diagnosis & further tests

Question 1

What to expect w/ condition of ovalocytes, *(include more0

Answer 1

• Macrocytic
• ovalocyte
• hypersegmentation*

Question 2

Dx this? & what further testing would you do?
FBC
- dec. Hb
- variable MCV
- sub.-pop of RBC

Peripheral blood film

• poikilocytosis: spherocytes*, schistocytes
• polychromasia (+++)
• nRBC
• inc reticulocytes (>2%)

Answer 2

Dx: Haemolytic anaemia

• dec. Hb = anaemia
• variable MCV = macrocytes /reticulocytes
• polychromasia = reticulocytes
• reticulocytes = inc erythropoeisis = compensate for anaemia

Further tests

• Osmotic fragility = inc bc if mostly macrocytic
• Serum bilirubin bc low Hb = inc bilirubin released
• Direct antiglobulin test (DAT) > see if haemolysis is due to Ab

Question 3

Dx this?

• Spherocytes
• osmotic fragility inc
• DAT: negative
• Reticulocytosis

Answer 3

Hereditary spherocytosis

Question 4

Dx this?
>25% eliptocytes
~4% reticulocytes

Answer 4

hereditary elliptocytosis

Question 5

Dx this? & further tests

• +++ stomatocytes
• macrocytosis

Answer 5

Dx: hereditary stomatocytes

Further test

• positive osmotic fragility test
• ektacytometric analysis

Question 6

Dx this? & further test

- BF: heinz bodies, Bliseter cells, Bite cells, hemighost cells, shistocytes

Answer 6

-Dx: glucose-6-phosphate dehydrogenase deficiency
Further test
- Fluorescent screen test = dec. NADPH, dec. fluorescence
- Definitive test = G6PD enzyme assay

Question 7

Dx this?

• echinocytes
• reticulocytosis

Answer 7

pyruvate kinase deficiency

Question 8

Dx this? & further test?

• FBC: macrocytosis (MCV), reticulocytosis
• BF: aggregates of RBC, Poikilocytosis, inc polychromasia

Answer 8

Dx: AIHA cold type

• Test: DAT

Question 9

• anemia,
• normocytic, normochromic,
• inc RDW (anisocytosis),
• reticulocytosis,
• hyperchromic/spheroc.
• BF: SPHEROCYTES*, inc. polychromasia/reticulo.

Answer 9

Dx: AIHA warm type
Further test:
- test: DAT = positive (IgG)
 - osmotic fragility = inc., 
- Ind. bilirubin = inc

Question 10

Dx this?
- AIHA
+ immune thrombocytopenia
+/or netropenia

Answer 10

evan’s syndrome

Question 11

What’s the condition that has

• Thrombocytopenia
• Anaemia
• leukopenia

Answer 11

pancytopenia

Question 12

Leokocytosis further testing

Answer 12

• immunophenotype

- Functional assay

Question 13

Dx reactive lymphocytosis

Answer 13

• **Viral infections
• Bacterial Infections
• Other infections: malaria

Question 14

Dx (at chronic phases) & further tests*

• leukocytosis (+ or +++ inc in WBC)
• Inc granulocyte?*
• Eosinophilia, basophilia
• ~50 mature neutrophils
• (>10% blast = accelerated phase)

Answer 14

Dx: Chronic myeloid leukaemia

Further tests:*

• cytogenetics to detect translocation in 9, 22
• FISH (fluorescence in situ hybridisation) to confirm fusion of genes

Question 15

Dx this? & Fyrther test?*

• inc Hb, PCV & RBC (*not always Hi)
• Thrombocytosis
• Granulocytosis

Answer 15

Dx: Polycythaemia vera

Further test*

• Epo conc. ?*
• JAK2?*

Question 16

Dx this? & Further test?

• Thrombocytosis
• anisocytosis of plts (sml to giant)
• microcytic, hypochromic anaemia

Answer 16

Dx: Essential thrombocythaemia

Further test:
- JAK?*

Question 17

Dx this? Further test?

• Left shift granulocytes
• Atypical MK
• Some (+, ++) microcytoc hypochromic anaema

Answer 17

Dx: Primary myelofibrosis - fibrotic phase

Question 18

Dx this? Further test?

• monocytosis
• Leukocytosis (inc WBC)
• normal morphology (<20% blast)

Answer 18

Dx: Chronic myelomonocytic leukaemia (CMML)

Further test:

• Cytogenetics = neg
• BM assessment

Question 19

Reasons/situations to explain reactive lymphocytes in cytoplasm

Answer 19

• Viral infections: influenza
• bacterial infections: tuberculosis
• Other infections: malaria
• Non-infectious: e.g. hypersensitivity

Question 20

Dx this? Further test?

• Inc MCV
• Normochromic
• Ovalocytes
• mild to marked anaemia

Answer 20

Dx: Megaloblastic macrocytic anaemia
Further test:
- FOlate test: bc could be deficient in folic acid
- Vit. B12 test bc could be defiecient

Question 21

Dx this? and further treatment

• anaemia
• leukopenia
• thrombocytopenia
• > 20% blast celles

Answer 21

Dx: acute leukaemia

Further test:

• Immunophenotype (detect cell linage affected?)
• Cytogenetic & genetic analysis

Question 22

diagnosis basophilic stippling (granules) in RBC

Answer 22

D: sideroblastic anaemia (granules of iron in RBC)
FT: iron studies like ferritin test

Question 23

dx this? further testing

• smudge cells
• lymphocytosis
• neutropenia, thrombocytopenia

Answer 23

Dx: (chronic) lymphocytic leukaemia
Further testing:
- immunophenotype

further test:
- immunophenotype: CD5+

Question 24

dx this?

• MICROCYTIC
• HYPOCHROMIC
• DACROCYTES/poikilocytes
• occasional HbH includions

Answer 24

dx: (alpha) thalassemia (minor)
further testing:
Hb electrophorhesis: HPLC (can distinguish to IDA -> abnormal iron studies results)

Question 25

dx this? further test

• microcytosis
• dacrocytes
• intracell. crystal
• inc MCHC

Answer 25

dx: HbC disease

FT: Hb Id

Question 26

Dx this? F tests

• from lymphopenia to -cytosis
• neutropenia, thrombocytopenia
• fine cytoplasmic projections like hair
• AIHA

Answer 26

dx: hairy cell leukaemia

further test:

• CD19+
• cytohem: pos for TRAP
• **molecular studies: BRAF V600E*

Question 27

what is satellitosis?

Answer 27

artefact: plts stuck on periphery of neutrophil

bc interacting w/ EDTA

Question 28

further testing if detect malaria (Plasmodium) in RBC

Answer 28

• confirm sp. by molecular testing

Question 29

dx this & FT

• intracellular bacteria in WBC
• vacoulation in neutrophil

Answer 29

dx: bacteremia

FT: blood culture

Question 30

what could rouleaux indicate

Answer 30

inflammatory disorder

Question 31

dx this? & FT

• low MCV
• microcytes ++
• (inc RCC)

Answer 31

dx; iron deficient erythropoeisis

FT: iron testing

Question 32

dx this

- marked nRBC

Answer 32

dx: normoblastemia

Question 33

dx this & further test

• thrombocytopenia
• SCHISTOCYTES

Answer 33

dx: DIC

FT: PT

• antithrombin levels
• coagulation test