Presentation on theme: "Hematology Case # 1 History of Present Illness"— Presentation transcript:
1 Hematology Case # 1 History 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.
2 Hematology Case # 1 Lab Data WBCNELYMOEOBAMETAMYELNRBChypersegmented Neutrophils4.629%60%2%3%2/100A few notedHGBMCVRDWPLT6812024.2124
3 Hematology Case # 1 Questions Interpret the laboratory and morphologic findings?List 4 possible underlying diseases?What additional tests would you do?
4 Hematology Case # 1 Question 1 Interpret the laboratory and morphologic findings?Macrocytic anemia with hypersegmented neutrophils, nucleated RBC, borderline neutropenia and stomatocytosis
5 List 4 possible underlying diseases? alcohol intake.liver diseaseabnormal DNA synthesis (megaloblastic) due to B12 or folate deficiencyDrugs such as methotrexateHypothyroidismMyelodysplastic syndrome
6 Hematology Case # 1 What additional tests would you do? Serum B12Serum and red cell Folic acidLiver EnzymesGamma GTALTTSHBone Marrow
7 Hematology Case # 2 History Physical Exam 21 year old female who is a University student noted over the past week increasing fatigue, sore throat, headaches, and fever.Physical ExamShe has erythematous throat and tonsils, Swollen cervical lymph nodes and hepatosplenomegaly
8 Hematology Case # 2 CBC with microscopic differential %Neutrophils24Lymphocytes71Monocytes2Eosinophils3BasophilsRBC x 1012/LHGB g/LMCV fLRDWPLT x 109/LWBC x 109/L
9 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?
10 Hematology Case # 2 Questions What morphologic alterations are seen in this blood smear field?Atypical lymphocytesWhat is the absolute lymphocyte count?8.4 x 109/LWhat is the differential diagnosis?viral infectionsInfectious mononucleosis, CMVPertussisToxoplasmosisWhat other tests would you order?Monospot testSerology for toxoplasmaSerology or molecular for CMV
11 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:
12 Case 3 CBC Hemoglobin 80 g/L MCV 65 fl platelet 400 WBC 7 x 109/L Neutrophils73%Lymphocytes24%Case 3 CBC
13 Case 3 questions What is your diagnosis? List 4 possible underlying disease?What additional tests would you do?Explain the platelet count?
14 Case 3 questions What is your diagnosis? Microcytic hypochromic anemiaList 4 possible underlying disease?(Fe deficiency)thalassemiaanemia of chronic diseaseSideroblastic anemiaPb toxicity
15 Case 3 questions What additional tests would you do? Serum Iron, TIBC Serum FerritinSerum Iron, TIBCHemoglobin ElectrophoresisBone marrow examinationLead levelExplain the platelet count?Typically seen in patients who are actively bleedingIncreased in erythropoietin levelsBone marrow hyperplasia
16 Hematology Case # 4 While examining your own blood you find: WBC 9 x 109 /LSegmented neuts 30%bands 5%Eos 7%Basos 3%Monos 5%Lymphs 50%
17 Hematology Case # 4 Questions Is this normal?Do you have too few neutrophils?Too many lymphocytes, eosinophils and basophils?
18 Hematology Case # 4 Questions Is this normal?YesDo you have too few neutrophils? (< 1.5 X 109/L)2.7 x 109 /LToo many lymphocytes? (> 4.0 X 109/L)4.5 x 109 /Leosinophils (> 0.35 X 109/L)0.63 x 109 /LBasophils (> 0.2 X 109/L)0.27x 109 /L
19 Hematology Case # 549 year old male patient presented with fatigue. There was splenomegaly presentCBC WBC 30. Hgb 120 and plt 400
20 Hematology Case # 5 Diff Diff % Segmented Neut 33 Band 15 Metamylocyte 6Meylocyte8Promyelocyte3Blast1Baso4Eos7MonoLymph22total100
21 Case 5 Questions What is the differential diagnosis? Reactiveinfection, inflammation, necrosis, physical agents, emotional stimuli, drugs, toxins, other neoplasia, metabolic, hormonal, and endocrine disturbances,NeoplasticChronic myeloproliferative disordersChronic myeloid leukemiaEssential thrombocythemiaChronic idiopathic myelofibrosisPolycythemia VeraList 3 key diagnostic testsRepeat CBCBone Marrow examinationMolecular for BCR/ABLCytogenetic Study
22 Case 5 Questions cont What is the Prognosis? List 2 treatment options This a slowly progressive diseaseMedian survival 5-7 yearsList 2 treatment optionsTargeted therapy tyrosine kinase inhibitors such as ImatinibBone marrow transplant
23 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.
25 Hematology Case # 6 Questions Calculate the absolute neutrophil count._______________ x 109/LWhat is your diagnosis?A. aplastic anemiaB. drug induced neutropeniaC. accelerated destruction of neutrophils
26 Hematology Case # 6 Questions Calculate the absolute neutrophil count.0.5 x 109/LWhat is your diagnosis?A. aplastic anemia