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
WBC NE LY MO EO BA
META
MYEL
NRBC
hypersegmented Neutrophils
4.6
29%
60% 2% 3%
2/100
A few noted
HGB
MCV
RDW
PLT 68
120
24.2
124

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 disease
abnormal DNA synthesis (megaloblastic) due to B12 or folate deficiency
Drugs such as methotrexate
Hypothyroidism
Myelodysplastic syndrome

6. Hematology Case # 1 What additional tests would you do?
Serum B12
Serum and red cell Folic acid
Liver Enzymes
Gamma GT
ALT
TSH
Bone 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 Exam
She has erythematous throat and tonsils, Swollen cervical lymph nodes and hepatosplenomegaly

8. Hematology Case # 2 CBC with microscopic differential%
Neutrophils 24
Lymphocytes 71
Monocytes 2
Eosinophils 3
Basophils
RBC x 1012/L
HGB g/L
MCV fL
RDW
PLT x 109/L
WBC 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 lymphocytes
What is the absolute lymphocyte count?
8.4 x 109/L
What is the differential diagnosis?
viral infections
Infectious mononucleosis, CMV
Pertussis
Toxoplasmosis
What other tests would you order?
Monospot test
Serology for toxoplasma
Serology or molecular for CMV

11. Hematology Case # 3
A 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
Neutrophils
73%
Lymphocytes
24%
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 anemia
List 4 possible underlying disease?
(Fe deficiency)
thalassemia
anemia of chronic disease
Sideroblastic anemia
Pb toxicity

15. Case 3 questions What additional tests would you do? Serum Iron, TIBC
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

16. Hematology Case # 4 While examining your own blood you find:
WBC 9 x 109 /L
Segmented 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?
Yes
Do you have too few neutrophils? (< 1.5 X 109/L)
2.7 x 109 /L
Too many lymphocytes? (> 4.0 X 109/L)
4.5 x 109 /L
eosinophils (> 0.35 X 109/L)
0.63 x 109 /L
Basophils (> 0.2 X 109/L)
0.27x 109 /L

19. Hematology Case # 5
49 year old male patient presented with fatigue. There was splenomegaly present
CBC WBC 30. Hgb 120 and plt 400

20. Hematology Case # 5 Diff Diff % Segmented Neut 33 Band 15 Metamylocyte6
Meylocyte 8
Promyelocyte 3
Blast 1
Baso 4
Eos 7
Mono
Lymph 22
total
100

21. Case 5 Questions What is the differential diagnosis?
Reactive
infection, inflammation, necrosis, physical agents, emotional stimuli, drugs, toxins, other neoplasia, metabolic, hormonal, and endocrine disturbances,
Neoplastic
Chronic myeloproliferative disorders
Chronic myeloid leukemia
Essential thrombocythemia
Chronic idiopathic myelofibrosis
Polycythemia Vera
List 3 key diagnostic tests
Repeat CBC
Bone Marrow examination
Molecular for BCR/ABL
Cytogenetic Study

22. Case 5 Questions cont What is the Prognosis? List 2 treatment options
This a slowly progressive disease
Median survival 5-7 years
List 2 treatment options
Targeted therapy tyrosine kinase inhibitors such as Imatinib
Bone marrow transplant

23. Hematology Case # 6
Your 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.

24. Hematology Case # 6 CBC Hgb 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.

25. Hematology Case # 6 Questions
Calculate the absolute neutrophil count.
_______________ x 109/L
What is your diagnosis?
A. aplastic anemia
B. drug induced neutropenia
C. accelerated destruction of neutrophils

26. Hematology Case # 6 Questions
Calculate the absolute neutrophil count.
0.5 x 109/L
What is your diagnosis?
A. aplastic anemia

27. Normal reference ranges
WBC 109/L (4.5 – 11.0)
HGB g/L ( ) Female
HGB g/L ( ) male
RBC 1012/L (3.8 – 5.8) Female
RBC 1012/L (4.5 – 6.5) male
MCV fL (80.0 – 97.0)
RDW % (11.5 – 14.5)
PLT 109/L ( )