Haem presentations Flashcards
A 25-year-old woman presents with a history of fatigue, ice craving, and dyspnoea upon exertion. She has three children. She did not tolerate antenatal vitamins during pregnancy, because of nausea. Examination reveals pallor and spooning of her nails. Vital signs are normal. There is no lymphadenopathy or hepatosplenomegaly.
Iron deficiency anaemia
A 26-year-old black woman presents in her thirteenth week of pregnancy with fatigue. She is found to be mildly anaemic with a haemoglobin of 110 g/L (11 g/dL) and an MCV of 75 femtolitres. She is empirically started on iron sulfate tablets and develops significant constipation. Four weeks later she has had no improvement in her haemoglobin and she is referred to haematology. She has never been pregnant previously. There is no known history of anaemia in her family. Her physical examination is unremarkable.
Alpha thalassemia
- More common in black africans
An 8-month-old boy of Mediterranean origin presents with pallor and abdominal distension, both of which are progressive. The perinatal history was uneventful, and the boy is noted to be pale, with poor feeding, decreased activity, and failure to thrive. Hepatosplenomegaly and mild bony abnormalities of the skull are noted (frontal and parietal bossing).
Beta thalassemia
A 6-month-old boy with no previous medical problems presents with fever and painful swelling of the hands and feet. His parents are concerned because he has been inconsolable for 6 hours. The infant has been refusing bottles and has needed fewer nappy changes over the last 2 days. The family recently moved from a country without established pregnancy and neonatal screening.
Sickle cell
An 18-year-old Greek man presents to the emergency department with severe nausea, vomiting, and diarrhoea. His mother explains that he had been at a lunch party with friends and none of the other guests were ill. The patient had ingested a meal of rice, meat, and freshly cooked beans. He has not had any significant illnesses in the past. Examination reveals a markedly dehydrated young man who is clinically anaemic and jaundiced. Investigations show a haemoglobin of 51 g/L (5.1 g/dL), raised WBC count with a predominant neutrophilia, elevated blood urea and creatinine, and deranged liver function.
G6PD deficiency
A 70-year-old man presents for a routine physical examination. He complains of fatigue, shortness of breath, and painful swallowing. He admits to daily alcohol consumption and decreased consumption of fresh vegetables and fruits. Physical examination reveals pallor, glossitis, flow murmur, and normal neurological examination.
Folate deficiency
A 58-year-old man presents to his primary care physician with increasing tiredness, accompanied by bruising on his legs. He also complains of aching bones. He has no recent history of illness. On examination, he is pyrexial and pale, has bony tenderness over the sternum and tibia, and has petechiae on his legs. There are no palpable lymph nodes. He has crepitations at the left base. The liver and spleen are not palpable.
AML
-Bony tenderness over sternum and tibia
54-year-old man presents to his primary care physician with a 2-month history of fever, malaise, and weight loss. He also reports frequent epistaxis, abdominal fullness, and early satiety. On examination, he is found to have splenomegaly.
CML
A 60-year-old man presents with swollen lymph nodes in the cervical and inguinal region that have been present for 2 months and are gradually increasing in size. The lymphadenopathy is painless and has not responded to a course of antibiotics prescribed by the primary care physician. The patient denies any recent history of infection, fever, or chills. A blood test shows an elevated WBC count. The WBCs are predominantly lymphocytes, with a differential of 88% lymphocytes and an absolute lymphocyte count of 80 x 10⁹/L (80,000 cells/microlitre).
CLL
A 38-year-old man presents to his primary care physician complaining of generalised weakness, epistaxis, mouth ulcers, and weight loss. He has an unremarkable past medical history and takes no medications. Physical examination reveals mild pallor and petechial haemorrhages over his lower limbs. He has multiple widespread small lymph nodes that are palpable, and mild splenomegaly.
ALL
-More serious symptoms so not CLL
- lymph nodes+splenomegaly so not AML/CML
A 25-year-old man presents to his general practitioner with a slowly enlarging, painless right neck mass. He denies recent upper respiratory tract infections, fevers, night sweats, or unintentional weight loss. He is otherwise healthy. Social history and family history are unremarkable. On examination he is afebrile with normal vital signs. Pertinent findings include a 3-cm, firm, round, non-tender, mobile mass in the mid-right neck. There is no other peripheral lymphadenopathy. Liver and spleen are not enlarged.
Hodgkin’s lymphoma
A 55-year-old male farmer presents with worsening shortness of breath, night sweats, fevers, bilateral axillary lymphadenopathy, and a 7.7 kg (12%) total body weight loss over 3 months. Recently, he has not been able to work because of fatigue. Physical examination reveals a 3.5 cm left axillary mass, enlarged cervical, axillary, and inguinal lymph nodes, splenomegaly, and no hepatomegaly.
Non hodgkin’s lymphoma
A 60-year-old previously healthy man presents with 2-3 months of back pain. Over the last 3 weeks, he has developed a cough and increasing fatigue. On examination he has evidence of pneumonia and osteolytic lesions on radiography. Laboratory data reveal anaemia associated with the presence of a monoclonal protein.
Multiple myeloma
A 45-year-old woman presents to the accident and emergency department with nausea, vomiting, and confusion. She has a history of low back pain of 6 months’ duration and increasing sciatic pain in the last 2 weeks. On physical examination, the patient is pale and dehydrated with bone tenderness in the lumbar region. Neurological examination reveals an upgoing plantar reflex on the left foot with intact power in all muscle groups and at all joints. Magnetic resonance imaging reveals an L5 compression fracture. This is associated with hypercalcaemia and renal insufficiency.
Multiple myeloma
A 55-year-old man has had routine physical examinations for several years and has always been healthy, does not smoke, and has no history of pulmonary disease. His primary care physician has noted a gradually increasing haemoglobin level over the past few years (to a current level of 195 g/L [19.5 g/dL]), mild leukocytosis, and mild thrombocytosis. He has frequent episodes of facial flushing that are associated with slight headaches and a feeling of fullness in his head and neck. He has noted intermittent burning, stinging, and tingling sensations in his fingertips. He has recurrent, often severe, pruritus that is exacerbated by taking a hot bath. On examination, he has a red face and neck and the spleen is mildly enlarged.
Polycythaemia Vera
