1. Slide Interpretation Dr Rosline Hassan Department Haematology,
School of Medical Sciences,
University Sains Malaysia

2. Case 1a A 26 year old lady has fever and fatigue. Hb 8.9 g/dl
WCC 87 x 109/l
Plt 655 x 109/l
Q1. What is the differrential diagnosis
Q2. What further tests required

3. Case 1b In this patient the following would be expected
A The Philadelphia chrom.
B A t(9;22) translocation in cells of granulocytic, erythroid and megakaryocytic lineages
C Hyperuricaemia
D Transformation to an acute leukaemia as part of the natural history of the disease

4. Case 2
20 year old man admitted for fever & cough. On exam. he was pink and had bilateral lung crepitation
Hb 10.4 g/dl
TWBC 29.8 x 109/l
Platelet 402 x 109/l

5. Case 2 The following are features of infection Neutrophilia
Toxic granules
Vacuolation
Dohle bodies
Left shift

6. Case 3 62 year old man was under investigation for chronic back-ache
Hb 10.3 g/dl
TWBC 3.0 x 109/l
Plt 86 x 109/l

7. Case 3
In this patient with blood film and bone marrow aspirate as shown, it is likely that
A erythrocyte sedimentation rate is high
B plasma globulin is increased
C he has massive hepatosplenomegaly
D x-ray shows osteoblastic lesion

8. Case 4a
This 35 year old lady diagnosed as acute leukaemia has marked bruises
The possible cause for
this lesion
thrombocytopenia
DIC
Haemolytic anaemia
Megaloblastic ananemia

9. Case 4b Bone marrow is as shown
A The patient has hypergranular promyelocytic leukaemia (M3 AML)
B Cytogenetic is helpful
C A high plasma fibrinogen is expected
D Anaemia is a feature

10. Case 5
41 year old lady complained of increased fatigue and increased in menstrual bleed
Hb 8.1 g/dl
TWBC 20.4 x 109/l
Neutrophil 1%
Platelet 19 x 109/l

11. Case 5 Based on blood film and count
A possible diagnosis of acute myeloid leukaemia
Myeloperoxidase staining is positive
Stem cell transplant is the first line of treatment
Reticulocytosis is a feature

12. Case 6 This blood film is from a 15year-old girl who
went to her GP with acute tonsillitis and rashes  
Urgent bone marrow examination is indicated
Epstein-Barr virus could be responsible
This abnormal cells are T-lymphocyte
Generalized lymphadenopathy is a feature

13. Case 7a This lady has cervical lymphadenopathy.
The possible causes are
Lymphoma
Chronic lymphocytic leukaemia
Essential thrombocytaemia
Tuberculosis

14. Case 7b Her peripheral blood film shows many mature lymphocyte
A most likely diagnosis is chronic lymphocytic leukaemia
It is a disease of childhood
The typical finding is peripheral blood lymphocytosis
Autoimmune haemolytic anaemia is one of its complication

15. Case 8
This blood film is from a two-year-old child with fever and a cough. The likely diagnosis is
A Chronic lymphocytic leukaemia
B Acute lymphoblastic leukaemia
C Tuberculosis
D Whooping cough

16. Case 9 Blood film is from a 6 year old boy Bone marrow is indicated
Cervical lymphadenopathy is a feature
The cells stain positive for Periodic acid Schiff
EBV virus is its possible causative

17. Case 10
This 55 year old man complained of headache. On examination he looks plethoric
Hb 17g/dl HCT 0.57l/l
TWBC 17 x 109/l
Plt 520 x 109/l
Possible cause
Ciggarate smoker
Polycythaemia vera
Megaloblastic anaemia
Renal tumour