Haematology Resources

The tests and services provided by the Department of Haematology have a wide range of clinical implications, the most common being:

  • Diagnosis of anaemia and its causes.
  • Screening blood for indications of infection.
  • Diagnosis of blood diseases such as leukaemia and lymphoma.
  • Diagnosis of exotic diseases such as malaria.
  • Screening and diagnosis of Haemoglobin disorders such as thalassaemia and sickle cell anaemia.
  • Monitoring of diseases and their treatments such as cancer and rheumatoid arthritis.
  • Screening and diagnosis of bleeding disorders such as Haemophilia.
  • Monitoring of anticoagulant therapy (Warfarin and Heparin), and provision of Warfarin dosing information.
  • Compatibility testing and provision of blood components for transfusion.
  • Advice to clinicians and medical staff.

For further information please follow the resource link below to take you to the GHT website page for Haematology guidelines.​

Monoclonal Gammopathies of Undertermined Significance (MGUS) and Chronic Lymphocytic Leukaemia (CLL)

Monoclonal Gammopathies of Undertermined Significance (MGUS) and Myeloma

  • Malignant proliferation of plasma cells in the bone marrow producing a monoclonal immunoglobulin in the plasma or the urine
  • Present in 3% over the age of 50 and 5% over 70
  • More likely to be MGUS than myeloma
  • 1% risk of progression to myeloma per annum
  • Risk depends on level of paraprotein
    • IgG >15, IgA or IgM >10, IgD or IgE rare

MGUS

Asymptomatic myeloma

Symptomatic myeloma

M-protein in serum <30 g/l

M-protein in serum >30 g/l and/or
Bone marrow clonal plasma cells >10 %

M-protein in serum and/or urine

Bone marrow clonal plasma cells <10 % and low level of plasma cell infiltration in a trephine biopsy (if done)

Bone marrow (clonal) plasma cells or biopsy proven plasmacytoma

No related organ or tissue impairment

No related organ or tissue impairment or symptoms

Myeloma-related organ or tissue impairment (including bone lesions)

  • Requires ongoing long term monitoring
  • Blood tests every 3 months for first 2 years then 4-6 monthly if  paraproteins stable
  • Check FBC, paraproteins, U+E, LFT and bone profile at every visit
  • Refer to haematology if IgG paraproteins >15 or Ig A >10 OR concentration of the M-protein increases by more than 25%.
  • If symptoms compatible with a diagnosis of myeloma or lymphoma develop
  • Any unexplained end organ damage e.g. abnormal renal function
  • Unexplained anaemia, other cytopenias or hypercalcaemia

           

C – hypercalcemia

R – renal dysfunction

A – anaemia

B – bone lesions

  • Hyperviscosity
  • Raised total protein
  • Raised PV or ESR
  • Rouleaux on blood film
  • Recurrent bacterial infections

Cord compression

5% of patients with myeloma

  • Sensory loss
  • Paraesthesiae
  • Limb weakness
  • Abnormal gait
  • Sphincter disturbance

Urgent radiotherapy / High dose dexamethasone

 

Hyperviscosity (PV usually >4)

  • Blurred vision
  • Headaches
  • Mucosal bleeding
  • SOB
  • Confusion

Start anti-myeloma treatment / Consider plasma exchange

 

Hypercalcemia

  • Confusion, coma and obtundation
  • Muscle weakness
  • Pancreatitis
  • Constipation
  • Thirst
  • Polyuria
  • AKI

IV fluids/ IV bisphosphonates

  • Control disease, maximise QoL and prolong survival
  • Novel agents have greatly increased survival
  • Improvement in depth of initial response, consolidated with an autologous transplant, translates to better survival
  • The best sequence and combination of treatment still uncertain

  • Neutropenia and risk of infection
  • Venous thromboembolism
  • Peripheral neuropathy
  • Dizziness and postural hypotension
  • Steroid effects – hypertension/hyperglycemia

BRONJ – avoid dental procedures

Please follow this link to view guidance for the Management of Monoclonal Gammopathies of Undertermined Significance (MGUS) from the Haematology and Immunology Team at GHFT.

The management advise is based on: 'UK Myeloma Forum (UKMF) and Nordic Myeloma Study Group (NMSG): guidelines for the investigation of newly detected M-proteins and the management of monoclonal gammopathy of undetermined significance (MGUS)'.

Chronic lymphotic leukaemia (CLL)

  • Commonest adult leukaemia
  • 70% incidental finding
  • Median age at diagnosis is 65 years
  • In the elderly:
    • usually indolent
    • cause of mortality is unrelated to CLL

                   

  • Patient education
  • Infection screening
  • Annual flu vaccine
  • Avoid live vaccines including shingles vaccine
  • Monitor FBC every 3 – 6 months

  • Progressive bone marrow failure
    • Haemoglobin or platelets <100
  • Massive or symptomatic splenomegaly
  • Massive nodes (>10cm) or symptomatic lymphadenopathy
  • Lymphocyte doubling time <6 months
  • B symptoms
    • Unintentional weight loss >10% in 6 months
    • Fevers >2 weeks
    • Night sweats >1 month
  • Auto immune haemolytic anaemia
'2 Sample Rule' Blood Transfusion Guidance - GHFT

The two sample rule is a national guideline to improve patient safety when receiving transfusions. Please follow the resource link below to view guidance on the current blood transfusion request from including explanation of the '2 sample rule.'

Supporting Information for GP's Referring to Haematology Oncology services

Please ‘view the resource’ to be taken to supporting information from the South West Clinical Network for GPs referring to Haematology Oncology services.  The topics covered are as follows:

  • D-dimers
  • Erythrocytosis
  • Increased bleeding tendency
  • Lymphadenopathy
  • Lymphocytopenia
  • Lymphocytosis
  • Neutrophilia
  • Raised Ferritin level
  • Recommendations For GP Monitoring Of Chronic Lymphocytic Leukaemia
  • Thrombocytopenia
  • Thrombocytosis
  • Travel related thrombosis

Please see the separate section below for the Gloucestershire MGUS guideline.

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