Anaemia Lymphoma Dr Hassen AlSader Consultant Haematologist Watford

Anaemia & Lymphoma Dr Hassen Al-Sader Consultant Haematologist Watford & UCLH Hospitals

Microcytic anaemia ● Most likely iron deficiency ● Could be haemoglobinopathy ● Normal ferritin is a good screening test ● However, it does not exclude iron deficiency ● Especially: inflammatory conditions, abnormal LFTs ● Check iron studies: Transferrin saturation <20%?

Macrocytic anaemia ● Deficiency: B 12 or folate ○ Metformin, Omeprazole, oestrogen, 1 -2 yrs post gastric surgery! ● Pregnancy ● Thyroid disease ● Haemolytic anaemia: ○ Retic count, Film, DAT, Bil, LDH, Haptoglobin ● MDS

Iron deficiency anaemia ● GI symptoms? Gastro to investigate ● Treatment with oral iron - tablets/liquid ○ Vitamin C ! ○ Tranexamic acid - stop if haematuria ● Intolerance: reduce dose, then if no improvement refer for IV iron ● Ineffective: exclude H. pylori, if negative, refer for IV iron

Normocytic anaemia ● Challenging ! ● Clinical: Hx & examination ● Chronic disease? CKD, RA, . . etc ○ Still need to exclude other causes ● ● ● Remember: Iron deficiency, B 12, folate PSA SPE, Blood film- infiltration? MDS

Urgent Transfusion ● Not only A&E! ● Ambulatory care ● Haematology day unit

2 week wait referral - not so appropriate ● Lymphocytosis 7. 0 x 10 9 ● Monoclonal band 5 g/l ● Lymph nodes following an infection ● Platelet of 70

Lymphoma ● Isolated lymph node ● Painless ● No infective symptoms ● Even if no B symptoms

Lymphoma management ● Low grade: Follicular, CLL, Marginal zone - watch and wait ● High grade: ○ Staging: PET CT or CT ○ Chemo +/- Radiotherapy ○ Usually 6 cycles, each cycle 3 -4 weeks ○ Clinic review pre each cycle ○ Interim scan & end of treatment assessment ○ F/U 3/12 for 1 yr, then 4 -6/12, eventually annually & may be discharge

Lymphoma late effects ● ● ● Cardiac & pulmonary, esp if radiotherapy to chest Carotid vessel disease with radiotherapy Thyroid disease Neuropathy Fertility ● Small risk of secondary malignancy, MDS