of Chronic Disorders ................... 228 Combined Iron Deficiency and Thalassemia .............................................. 228 Combined Iron Deficiency and Folate or Vitamin B)2 Deficiency .............. 228 Teaching Cases ................................................................................................ 229 Case #14 (Tables 8.2 and 8.3).......................................................................... 229 Case #15 (Examine Tables 8.4 and 8.5)........................................................... 230 Case #16 (Examine Table 8.6)......................................................................... 231 Case #17 (Examine Tables 8.7 and 8.8)........................................................... 232 Case #18 (Tables 8.9 and 8.10)........................................................................ 233 Case #19 (Tables 8.11 and 8.12)...................................................................... 233 Exercise Cases ................................................................................................. 235 Case #20 (Table 8.14)...................................................................................... 235 Questions .................................................................................................... 235 Answers ...................................................................................................... 235 Case #21 (Table 8.17)...................................................................................... 236 Questions .................................................................................................... 236 Answers ...................................................................................................... 236 Case #22 (Examine Tables 8.18 and 8.19)....................................................... 237 Questions .................................................................................................... 237 Answers ...................................................................................................... 238 Further Questions ....................................................................................... 238 Optional Advanced Reading ........................................................................... 239 Rarer Causes of a Microcytic or Hypochromic Red Cell Picture .................... 239 Classification of the Sideroblastic Anemias ................................................ 239 The Anemia of Chronic Disorders Revisited .............................................. 240 Advanced Notes on the Tnalassemias ......................................................... 240 The Pathophysiology of ß-Thalassemia...................................................... 241 Further Reading .............................................................................................. 244 References ....................................................................................................... 244 9 Macrocytosis: The Macrocytic Anemias ........................................................... 245 Defining Macrocytosis .................................................................................... 245 The General Pathology Causes of Macrocytosis ............................................. 245 Specific Causes of Macrocytosis ...................................................................... 245 Making the Diagnosis ..................................................................................... 246 Clinically Obvious or Suggestive Cases ....................................................... 247 Clinically Undefined Cases ......................................................................... 247 (Spurious) Macrocytosis Caused by Autoagglutination.................................. 247 The Megaloblastic Blood Picture .................................................................... 247 The Non-megaloblastic Macrocytic Blood Picture .......................................... 248 Contents The Blood Pictures of Aplasia and Reticulocytosis ......................................... 249 The Complete Brief Pseudoalgorithmic Approach to Macrocytosis ............... 249 Teaching Cases ................................................................................................ 250 Case #23 (Tables 9.1 and 9.2).......................................................................... 250 Case #24 (Table 9.5)........................................................................................ 252 Case #25 (Table 9.8)........................................................................................ 253 Exercise Case ................................................................................................... 253 Case #26 (Table 9.9)........................................................................................ 253 Questions ........................................................................................................ 254 Answers ........................................................................................................... 254 Questions ........................................................................................-·............... 254 Answers ........................................................................................................... 255 Further Reading .............................................................................................. 255 10 The Normocytic Anemias ................................................................................. 257 Defining Normocytosis ................................................................................... 257 The General Pathology Causes of a Normocytic Anemia ............................... 257 The Specific Causes of a Normocytic Anemia ................................................. 257 Endocrine Deficiencies ................................................................................ 257 Renal Anemia ............................................................................................. 258 Post-hemorrhagic Anemia .......................................................................... 258 Anemia of Chronic Disorders (ACD) ......................................................... 259 Combinations of Megaloblastic Anemia with Iron Deficiency or ACD ..... 259 Bone Marrow Infiltration or Replacement ................................................. 259 Hemolytic Anemias ..................................................................................... 259 Hypersplenism ............................................................................................ 260 The Distinction Between Hypersplenism and Hemolysis ............................ 260 Making the Diagnosis ..................................................................................... 260 Clinically Obvious or Suggestive Cases ....................................................... 261 Clinically Undefined Cases ......................................................................... 261 Teaching Cases ................................................................................................ 262 Case #27 (Examine Table 10.1)....................................................................... 262 Case #28 (Tables 10.3 and 10.4)...................................................................... 263 Case #29 (Tables 10.5 and 10.6)...................................................................... 264 Case #30 (Examine Table 10.7)....................................................................... 265 Case #31 (Examine Table 10.9)....................................................................... 266 Exercise Case ................................................................................................... 268 Case #32 (Table 10.10).................................................................................... 268 Questions .................................................................................................... 268 Answers ...................................................................................................... 268 Further Questions ....................................................................................... 268 Answers ...................................................................................................... 269 Case #33 (Table 10.13).................................................................................... 270 Questions .................................................................................................... 270 Answers ...................................................................................................... 270 Questions .................................................................................................... 270 Answers ...................................................................................................... 270 Questions .................................................................................................... 270 Answers ...................................................................................................... 271 Further Reading .............................................................................................. 271 11 Thrombocytopenia ........................................................................................... 273 Defining Thromboeytopenia ........................................................................... 273 The General Pathology Causes of Thrombocytopenia .................................... 273 Specific Causes of Isolated Thrombocytopenia ............................................... 273 Contents Disseminated Intravascular Coagulation .................................................... 274 Prosthetic Intravascular Devices ................................................................. 274 Extracorporeal Circulation ......................................................................... 274 Micro-vascular Disease ............................................................................... 274 Drug-Induced Thrombocytopenia .............................................................. 275 Thrombocytopenia Due to Infections ......................................................... 275 Alloimmune Thrombocytopenia ................................................................. 275 Autoimmune Thrombocytopenia ............................................................... 275 Making the Diagnosis ..................................................................................... 276 Platelet-Associated Antibody Testing ......................................................... 278 Diagnosis and Principles of Management of ITP ........................................ 278 Teaching Cases ................................................................................................ 279 Case #34 (Examine Table 11.1)....................................................................... 279 Case #35 (Table 11.3)...................................................................................... 280 Further Reading .............................................................................................. 282 12 Leukopenia ...................................................................................................... 283 Defining Leukopenia ....................................................................................... 283 Generalized Leukopenia .................................................................................. 283 Neutropenia .................................................................................................... 283 General Pathology Causes of Neutropenia ................................................. 283 Specific Causes of Neutropenia .................................................................. 285 Making the Diagnosis in a Case of Neutropenia ............................................. 287 The Clinical Examination ........................................................................... 288 Lymphopenia .................................................................................................. 290 Secondary Lymphopenia ................................................................................. 291 Teaching Cases ................................................................................................ 291 Case #36 (Examine Table 12.1)....................................................................... 291 Case #37 (Examine Table 12.2)....................................................................... 291 Case #38 (Examine Table 12.3)....................................................................... 292 Exercise Case ................................................................................................... 294 Case#39 (Table 12.5)...................................................................................... 294 Questions .................................................................................................... 294 Answers ...................................................................................................... 294 Reference ........................................................................................................ 295 Further Reading .............................................................................................. 295 13 Pancytopenia and Bicytopenia .......................................................................... 297 Defining Pancytopenia .................................................................................... 297 General Causes of Pancytopenia ................................................................. 298 Specific Causes of Pancytopenia ................................................................. 298 Making the Diagnosis ................................................................................. 300 Clinically Suggestive Presentations ............................................................. 300 Teaching Cases ................................................................................................ 300 Case #40 {Table 13.2)....................................................................................... 300 Case #42. (Examine Table 13.8)...................................................................... 302 Case #42 (Examine Table 13.9)....................................................................... 303 Case #43 (Table 13.11).................................................................................... 304 Exercise Cases ................................................................................................. 305 Case #44 (Examine Table 13.12)..................................................................... 305 Questions .................................................................................................... 305 Answers ...................................................................................................... 305 Further Questions ....................................................................................... 305 Answers ...................................................................................................... 306 xxii____________________________________________________________________________________________________Contents Further Questions ....................................................................................... 306 Answers ...................................................................................................... 306 Case #45 (Tables 13.15 and 13.16).................................................................. 306 Questions .................................................................................................... 307 Answers ...................................................................................................... 307 Further Question ........................................................................................ 307 Answer ........................................................................................................ 307 Further Reading .............................................................................................. 308 14 Thrombocytosis ................................................................................................ 309 Defining Thrombocytosis and Thronibocythemia ........................................... 309 The Anatomical Diagnosis .......................................................................... 309 The General Pathology Causes ................................................................... 309 Specific Causes of Thrombocytosis ................................................................. 310 Acute Hemorrhage ..................................................................................... 310 Acute Hemolysis ......................................................................................... 310 Splenectomy ................................................................................................ 310 Hyposplenism ............................................................................................. 311 Spurious Thrombocytosis ........................................................................... 311 Making the Diagnosis ..................................................................................... 311 Clinical Presentation ................................................................................... 311 The Clinical Examination ........................................................................... 312 Optional Advanced Reading ........................................................................... 313 Teaching Cases ................................................................................................ 313 Case #46.......................................................................................................... 313 Case #47 (Examine Table 14.1)....................................................................... 313 Case #48 (Examine Table 14.2)....................................................................... 313 Case #49 (Examine Table 14.3)....................................................................... 314 Exercise Case ................................................................................................... 315 Case #50 (Table 14.4)...................................................................................... 315 Questions .................................................................................................... 315 Answers ...................................................................................................... 315 Further Readings ............................................................................................ 316 15 The Leukocytoses ............................................................................................. 317 Defining Leukocytosis ..................................................................................... 317 Example #1 (Table 15.1)................................................................................. 318 Example #2 (Table 15.2)................................................................................. 319 Example #3 (Table 15.4)................................................................................. 319 Example #4 (Examine Table 15.5)................................................................... 319 The Approach to a Raised White Cell Count ............................................. 320 General Investigations in the Leukocytoses ................................................ 321 General Leukocytosis ................................................................................. 322 Making the Diagnosis in a Case of General Leukocytosis .............................. 322 Neutrophilia .................................................................................................... 323 Associated Features in the FBC That May Occur with Neutrophilia ......... 324 The General Causes of Neutrophilia ........................................................... 324 The Reactive and Physiological Causes of Neutrophilia ............................. 324 Infective Causes of Neutrophilia ................................................................. 325 Inflammatory Causes of Neutrophilia ...............,........................................ 326 Malignancies as Causes of Neutrophilia ..................................................... 326 Making the Diagnosis in a Case of Neutrophilia ............................................ 326 To Summarize the Laboratory Investigations ................................................. 327 Representative Clinical Presentations ............................................................. 327 Contents Monocytosis .................................................................................................... 328 Making the Diagnosis in Monocytosis ........................................................ 328 Lymphocytosis ................................................................................................ 328 Associated Features in the FBC That May Occur with Lymphocytosis ..... 329 The General Causes of Lymphocytosis ....................................................... 329 Making the Diagnosis in a Case of Lymphocytosis .................................... 330 Representative Clinical Presentations ......................................................... 331 Eosinophilia .................................................................................................... 332 Mild Eosinophilia ....................................................................................... 332 Moderate Eosinophilia ............................................................................... 333 Severe Eosinophilia ..................................................................................... 333 Parasitoses and Eosinophilia ...................................................................... 333 Making the Diagnosis in a Case of Eosinophilia ........................................ 334 Mild and Moderate Eosinophilia ................................................................ 335 Severe Eosinophilia ..................................................................................... 335 Basophil Leukocytosis ..................................................................................... 336 Unusual Causes of Leukocytosis ................................................................ 336 The Acute Leukémiás ...................................................................................... 337 Lymphoblastic Leukémiás .......................................................................... 337 Non-lymphoblastic Leukémiás ................................................................... 337 High-Grade Lymphomas in a Leukemie Phase ........................................... 337 Features in Other Tests ............................................................................... 338 The Chronic Leukémiás .................................................................................. 338 Chronic Lymphocytic Leukemia (CLL) ...................................................... 338 Chronic Myelocytic Leukemia (CML) ........................................................ 339 Making the Diagnosis ................................................................................. 340 Teaching Cases ................................................................................................ 340 Case #51.......................................................................................................... 340 Case #52 (Table 15.8)...................................................................................... 340 Case#53 (Table 15.10)..................................................................................... 341 Case #54 (Table 15.11).................................................................................... 342 Case#55 (Table 15.12).................................................................................... 342 Case #56 (Table 15.13).................................................................................... 343 Case #57 (Table 15.14).................................................................................... 343 Case #58 (Table 15.16).................................................................................... 344 Case #59 (Table 15.17).................................................................................... 345 Case #60 (Examine Table 15.18).................................................................... 345 Case # 61 (Table 15.20)................................................................................... 347 Case #62 (Tables 15.22 and 15.23).................................................................. 348 Exercise Cases ................................................................................................. 349 Case #63 (Tables 15.24 and 15.25).................................................................. 349 Questions .................................................................................................... 349 Answers ...................................................................................................... 349 Further Developments ................................................................................ 349 Questions..... ............................................................................................... 349 Answers ...................................................................................................... 350 Case #64 (Examine Table 15.27)..................................................................... 350 Questions .................................................................................................... 350 Answers ...................................................................................................... 351 Questions .................................................................................................... 351 Answers ....................................,................................................................. 352 Optional Advanced Reading ........................................................................... 352 Neutrophilia ,.............................................................................................. 352 Monocytosis .................................................................................................... 353 The FAB Classification of the Acute Leukémiás ............................................. 353 >odv ___________________________________________________________________________________________________________ Contente Reference ........................................................................................................ 354 Further Reading .............................................................................................. 354 16 Polycythemia ................................................................................................... 355 Defining Polycythemia .................................................................................... 355 General Causes of Polycythemia ..................................................................... 355 Chronic Myeloproliferative Disease ............................................................ 355 FBC Features .............................................................................................. 355 Features in Other Laboratory Tests ............................................................ 355 Common Clinical Features ......................................................................... 356 Specific Causes of Polycythemia ..................................................................... 356 Classical Polycythemia Vera (i.e., with All Three Cell Lines Increased) ...... 356 Increased Circulating Cortisol or Cortisol-Like Hormones ........................ 357 Dehydration ................................................................................................ 357 Making the Diagnosis ..................................................................................... 357 The Clinical Examination ........................................................................... 357 Differentiating the Possible Causes ................................................................. 357 Atypical Presentations ..................................................................................... 360 Teaching Cases ................................................................................................ 360 Case #65 (Table 16.1)...................................................................................... 360 Treatment of Polycythemia Vera and Its Effects ............................................. 362 Case #66 (Tables 16.4, 16.5, and 16.6)............................................................. 363 Case #67 (Examine Table 16.7)....................................................................... 364 Case #68 (Examine Table 16.9)....................................................................... 365 Optional Advanced Reading ........................................................................... 366 The Formal Definition of Polycythemia Vera............................................. 366 Further Causes of Polycythemia ................................................................. 366 The Natural History of PV (in the Absence of Thrombosis) ....................... 366 Management Issues, Complications, and Their Effect on the FBC ............. 367 Exercise Cases ................................................................................................. 369 Case#69 (Table 16.11).................................................................................... 369 Questions .................................................................................................... 369 Answers ...................................................................................................... 369 Subsequent Course ..................................................................................... 369 Comments ................................................................................................... 370 Case #70 (Examine Table 16.12)..................................................................... 370 Questions .................................................................................................... 370 Answers ...................................................................................................... 371 Further Reading .............................................................................................. 371 17 Erythrocytosis .................................................................................................. 373 Defining Erythrocytosis .................................................................................. 373 Dehydration .................................................................................................... 373 Gaisboçk Syndrome, Often Known as Apparent Erythrocytosis (and Previously Called Stress Polycythemia) .............................................. 373 Hypoxia .......................................................................................................... 374 Inappropriate Secretion of Erythropoietin ...................................................... 376 Early Polycythemia Vera................................................................................. 376 Making the Diagnosis ..................................................................................... 376 ЕРО Levels ..........................................,...................................................... 377 Teaching Cases ................................................................................................ 378 Case #71 (Examine Table 17.1).......................................................] ......... 378 Case #72 (Table 17.3)....................................................................... !ZľZZ 379 Case #73 (Examine Table 17.4)....................................................................... З8О Case #74 (Examine Table 17.6)..........................................................,........... 330 Contents Optional Advanced Reading ........................................................................... 382 Notes in Regard to Erythrocytosis .............................................................. 382 The Effect on Oxygen Transport of Treatment of Polycythemia (and Erythrocytosis) ........................................................................................... 384 Erythrocytosis in Perspective ...................................................................... 384 Advanced Teaching Cases ............................................................................... 384 Case #75 (Table 17.9)...................................................................................... 384 Case #76 (Table 17.13).................................................................................... 385 Exercise Case ................................................................................................... 388 Case #77 (Table 17.19).................................................................................... 388 Questions .................................................................................................... 388 Answers ...................................................................................................... 388 Further Reading .............................................................................................. 389 18 Bleeding Tendency ........................................................................................... 391 Defining Bleeding Tendency ........................................................................ 391 The Anatomical Diagnosis .............................................................................. 391 The General Pathology Diagnosis ................................................................... 391 Coagulation Defect ................................................................................. 392 Purpuric-Type Defect .............................................................................. 393 Mixed Presentation ..................................................................................... 393 The Special Pathology Diagnosis .................................................................... 393 Making the Diagnosis ..................................................................................... 394 Symptoms Suggesting Possible Pathological Bleeding ................................ 394 Signs Suggesting Possible Pathological Bleeding ........................................ 394 The Clinical History .................................................................................... 394 Miscellaneous Causes of or Comments Related to Bleeding Disorders ........... 395 The Clinical Examination of Suspected Bleeding Disorders ............................ 396 The Characteristic Laboratory Features of the Most Important Coagulation-Type Bleeding Disorders ............................................................ 397 Teaching Cases ................................................................................................ 397 Case #78.......................................................................................................... 397 Case #79 (Table 18.9)...................................................................................... 398 Case #80 (Table 18.10).................................................................................... 398 Case #81 (Examine Tables 18.13 and 18.14).................................................... 399 Case #82 (Examine Table 18.15)..................................................................... 399 Case #83 (Examine Tables 18.18 and 18.19).................................................... 400 Case #84 (Examine Tables 18.20 and 18.21).................................................... 401 Case #85 (Tables 18.23 and 18.24).................................................................. 401 Exercise Case ................................................................................................... 403 Case #86 (Tables 18.26 and 18.27).................................................................. 403 Questions .................................................................................................... 403 Answers ...................................................................................................... 403 Further Questions ....................................................................................... 404 Answers ...................................................................................................... 404 Optional Advanced Reading ........................................................................... 404 Hemophilia ..................................................................................................... 404 Acute Hemarthrosis .................................................................................... 404 Muscle Bleeds ............................................................................................. 405 Disseminated Intravascular Coagulation (DIC) ......................................... 406 Further Reading .............................................................................................. 406 19 Transfusion-Related Problems .......................................................................... 407 Complications of Transfusion of Blood Components ..................................... 408 Acute or Early Complications .................................................................... 408 Contents Long-Term Complications .......................................................................... 409 Transfusion Reactions ..................................................................................... 409 Acute Transfusion Reactions ...................................................................... 410 Delayed Transfusion Reactions .................................................................. 411 Components, Their Indications, and Their Dangers ....................................... 411 Whole Blood ............................................................................................... 411 Red Cells ..................................................................................................... 411 Platelets ....................................................................................................... 413 Plasma Components ................................................................................... 414 Patient Monitoring ..................................................................................... 416 Blood Substitutes ............................................................................................ 417 Red Cell Substitutes .................................................................................... 417 Teaching Cases ................................................................................................ 418 Case #87 (Examine Table 19.1)....................................................................... 418 Case #88 (Table 19.2)...................................................................................... 418 Case #89 (Examine Tables 19.4, 19.5, 19.6, and 19.7)..................................... 419 Follow-up (Table 19.8)............................................................................... 420 General Discussion ..................................................................................... 421 Exercise Case ................................................................................................... 422 Case #90 (Table 19.12).................................................................................... 422 Questions .................................................................................................... 422 Answers ...................................................................................................... 422 Questions .................................................................................................... 423 Answers ...................................................................................................... 423 Further Reading .............................................................................................. 423 20 Iron Overload .................................................................................................. 425 Mechanisms of Iron Overload ......................................................................... 425 Pathology and Resultant Clinical Features ................................................. 426 Hemochromatosis ........................................................................................... 426 Etiology ...................................................................................................... 426 Complications ............................................................................................. 426 Clinical Variability in Type I Hemochromatosis ......................................... 426 Teaching Cases ................................................................................................ 427 Case #91 (Table 20.1)...................................................................................... 427 Case #92 (Table 20.7)...................................................................................... 428 Case #93 (Examine Table 20.8)....................................................................... 429 Case # 94 (Table 20.9)..................................................................................... 429 Further Reading .............................................................................................. 431 21 The Hypercoagulable States ............................................................................. 433 The Primary Hypercoagulable States .............................................................. 433 A Note About Proteins С and S ................................................................. 434 A Note About Antithrombin ...................................................................... 434 Secondary Hypercoagulable States ................................................................. 434 The Antiphospholipid Syndrome (APS) ..................................................... 434 Venous Thromboembolic Disease (VTE) ........................................................ 435 Arterial Thrombosis ........................................................................................ 435 Making the Diagnosis ..................................................................................... 436 Making the Diagnosis of Antiphospholipid Syndrome ............................... 436 A Suggested Approach to Suspected Hypercoagulability ........................... 436 Making the Diagnosis of Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) ......................................................................... 437 The FBC in the Hypercoagulable States ..................................................... 438 The Hemostatic Screen in the Hypercoagulable States ............................... 438 Contents xxvii Teaching Cases ................................................................................................ 439 Case #95 (Examine Table 21.1)....................................................................... 439 Case #96 (Examine Table 21.2)....................................................................... 439 Case #97 (Table 21.3)...................................................................................... 440 Further Reading .............................................................................................. 440 22 The Immune Deficiencies and the Immuno-lympho-plasma Proliferative Disorders ......................................................................................................... 441 Immune Deficiencies ....................................................................................... 441 The Lymphomas ............................................................................................. 442 Myeloma and Related Conditions ................................................................... 442 M Proteins Produced Regularly in the Course of a Disease ........................ 442 Making the Diagnosis ..................................................................................... 444 The Clinical Examination ................................................................................ 444 Diagnosis in Practice ....................................................................................... 444 Teaching Cases ................................................................................................ 445 Case #98 (Examine Table 22.1)....................................................................... 445 Case #99 (Examine Table 22.3)....................................................................... 446 Case #100 (Table 22.7).................................................................................... 447 Case #101 (Table 22.8).................................................................................... 448 Further Reading .............................................................................................. 448 23 Complex and Compound Disorders ................................................................... 449 Case #102 (Examine Table 23.1)..................................................................... 450 Case #103 (Table 23.3).................................................................................... 450 Case #104 (Examine Table 23.8)..................................................................... 452 Case #105 (Examine Table 23.11)................................................................... 452 Case #106 (Examine Table 23.12)................................................................... 453 The Iron Overload ...................................................................................... 454 The Blood Pressure ..................................................................................... 455 The Possibility of a Chronic Intracellular Infection .................................... 455 Case #107 Examine Tables #23.17 and #23.18................................................ 456 24 Graded Exercises ............................................................................................. 457 General Hematological Problems .................................................................... 457 Case #108 (Table 24.1).................................................................................... 457 Questions .................................................................................................... 457 Answers ...................................................................................................... 457 Further Questions ....................................................................................... 458 Answers ...................................................................................................... 458 Further Questions ........................................................................................ 458 Answers ...................................................................................................... 458 Case #109 (Table 24.5).................................................................................... 459 Questions .................................................................................................... 459 Answers ....................................................................................................... 459 Further Question ........................................................................................ 459 Answer ........................................................................................................ 459 Case #110 (Examine Table 24.6)..................................................................... 459 Questions .................................................................................................... 459 Answers ...................................................................................................... 460 Question ..................................................................................................... 460 Answer ........................................................................................................ 460 Case # ill (Table 24.8)................................................................................... 460 Questions ..............................................................................................,..... 461 Answers ...................................................................................................... 461 Contents Further Questions ....................................................................................... 461 Answer ........................................................................................................ 461 Further Question ........................................................................................ 461 Answer ........................................................................................................ 461 Case 112 (Examine Tables 24.9 and 24.10)...................................................... 461 Questions .................................................................................................... 461 Answers ...................................................................................................... 461 Further Question ........................................................................................ 462 Answer ........................................................................................................ 462 Advanced Cases .............................................................................................. 462 Case #113 (Examine Tables 24.11 and 24.12).................................................. 462 Questions .................................................................................................... 462 Answers ...................................................................................................... 463 Case #114 (Examine Table 24.13)................................................................... 464 Questions .................................................................................................... 464 Answers ...................................................................................................... 465 Further Investigations .........................:....................................................... 465 Questions .................................................................................................... 465 Answers ...................................................................................................... 465 Case #115 (Table 24.16).................................................................................. 465 Bone Marrow Examination ........................................................................ 466 Questions .................................................................................................... 466 Answers ...................................................................................................... 466 Further Questions ....................................................................................... 466 Answers ...................................................................................................... 467 Further Questions ....................................................................................... 467 Answers ...................................................................................................... 467 Case #116 (Table 24.19).................................................................................. 468 Questions .................................................................................................... 468 Answers ...................................................................................................... 468 Further Questions ....................................................................................... 468 Answers ...................................................................................................... 468 Appendix A: Drags, the First-Line Tests, and Blood Diseases .................................. 469 Aplastic Anemia .............................................................................................. 469 Neutropenia .................................................................................................... 469 Thrombocytopenia .......................................................................................... 470 Hemolytic Anemia .......................................................................................... 470 Miscellaneous .................................................................................................. 470 Appendix B: Likelihood Ratios and the Fagan Nomogram ....................................... 471 Reference ........................................................................................................ 472 Appendix C: Emergency Tests of Hemostasis .......................................................... 473 The Bleeding Time (Duke s) ............................................................................ 473 The Whole Blood Coagulation Time (Lee and White) .................................... 473 Reference ........................................................................................................ 473 Index ....................................................................................................................... 475
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spelling	Beck, Norman Verfasser (DE-588)137962762 aut Diagnostic hematology Norman Beck London Springer 2009 XXX, 488 S. Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Blood Diseases Diagnosis Hematologic Diseases diagnosis Hematology Blutuntersuchung (DE-588)4136583-5 gnd rswk-swf Blutuntersuchung (DE-588)4136583-5 s b DE-604 Erscheint auch als Online-Ausgabe 978-1-84800-295-1 Digitalisierung UB Regensburg application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=017315738&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis
spellingShingle	Beck, Norman Diagnostic hematology Blood Diseases Diagnosis Hematologic Diseases diagnosis Hematology Blutuntersuchung (DE-588)4136583-5 gnd
subject_GND	(DE-588)4136583-5
title	Diagnostic hematology
title_auth	Diagnostic hematology
title_exact_search	Diagnostic hematology
title_full	Diagnostic hematology Norman Beck
title_fullStr	Diagnostic hematology Norman Beck
title_full_unstemmed	Diagnostic hematology Norman Beck
title_short	Diagnostic hematology
title_sort	diagnostic hematology
topic	Blood Diseases Diagnosis Hematologic Diseases diagnosis Hematology Blutuntersuchung (DE-588)4136583-5 gnd
topic_facet	Blood Diseases Diagnosis Hematologic Diseases diagnosis Hematology Blutuntersuchung
url	http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=017315738&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA
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