Slide Slide InterpretationInterpretation

Dr Rosline HassanDr Rosline Hassan

Department Haematology,Department Haematology,

School of Medical Sciences,School of Medical Sciences,

University Sains MalaysiaUniversity Sains Malaysia

Case 1aCase 1a

A 26 year old lady A 26 year old lady has fever and fatigue.has fever and fatigue.

Hb 8.9 g/dlHb 8.9 g/dl

WCC 87 x 10WCC 87 x 1099/l/l

Plt 655 x 10Plt 655 x 1099/l/l

Q1. What is the Q1. What is the differrential differrential diagnosisdiagnosis

Q2. What further tests Q2. What further tests requiredrequired

Case 1bCase 1b

In this patient the In this patient the following would be following would be expectedexpected

A The Philadelphia chrom.A The Philadelphia chrom.B A t(9;22) translocation B A t(9;22) translocation

in cells of granulocytic, in cells of granulocytic, erythroid and erythroid and megakaryocytic lineagesmegakaryocytic lineages

C HyperuricaemiaC HyperuricaemiaD Transformation to an D Transformation to an

acute leukaemia as part acute leukaemia as part of the natural history of of the natural history of the diseasethe disease

Case 2Case 2

20 year old man 20 year old man admitted for fever admitted for fever & cough. On & cough. On exam. he was exam. he was pink and had pink and had bilateral lung bilateral lung crepitation crepitation

Hb 10.4 g/dlHb 10.4 g/dlTWBC 29.8 x 10TWBC 29.8 x 1099/l/lPlatelet 402 x 10Platelet 402 x 1099/l/l

Case 2Case 2

• The following are The following are features of features of infectioninfection

A.A. NeutrophiliaNeutrophilia

B.B. Toxic granulesToxic granules

C.C. VacuolationVacuolation

D.D. Dohle bodies Dohle bodies

E.E. Left shiftLeft shift

Case 3Case 3

• 62 year old man 62 year old man was under was under investigation for investigation for chronic back-achechronic back-ache

Hb 10.3 g/dlHb 10.3 g/dl

TWBC 3.0 x 10TWBC 3.0 x 1099/l/l

Plt 86 x 10Plt 86 x 1099/l/l

Case 3Case 3

In this patient with blood In this patient with blood film and bone marrow film and bone marrow aspirate as shown, it is aspirate as shown, it is likely thatlikely that

A erythrocyte A erythrocyte sedimentation rate is sedimentation rate is highhigh

B plasma globulin is B plasma globulin is increasedincreased

C he has massive C he has massive hepatosplenomegalyhepatosplenomegaly

D x-ray shows osteoblastic D x-ray shows osteoblastic lesionlesion

Case 4aCase 4a

This 35 year old This 35 year old lady diagnosed as lady diagnosed as acute leukaemia has acute leukaemia has marked bruisesmarked bruises

The possible cause forThe possible cause forthis lesionthis lesionA.A. thrombocytopeniathrombocytopeniaB.B. DICDICC.C. Haemolytic anaemiaHaemolytic anaemiaD.D. Megaloblastic Megaloblastic

ananemiaananemia

Case 4bCase 4b

Bone marrow is as Bone marrow is as shownshown

A The patient has A The patient has hypergranular hypergranular promyelocytic promyelocytic leukaemia (M3 leukaemia (M3 AML)AML)

B Cytogenetic is B Cytogenetic is helpfulhelpful

C A high plasma C A high plasma fibrinogen is fibrinogen is expectedexpected

D Anaemia is a D Anaemia is a featurefeature

Case 5Case 5

• 41 year old lady 41 year old lady complained of complained of increased fatigue increased fatigue and increased in and increased in menstrual bleedmenstrual bleed

Hb 8.1 g/dlHb 8.1 g/dl

TWBC 20.4 x 10TWBC 20.4 x 1099/l/l

Neutrophil 1%Neutrophil 1%

Platelet 19 x 10Platelet 19 x 1099/l /l

Case 5Case 5

• Based on blood film and Based on blood film and countcount

A.A. A possible diagnosis of A possible diagnosis of acute myeloid leukaemiaacute myeloid leukaemia

B.B. Myeloperoxidase staining Myeloperoxidase staining is positiveis positive

C.C. Stem cell transplant is the Stem cell transplant is the first line of treatmentfirst line of treatment

D.D. Reticulocytosis is a feature Reticulocytosis is a feature

Case 6Case 6

This blood film is from a This blood film is from a 15year-old girl who15year-old girl who

went to her GP with acute went to her GP with acute tonsillitis and rashes  tonsillitis and rashes  

A.A. Urgent bone marrow Urgent bone marrow examination is examination is indicatedindicated

B.B. Epstein-Barr virus Epstein-Barr virus could be responsible could be responsible

C.C. This abnormal cells This abnormal cells are T-lymphocyteare T-lymphocyte

D.D. Generalized Generalized lymphadenopathy is a lymphadenopathy is a featurefeature

Case 7aCase 7a

• This lady has This lady has cervical cervical lymphadenopathy.lymphadenopathy.

• The possible causes The possible causes areare

A.A. LymphomaLymphoma

B.B. Chronic lymphocytic Chronic lymphocytic leukaemialeukaemia

C.C. Essential Essential thrombocytaemiathrombocytaemia

D.D. TuberculosisTuberculosis

Case 7bCase 7b

• Her peripheral blood Her peripheral blood film shows many mature film shows many mature lymphocyte lymphocyte

A.A. A most likely diagnosis A most likely diagnosis is chronic lymphocytic is chronic lymphocytic leukaemialeukaemia

B.B. It is a disease of It is a disease of childhoodchildhood

C.C. The typical finding is The typical finding is peripheral blood peripheral blood lymphocytosislymphocytosis

D.D. Autoimmune haemolytic Autoimmune haemolytic anaemia is one of its anaemia is one of its complication complication

Case 8Case 8

• This blood film is This blood film is from a two-year-old from a two-year-old child with fever and child with fever and a cough. The likely a cough. The likely diagnosis isdiagnosis is

A Chronic lymphocytic A Chronic lymphocytic leukaemialeukaemia

B Acute lymphoblastic B Acute lymphoblastic leukaemialeukaemia

C TuberculosisC TuberculosisD Whooping cough D Whooping cough

Case 9Case 9

• Blood film is from a Blood film is from a 6 year old boy6 year old boy

A.A. Bone marrow is Bone marrow is indicatedindicated

B.B. Cervical Cervical lymphadenopathy is lymphadenopathy is a featurea feature

C.C. The cells stain The cells stain positive for Periodic positive for Periodic acid Schiffacid Schiff

D.D. EBV virus is its EBV virus is its possible causativepossible causative

Case 10Case 10

This 55 year old This 55 year old man complained man complained of headache. On of headache. On examination he examination he looks plethoriclooks plethoric

Hb 17g/dl HCT Hb 17g/dl HCT 0.57l/l0.57l/l

TWBC 17 x 10TWBC 17 x 1099/l/l

Plt 520 x 10Plt 520 x 1099/l/l

Possible causePossible cause

A.A. Ciggarate smokerCiggarate smoker

B.B. Polycythaemia Polycythaemia veravera

C.C. Megaloblastic Megaloblastic anaemiaanaemia

D.D. Renal tumourRenal tumour