Blood Lab 2 & 3 - Needs edit, incomplete Flashcards
68 yr old woman, presented with fatigue and weakness. CBC data shows anemia, neutropenia and thrombocytopenia. This is an image of her bone marrow biopsy. What would be at the top of your differential diagnosis?
Myelodyslpastic Syndromes
- Heterogenous group of malignant stem cell disorders characterized by dysplastic and ineffective blood cell production resulting in peripheral cytopenias
Bone marrow aspirate and cytogenetic analysis required for definitive diagnosis
- Bone marrow: dysplastic and often normocellular/hypercellular
- Cytogenetics: partial or total loss of chromosome 5, 7, Y or trisomy 8
68 yr old woman, presented with fatigue and weakness. CBC data shows anemia, neutropenia and thrombocytopenia. This is an image of her bone marrow aspirate. What would be at the top of your differential diagnosis?
Myelodyslpastic Syndromes
- Heterogenous group of malignant stem cell disorders characterized by dysplastic and ineffective blood cell production resulting in peripheral cytopenias
Bone marrow aspirate and cytogenetic analysis required for definitive diagnosis
- Bone marrow: dysplastic and often normocellular/hypercellular
- Cytogenetics: partial or total loss of chromosome 5, 7, Y or trisomy 8
49 yr old man, presented with fatigue, weakness and heaviness in left flank. Physical examination revealed splenomegaly ( 13 cms). CBC data showed anemia, and peripheral blood smear showed “leuko-erythroblastic picture” . What is the name of the cell in the image provided? What disease is this characteristic of and what other types of cells might you see in the smear?
Primary Myelofibrosis = Idiopathic Myelofibrosis
- Excessive bone marrow fibrosis leading to marrow failure
- Characterized by anemia, extramedullary hematopoiesis, leukoerythroblastosis, teardrop red cells in peripheral blood and hepatosplenomegaly
- Leukoerythroblastic blood film = primitive RBCs and WBCs present in blood
- PBS: leukoerythroblastosis with teardrop RBCs, nucleated RBCs, variable polychromasia, large platelets and megakaryocyte fragments
The image shows a tear drop cell. See attached image for other primitive cells that may be present in the smear.
49 yr old man, presented with fatigue, weakness and heaviness in left flank. Physical examination revealed splenomegaly ( 13 cms). CBC data showed anemia, and peripheral blood smear showed “leuko-erythroblastic picture”. Describe what you might find in a bone marrow biopsy of these patients. See attached image.
Primary Myelofibrosis
Bone marrow biopsy is essential for diagnosis: fibrosis, atypical megakaryocytic hyperplasia, thickening and distortion of the bony trabeculae (osetosclerosis)
The patient is a 25-year-old African-American male who is asymptomatic. The physical examination is unremarkable.
–Hgb………..148 g/L
–MCV……….93.1fL
–WBC……….4.6x109/L
–Plt…………..279x109/L
PBS shows no abnormalities.
What is your diagnosis based on the electrophoresis?
Hb S Trait
- A glutamic acid to valine mutation at the 6th amino acid position of the β chain
- Highest frequency in Africa, the northeast corner of Saudi Arabia and Kuwait, and an area in east central India
- Usually asymptomatic
- CBC and smear are within normal limits
- Hematuria (<1%), very rare sickling complication under extreme circumstances
- Hb S 35-40%
Needs Edit
•History
–The patient is a 25-year-old male of Asian descent who is asymptomatic. The physical examination showed no abnormalities
–Please see lesson attachment for laboratory information, investigation and diagnosis
•Blood Count Data
–RBC…………. 6.3x1012/L
–Hgb…………..149 g/L
–MCV………… 76.0fL
–WBC………….8.9x109/L
–Plt…………… 324x109/L
•Peripheral Blood Smear
–There is minimal microcytosis and occasional target cells
HbE Trait
- A substitution of lysine for glutamic acid at the 26th amino acid of the β globin chain
- Common in Southeast Asia
- Not cause anemia but mildly thalassemic picture, including mild microcytosis and target cells on the peripheral smear
- Hb E 30-35%
- Alkaline electrophoresis, co-migrates with Hb C, Hb O, Hb C-Harlem
- Acid Electrophoresis, Hb E migrate with Hb A, the other three migrate different position
Needs EDIT
The patient is a 35-year-old male from Kuwait. He has a history of chronic anemia since childhood and has had multiple blood transfusion. He had a splenectomy 8 years previous for splenic enlargement.
–RBC…………. 2.9 x1012/L
–Hgb………….. 82 g/L
–MCV………… 94 0fL
–WBC…………. 12.9 x109/L
–Plt…………….. 775 x109/L
•Peripheral Blood Smear
–The PBS shows marked red cell anisopoikilocytosis. This includes target cells, microcytes, and acanthocytes. There are Howell-Jolly bodies and Pappenheimer bodies. There is moderate polychromasia and many nucleated RBCs.
Homozygous ß0-thalassemia (ß-thalassemia major)
- Usually moderate to severely anemia
- Require lifelong transfusion
- Often splenomegaly
- Signs of increased bone marrow expansion:
–Frontal bossing
–Extramedullary tumors
Needs EDIT
- The patient is a 16-year-old African-American male who had a long history of recurrent abdominal and joint pain, often requiring narcotics for relief. The physical examination revealed a slender, black male in acute distress from abdominal pain. There was moderate scleral icterus and pale conjunctivae and mucous membranes. The spleen was not palpable.
- Please see lesson attachment for laboratory information, investigation and diagnosis
- Blood Count Data
–RBC…………. 1.6 x1012/L
–Hgb………….. 54 g/L
–MCV………… 85. 0 fL
–WBC…………. 12.9 x109/L
–Plt…………….. 253 x109/L
•Peripheral Blood Smear
Crescentic shaped RBCs, target cells, and Howell-Jolly bodies
. Other Blood Count Data
The solubility test for sickling hemoglobin is positive.
Sickle Cell Anemia
- Single nucleotide base change codes for valine instead of glutamic acid at the 6th position form the N-terminus of the beta globin chain
- Affects the shape and deformability of the red blood cells
- Leads to veno-occlusive disease (painful crises, CVA), hemolysis, and autosplenectomy
A 58 yr old man presented with anemia, neutropenia and splenomegaly. CBC data show monocytopenia and rare atypical lymphocytes. What type of cell is shown in the image below and what is the diagnosis based on the smear and symptoms given?
Hairy Cell Leukemia
What is type of cell is the unlabelled arrow pointing to? What type of leukemia is this associated with?
Chronic Lymphocytic Leukemia
Peripheral blood film:
- Lymphocytes are small and mature
- Smudge cells (unlabelled arrow)
What is the finding that the unlabelled arrow is pointing to? What diagnosis is this pathognomonic for?
Acute Myeloid Leukemia
- Rapidly progressive malignancy characterized by failure of myeloid cells to differentiate beyond blast stage
Peripheral Blood Smear
- Circulating blasts with Auer rods (azurophilic granules) are pathognomonic for AML
