Hematologic diseases

Chapter 4

Hematologic diseases

14 topics

  1. 57Iron deficiency anemiaIron deficiency is the commonest cause of anaemia in the world. This page covers anaemia in general (how it is defined, what it does to the body and how the red cell indices sort it), iron metabolism, the causes of iron deficiency and who needs endoscopy, the tests and their traps, oral and intravenous iron, and the other microcytic anaemias.
  2. 58Macrocytic and megaloblastic anemiasA macrocytic anaemia has large red cells. In megaloblastic anaemia, the commonest important kind, a lack of vitamin B12 or folate slows DNA synthesis in the marrow. This page covers how the two vitamins are absorbed and used, the causes of their deficiency, the blood, marrow and nervous system in B12 deficiency, the tests, treatment and its dangers, and the large red cells without megaloblasts.
  3. 59Haemolytic anemias. HemolysisAnaemia from red cells destroyed before their time, inside the vessels or in the spleen and liver; how blood and urine tests prove haemolysis, how the film and the direct antiglobulin test sort its many causes, and how each inherited and acquired form is treated today.
  4. 60Aplastic anemia. AgranulocytosisFailure of the bone marrow, and the loss of neutrophils that makes it lethal; how acquired aplastic anaemia, an immune attack on the stem cells, is told apart from its mimics and graded, how transplantation and immunosuppression treat it, and how drug-induced agranulocytosis and febrile neutropenia are recognised and handled as emergencies.
  5. 61Hodgkin’s diseaseA B-cell lymphoma, mostly of young adults, in which a few large Hodgkin and Reed–Sternberg cells live among many reactive immune cells; how it presents, how a biopsy and PET-CT set its stage and risk group, and why most patients are cured but are followed for life for the late effects of treatment.
  6. 62Non-Hodgkin’s lymphomasAll the lymphomas other than Hodgkin, a family of B-, T- and NK-cell cancers that run from slow and incurable to fast and curable; how they are classified and caused, how they present and are staged, and how the commonest are treated today.
  7. 63Chronic lymphocytic leukemiaThe commonest leukaemia of adults in Europe, a slow build-up of small, long-lived B cells that is often found by chance on a blood count. How it is recognised and staged, why most patients are watched rather than treated, and how BTK and BCL2 inhibitors have replaced chemotherapy.
  8. 64Myeloma multipleA cancer of marrow plasma cells that make one useless antibody. The plasma cell disorders from MGUS to myeloma, the CRAB and SLiM criteria, the four emergencies, and treatment with anti-CD38 quadruplets, transplant and T-cell therapies.
  9. 65Chronic myelogenous leukemiaA myeloproliferative neoplasm caused by one fusion gene, BCR::ABL1, and often found on a routine blood count: how tyrosine kinase inhibitors, steered by a quantitative PCR, gave patients a near-normal life expectancy, and when treatment can be stopped.
  10. 66Polycythemia veraA clonal excess of red cells driven by JAK2, whose main danger is thrombosis: how to tell it from the far commoner secondary polycythaemia, the WHO criteria, treatment by venesection, aspirin and cytoreduction, and its sister neoplasms essential thrombocythaemia and myelofibrosis.
  11. 67Acute myeloid leukemiaThe commonest acute leukaemia of adults, in which myeloid blasts fill the marrow within weeks. This page also holds what every acute leukaemia shares (how it presents, the first tests and the emergencies), then how genetics and fitness decide treatment, with acute promyelocytic leukaemia as an emergency of its own.
  12. 68Acute lymphocytic leukemia (ALL) in adults.Acute lymphoblastic leukaemia in adults, a cancer of B or T lymphoblasts that is the commonest cancer of childhood but harder to cure with every decade of age. This page covers what sets it apart from acute myeloid leukaemia, the Philadelphia chromosome, and how residual disease, antibodies and CAR-T cells have changed treatment.
  13. 69Hemorrhagic diathesis – normal hemostasis. Thrombocytopenia – classification. Immune thrombocytopenia.How bleeding normally stops and how its first half, the platelet plug, fails, with the kinds of bleeding disorder, a low platelet count sorted by its cause, immune thrombocytopenia in depth, and the causes that must not be missed.
  14. 70Hemorrhagic diathesis – normal hemostasis. HemophiliaHow the clotting factors make fibrin and how the laboratory tests them, then haemophilia A and B, the X-linked lack of factor VIII or IX, from joint bleeds to factor replacement, emicizumab, the newer drugs and gene therapy, with von Willebrand disease and acquired haemophilia in the differential.