HOW TO INTERPRET YOUR BLOODWORK Saturday, April 18, 2020 Cyrus C. - - PowerPoint PPT Presentation

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HOW TO INTERPRET YOUR BLOODWORK Saturday, April 18, 2020 Cyrus C. - - PowerPoint PPT Presentation

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HOW TO INTERPRET YOUR BLOODWORK Saturday, April 18, 2020 Cyrus C. Hsia, HBSc, MD, FRCPC Associate Professor of Medicine Program Director of the Hematology Training Program Schulich School of Medicine and Dentistry, Western University Associate

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HOW TO INTERPRET YOUR BLOODWORK

Saturday, April 18, 2020 Cyrus C. Hsia, HBSc, MD, FRCPC Associate Professor of Medicine Program Director of the Hematology Training Program Schulich School of Medicine and Dentistry, Western University Associate Medical Director, Blood Transfusion Laboratory London Health Sciences Centre

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  • Presenting from London, Ontario

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OBJECTIVES

  • Outline of presentation: The end of the presentation, the audience will be

able to..

  • Describe and evaluate the parts of a complete blood count (CBC)
  • Describe myelodysplastic syndromes (MDS)
  • *COVID-19 & MDS
  • Discuss questions on blood tests and what their results mean

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Our bodies are made of cells and more cells..

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The easiest way to collect a sample of your blood cells is to take a blood sample. A laboratory technologist (sometimes referred to as a phlebotomist) will draw a blood sample from your arm. Blood is collected in a test tube and sent to the local laboratory for testing. We are going to talk about the complete blood count (CBC)

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The complete blood count

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What is blood made of?

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This is an example of a complete blood count (CBC) and a white cell differential

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This is an example of a complete blood count (CBC) and a white cell differential

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This is the CBC This is the white cell differential

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The complete blood count doesn’t measure everything. Notice that it does not contain other tests of the blood such as iron levels, kidney function, liver function, thyroid function, sugar levels, cholesterol, calcium, electrolytes.. These other tests are for another discussion and followed by various physicians.

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This is the CBC This is the white cell differential

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What is a reference range? How do we come up with this?

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Patient Results Reference Range

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Let’s talk about height as an example You have to decide to cut off the range somewhere..

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Reference Ranges for each lab value is determined by each individual lab based on their reagents and “normal” controls.

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Patient Results Reference Range

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What are white blood cells?

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White blood cells (WBC) are also called leukocytes (LKC).

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White blood cells are also called leukocytes (LKC) There are many different types of white blood cells that have different functions.

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What do white blood cells do? These cells are primarily for fighting infections and has a role in inflammation.

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WBC or LKC is part of the complete blood count (CBC) WBC is made up of a number of different white blood cells provided in the white cell differential

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This is the CBC This is the white cell differential

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What do these white cells do?

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This is the white cell differential

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What do these white cells do? If these blood cells are too low you can have these problems. Note: Low neutrophils is called (neutropenia). You may have been told this in clinic that if you have neutropenia to watch for fevers.

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  • Neutrophils
  • fight bacteria, fungi
  • Lymphocytes
  • fight viruses
  • Monocytes
  • help fight infections, can migrate to other tissues to

engulf infections and debris

  • Eosinophils
  • help fight larger parasites, part of allergic response
  • Basophils
  • release histamine, part of inflammatory response
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What are red blood cells?

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Red blood cells (RBC) are also called erythrocytes ERC is the erythrocyte count

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There are different measures that involve red blood cells such as hemoglobin, hematocrit, MCV and RDW.

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Hemoglobin molecules are essential.. They carry

  • xygen in the red blood

cells.

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Hemoglobin molecules are essential.. They carry

  • xygen in the red blood

cells.

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Anemia means low hemoglobin.

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Hematocrit is the volume of blood occupied by red blood cells.

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MCV = mean cell volume. This is the average size of red blood cells. RDW = red cell distribution

  • width. This is how variable

the size of red cells are.

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What are platelets?

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Platelets are also called thrombocytes

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Function to form a clot along with clotting factors

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Low platelets lead to easy bleeding and bruising

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The factory..

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Where do all of our blood cells come from?

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This is the factory that makes all of our blood cells..

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In the bone marrow factory, all of our blood cells come from a stem cell. Stem cells divide and grow and eventually become these different blood cells.

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This is how we take a bone marrow sample..

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This is how we take a bone marrow sample..

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All blood cells come from the bone marrow factory.

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What is MDS?

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MYELODYSPLASTIC SYNDROMES

  • Definition
  • Myelodysplastic syndromes (MDS) form a group of clonal

hematopoietic stem cell malignancies characterized by ineffective hematopoiesis in one or more cell lineages, associated peripheral cytopenias, and risk of transformation to acute myeloid leukemia

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Sloand EM. Myelodysplastic syndromes: introduction. Semin Hematolo. 2008;45:1-2. Valent P, Horny HP, Bennett JM, et al. Leuk Res 2007;31:72-36.

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  • Dr. Robert Barr and the Ford Pinto

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MYELODYSPLASTIC SYNDROMES

  • In other words..
  • MDS is a group of blood and bone marrow disorders

(cancers) where the blood cells are made with defects and don’t survive as long as it should.

  • This leads to low blood counts in 1 or more of the blood cells.
  • It is NOT leukemia, but can be considered pre-leukemic.
  • It is NOT 1 disease and behaves differently in different

people.

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HOW COMMON IS MDS?

  • Actual incidence very difficult to determine
  • Approx 3-4 per 100,000, much more common in elderly, approx

1 in 1000

  • Median age at diagnosis 65 – 70 years

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World Health Organization Classification of Tumours. Pathology & Genetics: Tumours of Haematopoietic and Lymphoid Tissues. Edited by Elaine S. Jaffe, Nacy Lee Harris, Harald Stein, James W. Vardiman. IARC Press Lyon 2001. Silverman, LR. Modulation of the Clone: Altering the Course of Myelodysplastic Syndrome. Blood & Bone Marrow Transplantation Reviews 2006; 16(3):5-8.

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WHAT CAUSES MDS?

  • Causes?
  • idiopathic (meaning we don’t know)
  • can be secondary to toxic exposures such as chemotherapy,

radiation, environmental toxins

  • may be associated with some hereditary disorders but MDS in

general is NOT hereditary

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World Health Organization Classification of Tumours. Pathology & Genetics: Tumours of Haematopoietic and Lymphoid Tissues. Edited by Elaine S. Jaffe, Nacy Lee Harris, Harald Stein, James W. Vardiman. IARC Press Lyon 2001. Silverman, LR. Modulation of the Clone: Altering the Course of Myelodysplastic Syndrome. Blood & Bone Marrow Transplantation Reviews 2006; 16(3):5-8.

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  • Patient
  • Poor quality of life - time and commitment to transfusions
  • Complications of Iron Overload
  • Cardiorespiratory symptoms
  • Hospitalizations for cardiac complications, infections, bleeding,

increased risk of leukemic transformation

  • Increased risk of shorter survival
  • Society
  • Transfusion burden
  • Hospitalizations for cardiac complications, infections, complications of

iron overload, bleeding, leukemia

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MANAGEMENT FOR MDS PATIENTS

  • The mainstay of management is supportive
  • Transfusions, antibiotics
  • No specific transfusion threshold, rather patient dependent based on level of

hemoglobin associated with symptoms of anemia

Steensma DP and Bennett JM. The Myelodysplastic Syndromes: Diagnosis and Treatment. Mayo Clin Proc. 2006;81(1):104-130.

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TREATMENTS IN MDS

  • It depends on the type of MDS you have and how fit you are
  • Lower risk MDS
  • Transfusions and other supportive care
  • Erythropoietin (EPO) – if your body is not producing enough
  • Iron chelation therapy – if you have too much iron from transfusions
  • Revlimid (lenalidomide) – if you have the 5q deletion
  • Higher risk MDS
  • Transfusions and other supportive care
  • Stem Cell Transplant - Reserved for the “younger” patient with severe disease
  • Vidaza (azacytidine) – For patients who can come to the cancer centre 7 days

every 28 days

Steensma DP and Bennett JM. The Myelodysplastic Syndromes: Diagnosis and Treatment. Mayo Clin Proc. 2006;81(1):104-130.

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Bone marrow factory - The future

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What does it mean in patients with MDS?

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  • Coronaviruses are a large family of viruses. Some cause illness in people and
  • thers cause illness in animals. Human coronaviruses are common and are

typically associated with mild illnesses, similar to the common cold.

  • COVID-19 is a new disease that has not been previously identified in humans.

Rarely, animal coronaviruses can infect people, and more rarely, these can then spread from person to person through close contact.

  • Human coronaviruses cause infections of the nose, throat and lungs. They are

most commonly spread from an infected person through:

  • respiratory droplets generated when you cough or sneeze
  • close, prolonged personal contact, such as touching or shaking hands
  • touching something with the virus on it, then touching your mouth, nose or eyes before

washing your hands

  • Current evidence suggests person-to-person spread is efficient when there is

close contact.

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https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus- infection/symptoms.html?topic=ex-col-faq#a

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  • A pneumonia of unknown cause detected in Wuhan, China was first

reported to the WHO Country Office in China on 31 December 2019.

  • WHO is working 24/7 to analyse data, provide advice, coordinate with

partners, help countries prepare, increase supplies and manage expert networks.

  • The outbreak was declared a Public Health Emergency of International

Concern on 30 January 2020.

  • The international community has asked for US$675 million to help

protect states with weaker health systems as part of its Strategic Preparedness and Response Plan.

  • On 11 February 2020, WHO announced a name for the new coronavirus

disease: COVID-19.

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https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen

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  • COVID-19: Disease name
  • COrona Virus Infectious Disease-19
  • SARS-COV-2: Virus itself
  • Causative agent of COVID-19
  • HCoV-19 –Human Coronavirus-19 (old name)
  • SARS-COV: Severe Acute Respiratory Syndrome -COronaVirus
  • Causative agent of SARS (outbreak 2002 –2003)

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Lu et al.Genomic characterizationand epidemiology of 2019 novel coronavirus: implications for virus origins and receptor Binding. Lancet 2020

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https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen

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https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen

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https://www.wired.com/story/whats-social-distancing-flattening-curve-covid-19-questions/

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https://www.visualcapitalist.com/infection-trajectory-flattening-the-covid19-curve/

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  • In an effort to prevent the spread of COVID-19 within communities and

across the country, all Canadians are advised to:

  • stay at home unless you have to go to work
  • talk to your employer about working at home if possible
  • avoid all non-essential trips in your community
  • do not gather in groups
  • limit contact with people at higher risk, such as older adults and those in poor

health

  • go outside to exercise but stay close to home
  • if you leave your home, always keep a distance of at least 2 arms lengths

(approximately 2 metres) from others

  • household contacts (people you live with) do not need to distance from each
  • ther unless they are sick or have travelled in the last 14 days

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https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus- infection/symptoms.html?topic=ex-col-faq#a

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https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus- infection/symptoms.html?topic=ex-col-faq#a

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  • Hygiene: Proper hygiene can help reduce the risk of infection or

spreading infection to others:

  • wash your hands often with soap and water for at least 20 seconds, especially

after using the washroom and when preparing food

  • use alcohol-based hand sanitizer if soap and water are not available
  • when coughing or sneezing:
  • cough or sneeze into a tissue or the bend of your arm, not your hand
  • dispose of any tissues you have used as soon as possible in a lined waste

basket and wash your hands afterwards

  • avoid touching your eyes, nose, or mouth with unwashed hands

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https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus- infection/symptoms.html?topic=ex-col-faq#a

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https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus- infection/symptoms.html?topic=ex-col-faq#a

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The American Society of Hematology (ASH) https://www.hematology.org/covid-19/covid-19-and-myelodysplastic-syndromes

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The American Society of Hematology (ASH) https://www.hematology.org/covid-19/covid-19-and-myelodysplastic-syndromes

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The American Society of Hematology (ASH) https://www.hematology.org/covid-19/covid-19-and-myelodysplastic-syndromes

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The American Society of Hematology (ASH) https://www.hematology.org/covid-19/covid-19-and-myelodysplastic-syndromes

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Consider enrolling in a registry

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https://www.hematology.org/covid-19/covid-19-and-myelodysplastic-syndromes

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https://blood.ca/en/convalescentplasma

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LET’S TAKE YOUR QUESTIONS..

  • Do you have any questions about this talk?
  • Do you have questions about your own blood tests and results?

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REFERENCES

ASH Education Book 2005 – 2019

World Health Organization Classification of Tumours. Pathology & Genetics: Tumours of Haematopoietic and Lymphoid Tissues. Edited by Elaine S. Jaffe, Nacy Lee Harris, Harald Stein, James W. Vardiman. IARC Press Lyon 2001 and updated WHO 2008 and 2016.

Bennett JM, Catovsky D, Daniel MT, et al. Proposals for the classification of the myelodysplastic syndromes. British Journal of

  • Haematology. 1982; 51:189-199.

Harris NL, Jaffe ES, Diebold J, et al. World Health Organization Classification of Neoplastic Diseases of the hematopoietic and lymphoid tissues: report of the clinical advisory committee meeting – Airlie House, Virginia, November 1997. J Clin Oncol. 1999;17:3835-3849.

Greenberg P, Cox C, LeBeau MM, et al. International Scoring System for evaluating prognosis in myelodysplastic syndromes.

  • Blood. 1997;89:2079-2088.

Steensma DP and Bennett JM. The Myelodysplastic Syndromes: Diagnosis and Treatment. Mayo Clin Proc. 2006;81(1):104- 130.

Komrokji RS and Bennett JM. Evolving classifications of the myelodysplastic syndromes. Current Opinion in Hematology. 2007;14:98-105.

Malcovati L. Prognostic Factors and Life Expectancy in Myelodysplastic Syndromes Classified According to WHO Criteria: A Basis for Clinical Decision Making. J Clin Oncol 2005;23:7594-7603.

Tefferi A, Vardiman JW. Myelodysplastic syndromes. N Engl J Med. 2009 Nov 5;361(19):1872-85. PMID: 19890130

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