Table of Contents
Preface xi
1 Physiology of the Blood and Bone Marrow 1
Blood Cells and Their Functions 1
Bone Marrow Cells and Normal Haemopoiesis 7
Conclusions 19
2 The Blood Count and Film 20
The Full Blood Count 20
The Differential White Cell Count 24
Haematological Terminology 25
Normal Ranges and Reference Ranges 26
How to Interpret a Blood Count and Develop a Differential Diagnosis 36
The Erythrocyte Sedimentation Rate 40
Conclusions 40
3 Microcytic Anaemias and the Thalassaemias 41
Introduction 41
Iron Deficiency Anaemia 43
Anaemia of Chronic Disease 49
The Thalassaemias 52
Other Causes of Microcytic Anaemia 60
Conclusions 61
4 Macrocytic Anaemias 63
Introduction 63
Vitamin B12 Deficiency 65
Folic Acid Deficiency 70
Other Causes of Macrocytosis 72
Conclusion 76
5 Haemoglobinopathies and Haemolytic Anaemias 77
Introduction 78
Mechanisms of Haemolysis 81
Diagnosis of Haemolysis 82
The Haemoglobinopathies 83
Red Cell Membrane Defects 93
Defects in the Glycolytic Pathway 97
Defects in the Pentose Shunt 97
Immune Haemolytic Anaemias 100
Microangiopathic Haemolytic Anaemia 101
Conclusions 101
6 Miscellaneous Anaemias, Pancytopenia and the Myelodysplastic Syndromes 104
Normocytic Normochromic Anaemia and Other Miscellaneous Anaemias 104
Pancytopenia 107
The Myelodysplastic Syndromes 112
Conclusions 119
7 Leucocytosis, Leucopenia and Reactive Changes in White Cells 121
Leucocytosis 121
Conclusions 130
8 Leukaemias and Lymphomas 133
The Nature of Leukaemia and Lymphoma 133
Principles of Treatment 142
Acute Lymphoblastic Leukaemia 146
Acute Myeloid Leukaemia 151
Chronic Myelogenous Leukaemia 158
Non-Hodgkin Lymphoma 166
Hodgkin Lymphoma 178
Conclusions 180
9 Polycythaemia, Thrombocytosis and the Myeloproliferative Neoplasms 182
The Nature of the Myeloproliferative and Myelodysplastic/Myeloproliferative Neoplasms 182
Polycythaemia 184
Thrombocytosis 190
Bone Marrow Fibrosis 193
Myelodysplastic/Myeloproliferative Neoplasms 197
Conclusions 199
10 Multiple Myeloma 201
Introduction 201
Multiple Myeloma 202
Monoclonal Gammopathy of Undermined Significance 213
Other Conditions Associated with Paraproteinaemia 214
Conclusions 216
11 Platelets, Coagulation and Haemostasis 217
Overview of Haemostasis 217
In Vitro Coagulation 222
Limitation of Coagulation and Fibrinolysis 222
Assessment of Coagulation Status 224
Inherited Coagulation Defects 230
Acquired Defects of Coagulation 233
Thrombocytopenia 237
Defective Platelet Function 242
Conclusions 243
12 Thrombosis and Its Management - Anticoagulant, Antiplatelet and Thrombolytic Therapy 245
Haemostasis and Thrombosis 245
Thrombophilia 248
The Need for Anticoagulant and Antiplatelet Therapy 250
Non-Pharmacological Means of Reducing Venous Thromboembolism 250
Parenteral Anticoagulants 251
Antiplatelet Agents 257
Thrombolytic Therapy 259
Antithrombotic Management of Specific Conditions 260
Conclusions 262
13 Blood Transfusion and Haemopoietic Stem Cell Transplantation 263
Blood, Blood Products and Blood Components for Transfusion 263
Recruitment, Screening and Testing of Blood Donors 267
Major Blood Group Systems 267
Tests Done in a Blood Transfusion Laboratory 274
The Indications for Blood Transfusion 276
The Adverse Effects of Transfusion 280
How Blood Transfusion Can Be Made Safer 281
Bone Marrow and Other Haemopoietic Stem Cell Transplantation 282
Conclusions 285
14 Things You Have to Know Before You Graduate 287
How to Take a Clinical History 288
How to Perform a Physical Examination 289
How to Request Laboratory Tests 290
How to Interpret Laboratory Tests 290
How to Prescribe Blood Components 291
How to Prescribe and Monitor Anticoagulant Therapy 291
When to Suspect a Haematological Disorder and How to Recognise a Haematological Emergency 291
How to Acquire Information You Do Not Have 292
How to Relate to a Patient 293
Conclusions 293
15 Further Reading 294
General 294
1 Physiology of the Blood and Bone Marrow 295
2 The Blood Count and Film 295
3 Microcytic Anaemias and the Thalassaemias 295
4 Macrocytic Anaemias 295
5 Haemoglobinopathies and Haemolytic Anaemias 296
6 Miscellaneous Anaemias, Pancytopenia and the Myelodysplastic Syndromes 297
7 Leucocytosis, Leucopenia and Reactive Changes in White Cells 297
8 Leukaemias and Lymphomas 297
9 Polycythaemia, Thrombocytosis and the Myeloproliferative Neoplasms 298
10 Multiple Myeloma 298
11 Platelets, Coagulation and Haemostasis 299
12 Thrombosis and Its Management - Anticoagulant, Antiplatelet and Thrombolytic Therapy 299
13 Blood Transfusion and Stem Cell Transplantation 300
14 Things You Have to Know Before You Graduate 300
16 Preparing for Examinations and Self-Assessment 301
Preparing for Exams 301
Self-Evaluation Questions 302
Basic Multiple Choice Questions 302
Single Best Answer Multiple Choice Questions 307
Extended Matching Questions 311
Answers to Questions 318
Basic Multiple Choice Questions 318
Single Best Answer Multiple Choice Questions 320
Extended Matching Questions 322
17 Answers to Test Cases 323
Test Case 3.1 323
Test Case 4.1 323
Test Case 5.1 324
Test Case 5.2 324
Test Case 6.1 325
Test Case 7.1 325
Test Case 7.2 325
Test Case 8.1 325
Test Case 8.2 326
Test Case 9.1 326
Test Case 10.1 327
Test Case 11.1 327
Test Case 11.2 327
Test Case 12.1 327
Test Case 13.1 328
Index 329