acute leukaemia

Question 1

blood film

anaemia (red cells further apart)

blast cells (large stained cells)

mediastinal mass

WCC - 180

Answer 1

ALL

mass in posiyion of thymus, thymic infilitration of T cells (T-linegae)

Question 2

best to confirm diagnosis of ALL

immunophenotyping

cytochemsitry

Answer 2

Immunophenotyping (CD34 precurosr/stem cells + CD3 T cells)

as cytochemistry peroxidase/esterase wont show enough

Question 3

48 yr old male 2 weeks of bleding gums

1episode of haematuria

slightly reduced APTT

WCC normal

low platelets

HB slightly reduced

Bone marrow auer rods and granulocytes very granular

Answer 3

acute promyelocytic leukaemia

marrow obliterated by a population of myelocytes

diagnosis is by cytogenetic analysis /FISH/molecular genetic analysis 15:17 translocation and PML fusion

Question 4

anaemia blood film macrocytes but no hypersegmented neutrophils

+hypochromic microcytes

dimorphic film

bone marrow aspirate

12% blast cells (normal <5%)

45% erythroblasts

ringed sideroblasts

Answer 4

diagnosis: myelodysplastic syndrome

later needed red cell transfusion

ferritin was 875 (20-200)

need to keep eye on it , ferritin not high enough to risk liver/cardiac disease due to iron deposition

need to monitor

Question 5

72 W, vegetarian SOB fatigue painful gums/tongue, cant eat spicy food

pallor on examination

wcc normal

sever anaemia 52 hb

122McV

normal platelets

blood film: hypersegmented neutophils , tear drop cell

Answer 5

vitamin b12 folate assays

liver function

thyroid function

normal b12 folate

so now do a bone marrow aspirate

myelodplastic syndrome? no she has parietal cell antibodies positive and intrinsic factor antibodies positive