Blood Laboratory Flashcards
1
Q
Complete the diagam of blood cells
A
2
Q
Complete the diagram of blood
A
3
Q
What blood group is this patient?
A
This patient is B Rh Positive
4
Q
A red cell is roughly the same size as which white cell?
A
Lymphocyte
5
Q
What is a normal Hb level?
A
- Male Hb 135-180 g/L
- Female Hb 115-165 g/L
6
Q
What is a normal mean corpuscular volume?
A
MCV 80-100fL
7
Q
- 35 year old woman with heavy periods
- Hb 83g/L, MCV 71fL, MCH 20
- WBC 12.9 x109/L
- Platelets 293 x109/L
Questions:
- Comment on the morphology of the red cells (compared to normal red cells)?
- How do these abnormalities relate to the full blood count results given above?
- Think about a clinical cause for these findings
A
- Red cells pale and small. Some look like “pencil cells”.
- Low haemoglobin, low mean cell volume.
- This is iron deficiency anaemia.
- Commonest cause in the UK is blood loss.
- Here it is due to heavy periods.
8
Q
- 17 year old boy
- Sore throat, enlarged tonsils
- Fever and painful glands in the neck
- Hb 146g/L, Platelets 190x109/L
- WBC 9.2x109/L, Neuts 2.0, Lymphs 6.8
Questions:
- Comment on the morphology of the white cells (compared to normal white cells)?
- What type of white cell are the abnormal cells?
- Using the clinical information, think about a diagnosis
A
- The lymphocyte count is increased and there are large atypical looking mononuclear cells with blue cytoplasm
- These are activated T-cells that are reacting to B cells infected with virus called Epstein Barr virus.
- This is glandular fever (infectious mononucleosis)
- Confirm with a Monospot test
- Look for IgM and IgG EBV-specific serology
9
Q
- Male medical student returning from elective in Kenya
- Bitten by mosquitoes while there
- Irregular fever, headache and muscle pains
- Hb 136g/L
- Platelets 92 x109/L
Questions:
- What do you notice about the red cells?
- What do you think these abnormalities might be?
- Use the parasite ID charts to determine a diagnosis?
- Why does the patient have these symptoms?
A
- Red cell with an inclusion
- A parasite in the shape of a ring
- Delicate ring of Plasmodium falciparum
- Carried by female Anopheles mosquito
- Intravascular haemolysis
- Caused by parasite rupturing the red cell
- Platelets are consumed by intravascular clotting
10
Q
- 35 year old woman with fever and asthma
- Hb 120g/L, WBC 14.8x109/L, Platelets 188x109/L
Questions:
- Which type of white blood cell is increased compared with a normal white cell differential? (use approx %)
- What is the role of these cells?
- In what conditions are these cells increased?
A
- The eosinophil white cell predominates here.
- Typically have bilobed nucleus and orange granules
- Involved in allergic reactions and parasitic infections:
–Bronchial asthma
–Hay fever
–Drug allergy
–Worm infestation
–Hodgkin’s disease
–Vasculitis
Leukaemia
11
Q
- 76 year old man, regularly attends haematology clinic
- Large spleen and generalised lymph node enlargement
- Hb 122g/L, WBC 93 x109/L, Platelets 236 x109/L
Questions:
- What type of white blood cell is increased compared to a normal white cell differential? (use approx %)
- Describe the morphology of these cells
- Think about a possible diagnosis based on clinical findings
A
- Lymphocyte – slightly larger than a red cell
- Large blue nucleus with a thin rim of cytoplasm
- Anaemia, otherwise well, no fever
- Lymphoproliferative disorder
- Most likely chronic lymphocytic leukaemia (CLL)
12
Q
- 8 year old boy with lethargy and bruising
- Unwell, with a fever, purpuric rash, and weight loss
- Hb 78g/L
- WBC 21.8 x109/L, Neuts 0.2, Lymphs 0.4
- Platelets 22x109/L
Questions:
- Discuss the morphology of the white blood cells
- What type of cells do you think these might be? (use haematopoiesis diagram for help)
- How do the clinical findings relate to the blood results?
- Attempt a diagnosis
A
- Very large white cells present
- Very little cytoplasm
- Large nucleus which contains 1-2 holes (nucleoli)
- Primitive cell = Lymphoblast
- Normal marrow replaced by these primitive cells
- Low platelets cause bleeding
Diagnosis is acute lymphoblastic leukaemia (ALL)
13
Q
- 72 year old man with malaise and bleeding gums
- Hb=106 g/L
- WBC 52 x109/L, Neuts 2.1,Lymphs 3.7
- Platelets 18x109/L
Questions:
- Discuss the morphology of the white blood cells.
- What type of cells do you think these might be? (use haematopoiesis diagram for help)
- Attempt a diagnosis
A
- Large white cell with open chromatin in the nucleus
- 2-4 nucleoli per cell
- Plenty cytoplasm with pink granules
- Myeloblast
- Low platelets causes bruising
- Anaemia
- Raised white count with blasts in the blood
- Diagnosis is acute myeloblastic leukaemia (AML)
14
Q
- 8 year old Afro-Caribbean boy
- History of intermittent bone and muscle pain
- Previous stroke
- Hb 74g/L, MCV 78fL
- WBC 10.6 x109/L
- Platelets 418 x109/L
Questions:
- Discuss the morphology of the red blood cells
- How might this cause the clinical findings?
- What is the diagnosis?
A
- Red cells have an abnormal shape – sickled cells
- Target cells and Howell Jolly bodies also seen
- These cells do not deform and get stuck in small blood vessels to cause death of the tissues.
- This produces pain in bone and muscle and death of nerve tissue
- Diagnosis sickle cell anaemia HbSS (or HbSC disease)
15
Q
- 65 year old woman presents with angina of effort
- Shortness of breath and dependant ankle oedema
- Lives alone. Poor diet (mostly tea and toast)
- No fresh vegetables
- Hb 59g/L, MCV 134fL
- WBC 3.5 x109/L, Platelets 78 x109/L
Questions:
- Comment on the morphology of the red cells and white cells compared with normal
- How does the red cell morphology relate to the FBC results?
- Discuss possible causes for the clinical and laboratory findings
A
- Larger red cells that look like rugby balls
- Multi-lobed neutrophil (hyper-lobated)
- Anaemia with macrocytic well-haemoglobinised red cells
- Macrocytic, normochromic
- Megaloblastic anaemia
- Heart failure due to anaemia
- Diet deficient in folic acid due to poor diet
