Clinical Haematology |
E13
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Frequently Asked Questions
Advice for GPs:
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Advice has highlighted a number of frequently asked questions including;
How to interpret low B12 results
Dr Knechtli has just completed a new and comprehensive review of B12 deficiency which acts as a reference and also contains a useful algorithm for managing these patients.
When to do thrombophilia testing and how to interpret the results
Recent guidelines suggest that indiscriminate testing of unselected patients with a single episode of VTE is not indicated and that the management of these patients should be the same with or without a thrombophilia. Testing of asymptomatic relatives of a patient with a low risk thrombophilia such as Factor V Leiden is also not indicated. A full summary of the latest thrombophilia guidelines is available at: http://www.bcshguidelines.com.
What does a low lymphocyte count mean?
Lymphopenia is very common as part of an acute response to stress although it is often overshadowed by coexisting changes in neutrophils. When the lymphocyte count falls to below 0.5 x 109/l it is worth considering HIV. Remember any form of steroids including endogenous steroids will result in a lymphopenia.
What to do about a low neutrophil count?
It is particularly important when looking at the neutrophil count to remember that Africans and Afro-Caribbean's have neutrophil counts lower than Caucasians. An automated low neutrophil count should always be confirmed on a blood film as it maybe factitious. In many cases the cause of neutropenia is apparent from the history, however if in doubt we are happy to discuss.
What is the difference between a polyclonal and monoclonal gammopathy?
A monoclonal gammopathy is the increased production of one type of immunoglobulin by a single clone of cells. The abnormal protein is called a paraprotein and can be composed of whole immunoglobulin molecules or light chains only. This occurs in myeloma, lymphoproliferative disorders, and occasionally chronic inflammatory or immune-mediated diseases.
A polyclonal gammopathy or a hypergammaglobulinemia resulting from an increased production of several different immunoglobulins is usually attributable to persistent, high level exposure to antigens and occurs in a wide variety of infectious, inflammatory, and immune-mediated diseases and is not an indicator of a haematological malignancy.
If you need any advice concerning haematology results, managing a patient with a haematology problem or just whether you should be referring a patient to clinic , contact us via Consultant Connect