What do Students Need to Know About Diagnostic Haematology

1
What do Students Need to Know About Diagnostic
Haematology?

• Barbara Bain

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How to take a clinical history

• No special skills but need to be able to identify
  
• History of significant bleeding
• History of thrombosis
• History suggestive of haemolysis
• Symptoms suggestive of lymphoma
• Symptoms suggestive of sickle cell disease
• Symptoms suggestive of immune deficiency
• Need to be able to take a dietary history and a
  drug/alcohol/smoking history

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How to elicit a family history

• Knowledge of different form of inheritance and
  ability to elicit a family history of a possible
  haematological condition
• Knowledge of ethnic prevalence of important
  haematological disorders and ability to identify
  ethnic origin

4
How to examine a patient

• Ability to perform a thorough and accurate
  physical examination, in particular to be able to
  identify and describe
• Pallor
• Lymphadenopathy
• Splenomegaly
• Hepatomegaly
• Petechiae, ecchymoses and bruises
• Skin infiltration

5
How to interpret a full blood count

• Be able to explain normal range and reference
  range
• Knowledge of what abbreviations mean (WBC, RBC,
  Hb, MCV, MCH, MCHC)
• Ability to identify and interpret abnormalities
  in the blood count
• Ability to identify and interpret a high and low
  reticulocyte count and the presence of
  polychromasia
• Ability to explain all the terms commonly used to
  describe abnormalities in a blood film

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How to interpret a full blood count

• Knowledge of approximate normal range for WBC,
  Hb, MCV and platelet count in Caucasian adults
• Ability to recognize
• Neutrophil, eosinophil, basophil, monocyte,
  lymphocytes
• Ability to recognize
• Microcytosis, macrocytosis, hypochromia,
  spherocytosis, sickle cells

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How to interpret a full blood count

• Ability to explain the significance of
• Left shift, toxic granulation, atypical
  lymphocytes, leucoerythroblastic film
• Ability to suggest the significance of blast cells

8
Ability to take a blood sample for haematological
tests

• Knowledge of which bottles are used for
• FBC
• Coagulation screen
• Vitamin B12 and folate assays
• Blood transfusion specimens
• Ability to take a blood sample from a patient
• Using a needle and syringe
• Using evacuated tubes

9
Ability to synthesize information

• Ability to integrate information from history,
  physical examination and preliminary blood tests
  to make a provisional diagnosis or differential
  diagnosis
• Ability to plan further investigation and develop
  a management plan
• Ability to recognize a clinically urgent
  situation (e.g. acute leukaemia, DIC, high grade
  lymphoma, acute haemolysis)

10
Ability to recognize and investigate common or
otherwise important conditions

• Iron deficiency anaemia
• Anaemia of chronic disease
• Megaloblastic anaemia
• Sickle cell anaemia
• Hereditary spherocytosis
• G6PD deficiency

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Ability to recognize and investigate common or
otherwise important conditions

• Autoimmune haemolytic anaemia
• Autoimmune thrombocytopenic purpura

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Ability to recognize and investigate common or
otherwise important conditions

• Explain why sickle cell trait matters and how it
  is recognized
• Explain how a and ß thalassaemia are recognized
  and why they matter

13
Knowledge of the nature and significance,
diagnostic features and principles of management
of major haematological neoplasms

• Acute lymphoblastic leukaemia
• Acute myeloid leukaemia
• Polycythaemia vera (including differential
  diagnosis)
• Essential thrombocythaemia
• Chronic myelogenous leukaemia

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Knowledge of the nature and significance,
diagnostic features and principles of management
of major haematological neoplasms

• Primary myelofibrosis
• Hodgkin lymphoma
• Non-Hodgkin lymphoma
• Multiple myeloma

15
Ability to suspect rare but important conditions

• Thrombotic thrombocytopenic purpura
• Haemophilia

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What does the student NOT need to know?

• When to suspect and how to diagnose rare
  conditions that are unlikely to require emergency
  diagnosis, e.g.
• Paroxysmal nocturnal haemoglobinuria
• Dyskeratosis congenita