Buku Medicine

High haemoglobin

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Low haemoglobin

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High MCV

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Low MCV

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High B12

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High platelets

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Low platelets

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High white cell count

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High neutrophils

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Low neutrophils

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High lymphocytes

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Low lymphocytes

Quick tip; HIV is the most significant cause of lymphopenia, and otherwise often has little clinical significance

Lymphopenia is almost always due to reversible causes and a count of over 0.5 x 109/L is rarely of clinical significance.

Common causes

  • Bacterial infection
  • Increased age
  • HIV infection
  • Autoimmune disease e.g rheumatoid arthritis
  • Drugs; chemotherapy e.g immunosuppressants, alcohol 
  • Congenital immunodeficiency syndrome
  • Bone marrow disease e.g  lymphoma, myelodysplastic syndrome (uncommon, especially in the absence of other cytopenias)

Workup

  • History for above risk factors and examination for organomegaly or lymphadenopathy
  • Repeat full blood count in 2-3 months with blood film
  • HIV screen
  • Autoimmune screen
  • Serum immunoglobulins

If lymphopenia is mild (>1 x109/L) and remains stable over a 6-12 month period with no other indicators of underlying disease then no specialty referral is needed as there would be no treatment for it and it does not confer a clinical risk. Persistent lymphopenia of <1 x109/L would merit further investigation as above and referral to the appropriate medical specialty

Lymphopenia is incredibly common in clinical practice and haematological causes for it are rare therefore referral to haematology is only recommended if there is other evidence to support underlying haematological problems like other cytopenias (e.g suspected MDS) or symptoms or signs in keeping with lymphoma (weight loss, fevers, sweats, lymphadenopathy)

Links:   BMJ (requires subscription)  

High eosinophils

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High monocytes

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High ferritin

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Paraprotein

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Elevated light chains

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