Hematology Cases

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<p>Hematology Case # 1History of Present Illness The patient was a 47-year-old white male who was seen in the clinic, with the complaint of weakness and fatigue. He had loss of appetite. He had lost 10 pounds in the past month, felt weak and was bed ridden. The patient was dizziness on standing. His Temp was 36.8 degrees.</p> <p>Hematology Case # 1 Lab DataWBC 4.6 NE LYMO EO BA META</p> <p>MYEL 2%</p> <p>NRBC 2/100 WBC</p> <p>hypersegmented NeutrophilsA few noted</p> <p>29% 60%</p> <p>2% 2%</p> <p>2% 3%</p> <p>HGB</p> <p>MCV</p> <p>RDW</p> <p>PLT</p> <p>68</p> <p>120</p> <p>24.2</p> <p>124</p> <p>Hematology Case # 1 QuestionsInterpret the laboratory and morphologic findings? List 4 possible underlying diseases? What additional tests would you do?</p> <p>Hematology Case # 1 Question 1Interpret the laboratory and morphologic findings? Macrocytic anemia with hypersegmented neutrophils, nucleated RBC, borderline neutropenia and stomatocytosis</p> <p>List 4 possible underlying diseases?alcohol intake. liver disease abnormal DNA synthesis (megaloblastic) due to B12 or folate deficiency Drugs such as methotrexate Hypothyroidism Myelodysplastic syndrome</p> <p>Hematology Case # 1 What additional tests would you do?Serum B12 Serum and red cell Folic acid</p> <p>Liver Enzymes Gamma GT ALT</p> <p>TSH Bone Marrow</p> <p>Hematology Case # 2History 21 year old female who is a University student noted over the past week increasing fatigue, sore throat, headaches, and fever.</p> <p>Physical Exam She has erythematous throat and tonsils, Swollen cervical lymph nodes and hepatosplenomegaly</p> <p>Hematology Case # 2 CBC with microscopic differentialDiff % 24</p> <p>RBC HGB MCV RDW PLT WBC</p> <p>5.25 x 1012/L 154 g/L 87.9 fL 12.2 150 x 109/L 11.9 x 109/L</p> <p>Neutrophils</p> <p>LymphocytesMonocytes Eosinophils Basophils</p> <p>712 3 0</p> <p>Hematology Case # 2 Questions What morphologic alterations are seen in this blood smear field? What is the absolute lymphocyte count? What is the differential diagnosis? What other tests would you order?</p> <p>Hematology Case # 2 Questions What morphologic alterations are seen in this blood smear field? Atypical lymphocytes</p> <p> What is the absolute lymphocyte count? 8.4 x 109/L</p> <p> What is the differential diagnosis? viral infections Infectious mononucleosis, CMV</p> <p> Pertussis Toxoplasmosis</p> <p> What other tests would you order? Monospot test Serology for toxoplasma Serology or molecular for CMV</p> <p>Hematology Case # 3A 15-year-old girl complained of fatigue and loss of stamina. Her appetite was poor. Her monthly menstrual flow was heavy. Here CBC was as follows:</p> <p>Hemoglobin MCV platelet WBC</p> <p>80 g/L 65 fl 400 7 x 109/L</p> <p>Case 3 CBC</p> <p>NeutrophilsLymphocytes</p> <p>73%24%</p> <p>Case 3 questionsWhat is your diagnosis? List 4 possible underlying disease? What additional tests would you do? Explain the platelet count?</p> <p>Case 3 questionsWhat is your diagnosis? Microcytic hypochromic anemia</p> <p>List 4 possible underlying disease? (Fe deficiency) thalassemia anemia of chronic disease Sideroblastic anemia Pb toxicity</p> <p>Case 3 questionsWhat additional tests would you do? Serum Ferritin Serum Iron, TIBC Hemoglobin Electrophoresis Bone marrow examination Lead level Explain the platelet count? Typically seen in patients who are actively bleeding Increased in erythropoietin levels Bone marrow hyperplasia</p> <p>Hematology Case # 4While examining your own blood you find: WBC 9 x 109 /LSegmented neuts 30% bands 5% Eos 7% Basos 3% Monos 5% Lymphs 50%</p> <p>Hematology Case # 4 QuestionsIs this normal? Do you have too few neutrophils? Too many lymphocytes, eosinophils and basophils?</p> <p>Hematology Case # 4 QuestionsIs this normal? Yes</p> <p>Do you have too few neutrophils? (&lt; 1.5 X 109/L) 2.7 x 109 /L</p> <p>Too many lymphocytes? (&gt; 4.0 X 109/L) 4.5 x 109 /L</p> <p>eosinophils (&gt; 0.35 X 109/L) 0.63 x 109 /L</p> <p>Basophils (&gt; 0.2 X 109/L) 0.27x 109 /L</p> <p>Hematology Case # 549 year old male patient presented with fatigue. There was splenomegaly present CBC WBC 30. Hgb 120 and plt 400</p> <p>Diff Segmented Neut Band</p> <p>Hematology Case # 5 Diff% 33 15</p> <p>Metamylocyte Meylocyte Promyelocyte Blast Baso Eos Mono Lymph total</p> <p>6 8 3 1 4 7 1 22 100</p> <p>Case 5 QuestionsWhat is the differential diagnosis? Reactiveinfection, inflammation, necrosis, physical agents, emotional stimuli, drugs, toxins, other neoplasia, metabolic, hormonal, and endocrine disturbances,</p> <p> NeoplasticChronic myeloproliferative disorders Chronic myeloid leukemia Essential thrombocythemia Chronic idiopathic myelofibrosis Polycythemia Vera</p> <p>List 3 key diagnostic tests Repeat CBC Bone Marrow examination Molecular for BCR/ABL Cytogenetic Study</p> <p>Case 5 Questions contWhat is the Prognosis? This a slowly progressive disease Median survival 5-7 years</p> <p>List 2 treatment options Targeted therapy tyrosine kinase inhibitors such as Imatinib Bone marrow transplant</p> <p>Hematology Case # 6Your second patient is a 37-year-old man complained of weakness. He is pale and gave a history of petechiae and hematuria. He is tired.</p> <p>Hematology Case # 6 CBCHgb 70 g/L, WBC 2.2 x109/L, Plt 30 x109/L Diff % Neut 23, Lymph 70 Mono 3 Eos 3 Baso 1 The PB smear showed normocytic/normochromic RBCs.</p> <p>Hematology Case # 6 QuestionsCalculate the absolute neutrophil count. _______________ x 109/L</p> <p>What is your diagnosis? A. aplastic anemia B. drug induced neutropenia</p> <p> C. accelerated destruction of neutrophils</p> <p>Hematology Case # 6 QuestionsCalculate the absolute neutrophil count. 0.5 x 109/L</p> <p>What is your diagnosis? A. aplastic anemia</p> <p>Normal reference rangesWBC HGB HGB RBC RBC MCV RDW PLT 109/L g/L g/L 1012/L 1012/L fL % 109/L (4.5 11.0) (120 - 160) (140 - 180) (3.8 5.8) (4.5 6.5) (80.0 97.0) (11.5 14.5) (150 - 350) Female male Female male</p>