Basophil
Basophil
Basophils
• Least numerous cells in peripheral blood• Large dark purple granules which obscure nucleus
• Increased in myeloproliferative disorders
Thrombocytopenia
• Decreased production
• Increased destruction/consumption– ITP– DIC– HUS / TTP
• Hypersplenism
• Dilution (post transfusion)
History in Bleeding Tendency
• Onset of bleeding
• Nature of bleeding
• Drugs used
• Family history
• Spontaneous or following trauma
Evaluation of Bleeding (1)
Thrombocytopenia
• Spontaneous bleeding (platelets < 10 X 109/l)• Mucosal bleeding (epistaxis, gum bleeding)• Ecchymoses and petechiae
Evaluation of Bleeding (2)
Clotting factor deficiency
• Bleeding after surgery (dental extraction, circumcision)
• Bleeding into joints or muscles• Delayed bleeding• Family history
Evaluation of Bleeding (3)
Patient who is bleeding with a normal platelet count and normal coagulation screen:
Do bleeding time/PFA‐100
Platelet function defectVon Willebrand disease, aspirin
Erythrocyte sedimentation rate (ESR)
• Measures the rate of fall of a column of red cells in plasma in 1 hour
• Determined by plasma concentration of proteins
• Raised in anaemia• Non specific indicator of disease activity• ↑ ESR – infection, inflammation, malignancy, pregnancy
Westergren ESR
Bone marrow aspirate
Immunophenotyping (Flow Cytometry)
Translocation
Karyotype showing t(9;22)
Evidence of Clonality
• Differentiates reactive from neoplastic conditions
• Evidence of clonality:– Recurring cytogenetic abnormality e.g. Ph+– Light chain restriction i.e. kappa or lambda– IgH gene rearrangement– T‐cell receptor gene rearrangement