Clinical Investigations

Evaluation of anaemia is directed toward its classification as a hypoproliferative disorder (e.g., aplasia or hypoplasia), maturation disorder (e.g., megaloblastic anaemia), due to blood loss or due to haemolysis (e.g., haemoglobinopathies).

Full blood picture, red blood cell indices, reticulocyte count and red cell morphology aid classification.

Reticulocyte index < 2.5 suggests a maturation disorder or a hypoproliferative disorder. High reticulocyte index is usual in haemolytic anaemias.

Iron levels and iron storage indices: low in iron deficiency anaemia. Serum erythropoietin levels and red cell mass: increased in polycythemia. Bleeding time: is a sensitive measure of platelet function.

Platelet count: normal ranges 150,000-450,000/^L. Decreased platelet count increases risk of bleeding from severe trauma or spontaneously - petechiae in skin or intracranial haemorrhage.

Prothrombin time, partial thromboplastin time, thrombin time, clot lysis, clot solubility: are tests for detecting coagulation defects.

White blood cell count and differential leukocyte counts: valuable in diagnosing acute and chronic leukaemias, infections and inflammatory disorders such as lupus erythematosus.

Marrow aspirate: for definitive diagnosis of haematological disorders and haematological malignancies.

Role of the trephine biopsy: complementary to the aspirate. Main uses are - evaluation of cellu-larity particularly if there has been a dry tap due to a packed, fibrotic or empty marrow, spatial relationships between constituent cell types, enumeration and distribution of cells, staging of lymphomas, assessing lymphoid aggregates, staging other malignant disease, assessing fibrosis and post-chemotherapy changes (residual disease/remission/relapse). Other investigations are directed by clinical suspicion.

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