Peripheral Blood Film in MRCP(2)

Peripheral Blood film in MRCP(2)

I told you a few basic terms used in haematology in my previous post. Today, I will talk about a few common and popular blood films that are commonly asked in MRCP Part 1 and 2.

1) Sickle Cell disease

( Blood film of sickle cell, polychromasia and target cell)

By far, I think this the most popular blood film in MRCP. Remember that patients with sickle cell may present with bone pain ( due to bone necrosis), osteomyelitis, leg ulcers or even iron overload. Remember that it is one of the important causes of chronic haemolysis anaemia, therefore, you might find pallor with jaundice in patients with Sickle Cell Disease. However, remember that you may not find splenomegaly ( although you anticipate splenomegaly in patients with chronic haemolysis) because there is a possibility of splenic infarct!!

( Patient presents with painful bony infarction)

2) Thalassemia

This disease needs no further explanation. I have seen so many Thalassemic patients during my paediatric posting when I was a medical student.

Look at the following blood film,

( Blood film showing hypochromic, microcyctic red cells)

You may be given a photo of patient with classical thalassemic facies and you are expected to know about types of Thalassemia, chromosome involved and complications!

3) Malaria

OK, if you are living in UK or Ireland, you may not seen a case of malaria in your whole life. However, malaria is endemic in tropical countries including Malaysia and Thailand. You may still remember that there are various species of Plasmodium such as P.falciparum, P.vivax and P.ovale. Anyway, remember that in your MRCP, they always show you the ring form!

Infectious Disease in MRCP- Leptospirosis

Infectious Disease in MRCP-Leptospirosis

OK, I told you before a few common infections which are popular in MRCP examination. These infections include HIV, Tuberculosis, Infective endocarditis. Today, we are going to discuss another common infection which is popular if you are sitting MRCP Part 1 and 2 examination.

Yes, Leptospirosis is important because it is the most wide spread zoonosis caused by Gram-negative organism Leptospira interrogans. It is harboured by wide varities of animals but mainly by rats. Therefore, anyone exposed and has contact with animals, animal products ( like rats’ urine) or soil/water contaminated with leptospiras may get the infection.

Recreational activities like swimming, rafting, canoeing in contaminated rivers/lakes may expose someone to leptospiras.

Signs and symptoms of Leptospirosis

Always remember that patients always go through biphasic course during the illness. Phase 1 ( about 1 week) is considered as febrile/septicaemic phase where patients experience with high fever and non specific symptoms such as myalgia, headache, diarrhoea, arthralgia. ( symptoms that are common in viral infections)

During the second phase (4- 30 days), patients go through what is considered as immune phase where they may have aseptic meningitis, acute renal failure,pulmonary haemorrhage, myocarditis, liver failure ( therefore you may find jaundice) and ARDS.

Investigations

Always check FBC, LFT ( ALT usually mildly elevated), CK which may be raised due to carditis or muscle break down.
Remember that Leptospira can be cultured from blood or CSF during the first week of illness and from urine from 2-4 weeks of illness ( popular question in MRCP). However, diagnosis is usually confirmed by serology.

Complications
Acute renal failure ( common during immune phase), ARDS, DIVC

Treatment

IV penicillin or ceftrixaone or doxycyline for mild disease.