General Haematology findings and most probable causes

Classification Additional Laboratory Probable Cause

Anaemia Low MCV, High RDW Pencil cells Iron Def anaemia
Microcytic Low Iron + High Ferritin Anaemia of Chronic disease
Mentzer Index < 13 , Family Hx Target cells Haemoglobinopathy
Blood loss
High reticulocytes + Indirect Bili + Hapto. Polychromasia / Fragments Haemolysis
Normocytic
Pregnancy
Low Iron + High Ferritin Anaemia of Chronic disease
Oval macrocytes + low VitB12/Folate Hypersegmented neutrophils Megaloblastic anaemia
Round macrocytes + GGT Macrocytic anaemia / Alcohol
Macrocytic
Medication ARV therapy
High reticulocytes Polychromasia Haemolysis
Coombs + Agglutination Immune (Rh incompatibility) SLE
MCHC high (Exclude Cold Ab) Autoimmune haemolytic anaemia
Coombs - Sperocytes / Elliptocytes HS / HE (Membrane defect)
Haemolytic
Target cells / Sickle cells Hb Electrophoresis
RBC Fragments / Spherocytes DIC
G6PD / Enzyme defect
Polycythaemia Relative High Hct + Normal RCC Dehydration / Diuretics
High RCC + Low O2 saturation Arterial Hypoxemia
Chronic lung disease / Smokers
Secondary
Abnormal LFT, Urea, Creat + High EPO Renal Ca / Liver dysfunction
High EPO Athletes
Primary High WCC + Platelets (Low EPO) JAK2 positive Polycythemia Vera

Thrombocytosis Leucocytosis + Left shift Toxic granulation Acute infection

Anaemia + Low MCV Pencil cells Iron Def anaemia
Reactive /
Anaemia + High MCV Hypersegmented neutrophils Megaloblastic anaemia
Secondary
Medication / exercise
>500 x 10^9/L
Post-splenectomy Howell-Jolly bodies
Lymphadenopathy Lymphomas
Primary Anaemia + splenomegaly JAK2 positive Essential Thrombocytosis
>800 x 10^9/L Leucocytosis + Left shift JAK2 positive CML / Polycythemia Vera
Thrombocytopaenia Anaemia + High MCV Hypersegmented neutrophils Megaloblastic anaemia
Fever + Lymphocytosis Atypical / Activated lymphocytes Varicella / EBV / CMV
<140 x 10^9/L HIV / Autoimmune
Low WCC + Monocytosis + FUO Malaria Antigen positive Malaria
Medication
Prolonged PT, PTT / High D-Dimer RBC Fragments / Spherocytes DIC
<100 x 10^9/L
Normal coagulation Spherocytes ITP
< 20 x 10^9/L High LDH, Bili / Normal coagulation RBC Fragments TTP / HUS

Leukocytosis Acute Band cells (Left shift) Trauma, Infections, Meds

Neutrophilia Chronic Toxic Gran, Vacuole, Dohle, LS Bacterial Infections
Usually WCC > 50 (usually low CRP) **Left Shift (Phil Chr+) CML
Blasts (Auer rods) AML
Activated lymphocytes Viral Infection
Lymphocytosis Large Atypical lymphocytes CMV / EBV / TB
Usually WCC > 50 Smudge cells CLL
Blasts ALL
Chronic TB, Syphilis, Typhoid, malaria
Monocytosis
Chemotherapy + neutropenia Chemotherapy
Acute Asthma, Hay fever, Parasites
Chronic Pulmonary disease
Eosinophilia Atopic dermatitis
Rheumatologic disease
Lymphadenopathy Hodgkins, Lymphoma, HES
Basophilia Hypersensitivity reactions, CML
Leukopaenia Acute Medication / chemotherapy
Neutropaenia Bacterial / Viral Infection
Chronic MDS / HIV / PNH / SLE
Lymphopaenia HIV / Aplasia / Renal Failure
Monocytopaenia Hairy Cell Leukemia
High MCV Hypersegmented neutrophils Megaloblastic anaemia
Normal MCV Toxic granulation Infection
Pancytopaenia Myelodysplasia Hypo granular/seg Neutrophil MDS
Binucleated erythrocytes
Blasts Leukemia