slide interpretation dr rosline hassan department haematology, school of medical sciences,...
Post on 22-Dec-2015
220 views
TRANSCRIPT
Slide Slide InterpretationInterpretation
Dr Rosline HassanDr Rosline Hassan
Department Haematology,Department Haematology,
School of Medical Sciences,School of Medical Sciences,
University Sains MalaysiaUniversity Sains Malaysia
Case 1aCase 1a
A 26 year old lady A 26 year old lady has fever and fatigue.has fever and fatigue.
Hb 8.9 g/dlHb 8.9 g/dl
WCC 87 x 10WCC 87 x 1099/l/l
Plt 655 x 10Plt 655 x 1099/l/l
Q1. What is the Q1. What is the differrential differrential diagnosisdiagnosis
Q2. What further tests Q2. What further tests requiredrequired
Case 1bCase 1b
In this patient the In this patient the following would be following would be expectedexpected
A The Philadelphia chrom.A The Philadelphia chrom.B A t(9;22) translocation B A t(9;22) translocation
in cells of granulocytic, in cells of granulocytic, erythroid and erythroid and megakaryocytic lineagesmegakaryocytic lineages
C HyperuricaemiaC HyperuricaemiaD Transformation to an D Transformation to an
acute leukaemia as part acute leukaemia as part of the natural history of of the natural history of the diseasethe disease
Case 2Case 2
20 year old man 20 year old man admitted for fever admitted for fever & cough. On & cough. On exam. he was exam. he was pink and had pink and had bilateral lung bilateral lung crepitation crepitation
Hb 10.4 g/dlHb 10.4 g/dlTWBC 29.8 x 10TWBC 29.8 x 1099/l/lPlatelet 402 x 10Platelet 402 x 1099/l/l
Case 2Case 2
• The following are The following are features of features of infectioninfection
A.A. NeutrophiliaNeutrophilia
B.B. Toxic granulesToxic granules
C.C. VacuolationVacuolation
D.D. Dohle bodies Dohle bodies
E.E. Left shiftLeft shift
Case 3Case 3
• 62 year old man 62 year old man was under was under investigation for investigation for chronic back-achechronic back-ache
Hb 10.3 g/dlHb 10.3 g/dl
TWBC 3.0 x 10TWBC 3.0 x 1099/l/l
Plt 86 x 10Plt 86 x 1099/l/l
Case 3Case 3
In this patient with blood In this patient with blood film and bone marrow film and bone marrow aspirate as shown, it is aspirate as shown, it is likely thatlikely that
A erythrocyte A erythrocyte sedimentation rate is sedimentation rate is highhigh
B plasma globulin is B plasma globulin is increasedincreased
C he has massive C he has massive hepatosplenomegalyhepatosplenomegaly
D x-ray shows osteoblastic D x-ray shows osteoblastic lesionlesion
Case 4aCase 4a
This 35 year old This 35 year old lady diagnosed as lady diagnosed as acute leukaemia has acute leukaemia has marked bruisesmarked bruises
The possible cause forThe possible cause forthis lesionthis lesionA.A. thrombocytopeniathrombocytopeniaB.B. DICDICC.C. Haemolytic anaemiaHaemolytic anaemiaD.D. Megaloblastic Megaloblastic
ananemiaananemia
Case 4bCase 4b
Bone marrow is as Bone marrow is as shownshown
A The patient has A The patient has hypergranular hypergranular promyelocytic promyelocytic leukaemia (M3 leukaemia (M3 AML)AML)
B Cytogenetic is B Cytogenetic is helpfulhelpful
C A high plasma C A high plasma fibrinogen is fibrinogen is expectedexpected
D Anaemia is a D Anaemia is a featurefeature
Case 5Case 5
• 41 year old lady 41 year old lady complained of complained of increased fatigue increased fatigue and increased in and increased in menstrual bleedmenstrual bleed
Hb 8.1 g/dlHb 8.1 g/dl
TWBC 20.4 x 10TWBC 20.4 x 1099/l/l
Neutrophil 1%Neutrophil 1%
Platelet 19 x 10Platelet 19 x 1099/l /l
Case 5Case 5
• Based on blood film and Based on blood film and countcount
A.A. A possible diagnosis of A possible diagnosis of acute myeloid leukaemiaacute myeloid leukaemia
B.B. Myeloperoxidase staining Myeloperoxidase staining is positiveis positive
C.C. Stem cell transplant is the Stem cell transplant is the first line of treatmentfirst line of treatment
D.D. Reticulocytosis is a feature Reticulocytosis is a feature
Case 6Case 6
This blood film is from a This blood film is from a 15year-old girl who15year-old girl who
went to her GP with acute went to her GP with acute tonsillitis and rashes tonsillitis and rashes
A.A. Urgent bone marrow Urgent bone marrow examination is examination is indicatedindicated
B.B. Epstein-Barr virus Epstein-Barr virus could be responsible could be responsible
C.C. This abnormal cells This abnormal cells are T-lymphocyteare T-lymphocyte
D.D. Generalized Generalized lymphadenopathy is a lymphadenopathy is a featurefeature
Case 7aCase 7a
• This lady has This lady has cervical cervical lymphadenopathy.lymphadenopathy.
• The possible causes The possible causes areare
A.A. LymphomaLymphoma
B.B. Chronic lymphocytic Chronic lymphocytic leukaemialeukaemia
C.C. Essential Essential thrombocytaemiathrombocytaemia
D.D. TuberculosisTuberculosis
Case 7bCase 7b
• Her peripheral blood Her peripheral blood film shows many mature film shows many mature lymphocyte lymphocyte
A.A. A most likely diagnosis A most likely diagnosis is chronic lymphocytic is chronic lymphocytic leukaemialeukaemia
B.B. It is a disease of It is a disease of childhoodchildhood
C.C. The typical finding is The typical finding is peripheral blood peripheral blood lymphocytosislymphocytosis
D.D. Autoimmune haemolytic Autoimmune haemolytic anaemia is one of its anaemia is one of its complication complication
Case 8Case 8
• This blood film is This blood film is from a two-year-old from a two-year-old child with fever and child with fever and a cough. The likely a cough. The likely diagnosis isdiagnosis is
A Chronic lymphocytic A Chronic lymphocytic leukaemialeukaemia
B Acute lymphoblastic B Acute lymphoblastic leukaemialeukaemia
C TuberculosisC TuberculosisD Whooping cough D Whooping cough
Case 9Case 9
• Blood film is from a Blood film is from a 6 year old boy6 year old boy
A.A. Bone marrow is Bone marrow is indicatedindicated
B.B. Cervical Cervical lymphadenopathy is lymphadenopathy is a featurea feature
C.C. The cells stain The cells stain positive for Periodic positive for Periodic acid Schiffacid Schiff
D.D. EBV virus is its EBV virus is its possible causativepossible causative
Case 10Case 10
This 55 year old This 55 year old man complained man complained of headache. On of headache. On examination he examination he looks plethoriclooks plethoric
Hb 17g/dl HCT Hb 17g/dl HCT 0.57l/l0.57l/l
TWBC 17 x 10TWBC 17 x 1099/l/l
Plt 520 x 10Plt 520 x 1099/l/l
Possible causePossible cause
A.A. Ciggarate smokerCiggarate smoker
B.B. Polycythaemia Polycythaemia veravera
C.C. Megaloblastic Megaloblastic anaemiaanaemia
D.D. Renal tumourRenal tumour