Use Case January 2018

ExpertPath Haematology & Cytology

Use Case

January 2018 ExpertPath Haematology & Cytology

January 2018 Use Case

The situation:

•  Dr Jeremey Wallentine was presented with the workup of a patient with congenital deafness and thrombocytopenia.

•  The working diagnosis was May-Hegglin anomaly. •  The Peripheral blood smear was sent with a clinical

history of “Thrombocytopenia and deafness, ? May-Hegglin”.

May-Hegglin anomaly v’s another platelet disorder

Physician’s Questions

1)  Could I rule out or confirm a diagnosis of May-Hegglin anomaly or another platelet disorder.

2)  How could I best compare the diagnoses that I was considering?

3)  Where could I obtain evidence to back up my diagnosis?

January 2018 Use Case

It’s always helpful to highlight the differential diagnosis section since a key question every pathologist/clinician should ask while working up a patient is “what else should I be considering” or “what else could this be”?

Jeremy Wallentine, MD

Used ExpertPath to refresh knowledge on May-Hegglin anomaly

Contrasted the information obtained in ExpertPath with the medical facts and the peripheral blood smear from the patient

Upon review of the table and consideration of the peripheral blood smear findings I concluded that this, more likely, represented Epstein Syndrome

Key use case cont.

Using ExpertPath to validate diagnoses

Key Value: •  Key information allowed me to suggest a better working diagnosis, and also suggest the appropriate

next step in the workup

The Process followed

January 2018 ExpertPath Haematology & Cytology

January 2018 Use Case

Use Case: Haematology & Cytology In ExpertPath I searched for “May-Hegglin”.

January 2018 Use Case

Use Case: Haematology & Cytology

Because the anomaly is a disorder of white blood cells (Leukocytic Disorder), I filtered by “Hematology, Hemostasis, and Thrombosis”.

January 2018 Use Case

Use Case: Haematology & Cytology The top find was “MYH9 Mutations (macrothrombocytopenia), so my first assumption was that MYH9 mutations were the underlying abnormality for May-Hegglin anomaly so I clicked on that topic. Once I opened the topic I could see that May-Hegglin was highlighted throughout, so I was probably in the right topic. ‘Key facts’ stated that there are 4 MYH9-related diseases, one of which is May-Hegglin anomaly but what about the other 3?

January 2018 Use Case

Use Case: Haematology & Cytology So, I clicked on the table which nicely broke down the 4 syndromes and their respective findings.

January 2018 Use Case

Use Case: Haematology & Cytology Upon review of the table and consideration of the peripheral blood smear findings from the patient, I concluded that this more likely represented Epstein Syndrome, as this patient had both hearing loss and macrothrombocytopenia, but did not have any inclusions (Döhle bodies) in the granulocytes. May-Hegglin is characterized by the presence of abnormal Döhle bodies and patients do not have hearing loss, so this likely did not represent May-Hegglin anomaly.

The benefits of ExpertPath

January 2018 ExpertPath Haematology & Cytology

January 2018 Use Case

The benefits of ExpertPath

ExpertPath gives you instant access to the collective clinical experience and knowledge of renowned sub-specialists in every field of anatomic and clinical pathology. •  Over 4,000 common and complex diagnoses •  51,000 searchable, high-quality annotated pathology images •  Overviews of diagnosis groups •  Tables with summary information for organ systems •  Normal histology topics •  Specimen handling protocols and best practices

Each diagnosis topic delivers the tools you need to make a confident diagnosis: •  Differential diagnosis lists help you determine what other diseases you should

consider •  Ancillary testing lists help you prioritize and select appropriate studies •  Prognostic and therapeutic information help you provide vital information to

referring physicians