Blood Film in MRCP(1)

Peripheral Blood Film in MRCP(1)

Certainly before your MRCP Part 1 and 2, you need to know a very important topic in haematology, you are right, many candidates have the tendency to go to the examination without knowing anything about blood film.

You must know a few popular blood films in MRCP, before we proceed to revise a few important blood films, I think you must remember these useful terms here,

1) AniSocytosis- Variation in Size.
2) Poikilocytes- Variation in shaPe
3)

Basophilic stippling of RBCs is seen in lead poisoining, thalassemia and other dyserythropoetic anaemias

( Image over the left with arrow)

4) Blasts- Nucleated precursors cells
5) Howell Jolly bodies- Nuclear remnants seen in in RBCs especially in post splenectomy
6) Leukaemoid reaction- A marked reactive leucocytosis
7) Left shift- Immature white cells seen in circulating blood
8) Right shift- Hypersegmented polymorphs ( Image below)

9) Rouleaux formation- Red cells stack on each other
10) Target cells RBCs with central staining, a ring of pallor and an outer rim

Spondyloarthropathies in MRCP (2)

Spondyloarthropathies in MRCP (2)

I talked about Spondyloarthropathies ( Ankylosing spondylitis) in my previous post. In MRCP Part 1 and 2, there are a few more conditions you should know because these conditions are very popular.

1) Reiter’s syndrome

Remember the triad of conjunctivitis, urethritis and arthritis. This was described by Hans Reiter in 1916.

Reactive arthritis is triggered following enteric or urogenital infections. Reactive arthritis is associated with human leukocyte antigen (HLA)–B27, although HLA-B27 is not always present in an affected individual.

Bacteria associated with reactive arthritis are generally enteric or venereal and include the following:, Salmonella typhimurium, Salmonella enteritidis, Streptococcus viridans, Mycoplasma pneumonia, Cyclospora, Chlamydia trachomatis, Yersinia enterocolitica, and Yersinia pseudotuberculosis.

Remember that always suspect this in young patients who come in with large mono- or oligoarthritis especially knee pain.

Other features of this syndrome include Keratoderma blenorrhagica

( a popular image in MRCP, brown, aseptic abscesses on soles and palms)), iritis, mouth ulcers, enthesopathy ( plantar fascitis, Acgilles tendinitis) and aortic regurgitation ( rare)

You may do imaging such as , however, Plain radiography - May show no abnormalities early in the disease

Asymmetric, oligoarticular, and more common in the lower extremities pattern of joint involvement
Juxta-articular osteoporosis in acute episodes of arthritis - Erosions have indistinct margins and are surrounded by periosteal new bone.
Spinal pattern - Unilateral or bilateral sacroiliitis, asymmetric paravertebral comma-shaped ossification involving the lower thoracic and upper lumbar vertebrae

Treatment: bed rest and NSAID

2) Psoriatic arthropathy

Kindly visit PassPACES.com for further discussion

3) Enteropathic spondylitis

Always suspect this if patient has bowel symptoms ( diarrhoe and weight loss) and large mono- or oligo-arthropathy. However, remember as well that peripheral arthritis ( small joints) may be involved but it is rare!