2 Case 1Patient History:15 year old female sent home from summer camp because of fatigue, weakness and sore throat. The physician found that on physical examination she had an inflamed pharynx, enlarged tonsils, several enlarged and slightly tender lymph nodes in the neck, a palpable spleen and a tender palpable liver edge.
5 Case 1 What is the diagnosis in this case? Infectious mononucleosisWhat other laboratory tests may be helpful in confirming the diagnosis?A serologic test for infectious mononucleosis would confirm the diagnosis
6 Case 2Patient History:65 year old male who was in good health except for mild hypertension. At his last check up-, a CBC showed a markedly elevated white blood cell count and physical examination revealed several slightly enlarged lymph nodes in the neck and the axillae and the spleen was palpable.
9 Case 2 What is the predominant white blood cell type present? Most of the WBCs are small to medium-sized lymphocytes. In addition, there are some larger lymphocytes with abundant cytoplasm and a prominent nucleolus, which are prolymphocytes.What is the differential diagnosis?Chronic Lymphocytic Leukemia (CLL)
10 Case 3Patient History:52 year old male with gradually increasing fatigue together with discomfort in the left upper quadrant. Physical examination revealed an easily palpable spleen and liver edge. A few slightly enlarged lyph nodes were palpable in the neck.
14 Case 3 What type of blood cells are present? The WBC count is moderately elevated, with a wide spectrum of granulocytes at various stages of maturation (rare blasts and promyelocytes, myelocytes, metamyelocytes, bands and polys). Platelets are moderately increased in number and some large forms are seen.What do you think the diagnosis is in this case?Chronic Myelogenous Leukemia (CML)
15 Case 4Patient History:A 5 year old boy has been too tired to play with his friends for two months. His mother is also worried that whenever he falls or bumps into anything, a big bruise forms. For the past 2 days he had a high fever.
17 Case 4 Laboratory Findings: A bone marrow biopsy shows replacement by primitive cells that have large nuclei with delicate chromatin and indistinct nucleoli. There is scant cytoplasm with no granules and auer rods. These cells mark for CD10 (CALLA) antigen.
19 Case 4 What type of white blood cells are present? The WBCs present are predominantly lymphoblasts.What is the most likely diagnosis?Acute Lymphocytic Leukemia (ALL)What is the most likely outcome of this child’s disease with standard therapy?The most likely outcome of this child’s disease with standard therapy is good-a >90% chance for complete remission following chemotherapy.
20 Case 5Patient History:A 51 year old male was seen by his physician for a routine preoperative exam prior to dental surgery. He was found to have a large left upper quadrant mass. Marked splenomegaly was confirmed by CT scan.
21 Case 5 Laboratory Findings: CBC RBC: 3.36 x 1012/L Hgb: 10.9 g/dl Hct: 31.2%MCV 92.8 flMCH: 32.4 pgMCHC: 34.9 g/dlWBC: 9.3 X 109/LDiffPolys: 14Lymphs: 15Abnormal: 71Plt: 59 X 109/L
23 Case 5What morphologic alterations are seen in this blood smear field?Abnormal WBCs with round or indented nuclei with a fairly coarse chromatin pattern. They have variable amounts of grainy-blue cytoplasm with irregular ragged borders and numerous projections.What is the most likely diagnosis?Hairy Cell Leukemia
24 Case 6Patient History:A 15 year old girl complained of fatigue and loss of stamina. Her appetite was poor. Her monthly menstrual flow was heavy.
27 Case 6 What type of anemia does this patient have? Microcytic, HypochromicList 4 possible underlying causes of the diseaseIron deficiency, thalassemia, anemia of chronic disease, sideroblastic anemia or Pb toxicityWhat additional tests could be done to confirm diagnosis?Serum ferritin, serum iron, TIBC, Hemoglobin electrophoresis, bone marrow examination, lead level
28 Case 7A 37 year old male is complaining of weakness. He is pale and gave a history of petechiae and hematuria