Haematology case studies

Question 1

What are the normal values for Hb, MCV, platelets?

Answer 1

Hb 
- males 13.5-18g/dl
- females 11.5-16g/dl
MCV 75-95 fl
platelets - 150-450x10^9/L

Question 2

What are the normal values for WBC, neutrophils, lymphocytes, eosinophils, basophils?

Answer 2

WBC - 4 - 11x10^9/L
Neutrophil - 2.5-7.5x10^9/L
Lymphocytes - 1.5-3.5x10^9/L 
Eosinophils - 0.04-0.4x10^9/L
Basophils - 0.01-0.1x10^9/L

Question 3

What are the normal values for bleeding time, PT, APTT and TT?

Answer 3

Bleeding time - <10mins
PT <13 seconds
APTT <40 seconds
TT<11 seconds

Question 4

Case 1:

• 5 yr old pallor and jaundice
• Hb =: 6.7g/dl, MCV = 104fl, WCC 9x10^9/L, platelets = 278x10^9/L
• blood film: spherocytes++, polychromasia
• direct coombs test = negative (+ve in autoimmune)

What is the diagnosis?

Which biochemical tests below is most useful in following

Answer 4

Hereditary spherocytosis
- macrocytic anaemia

Bilirubin - as it is a haemolytic process

Question 5

What cell is elevated in a chronic asthma patient?

Answer 5

eosinophil

Question 6

Case 2:

• 78 caucasian M, fatigue, weight loss and altered bowel habits
• Hb - 7.3g/dl, MCV- 65fl, WCC 6.7x10^9/L, plt- 492x10^9/L

What is the likely diagnosis and what would you recommend as the next management step?

Answer 6

likely iron deficiency anaemia which increases risk of bowel cancer
=> refer for colonoscopy and biopsy

Question 7

Case 3:

• 2 yr old M, swollen, bruised elbow following a fall 4 hours ago
• well prior to the fall, apyrexial
• Hb - 13.7g/dl, WCC 8.7x10^9/L, plts- 279x10^9/L
• bleeding time = 8 mins
• APTT = 60s
• PT - 11.2s
• TT - 10s

What is the most likely underlying diagnosis ?

Answer 7

Haemophilia a
the APTT is abnormal = which is a measure of he intrinsic coagulation pathway

Haemophilia - joints tend to bleed

Question 8

Case 4:

• 2 yr old F recurrent spontaneous nose bleeds
• otherwise well
• Hb - 13.7g/dl, WCC 8.7x10^9/L, plts - 279x10^9/L
• Bleeding time 15 mins
• PT - 11.2s
• APTT 60s
• TT 10s

What is the most likely underlying diagnosis ?

Answer 8

Von willebrands disease - low levels of vWb factor therefore you consequently have low levels of FVIII as it carries it

tend to get mucosal bleeds, don’t occur in haemophilia

Question 9

Case 5:

• 23 M with painless cervical and mediastinal lymphadenopathy associated with fevers and night sweats
• FBC normal
• Lymph biopsy indicate hodgkin reinberg stem cells

What is the diagnosis and what is the prognosis with chemotherapy?

Answer 9

hodgkins lymphoma
- these cells have 2 nuclei = malignant cells

80% survival at 5 years - early stage is even better now

Question 10

Case 6:

• 79 F severe back pain, confusion and constipation
• Hb - 8.7g/dl, WCC 9.2x10^9/L, Plt- 274x10^9/L
• Na - 143mM, Creat - 179microM, Ca0 3.7mM, K- 4.2mM, urea - 10.3mM, Alb 40g.L
• bone marrow aspirate showed lots of plasma cells

What is the underlying diagnosis?
What is the cause of the confusion and constipation?

Answer 10

multiple myeloma

hypercalcaemia

Question 11

Case 7:

• 19 M 2/52 hx enlarged cervical lymph node to 2cm in size, fatigue, occasional low grade fever
• Hb - 14.2g/dl, WCC 15x10^9/L, plt 465x10^/L

What would be the next management step and what could the diagnosis be?

Answer 11

send blood sample for paul bunnell test

- could be glandular fever caused by EBV

Question 12

Case 8:

• 22 F easy bruising and increasing lethargy
• Hb 7g/dl, WCC 1.1x10^9/L, neutrophils 0.3x10^9/Lm plts 22x10^9/L

What is the most likely diagnosis?

Answer 12

idiopathic aplastic anaemia - extremely rare

Question 13

Case 9:

• 55 M lethargy
• Hb 10.2g/dl, MCV 82fl, WCC 223x10^9/L, plts 658x10^9/L
• ctyogenetic analysis of the bone marrow => chr 9 and Chr22 are abnormal

What is the likely diagnosis?

Answer 13

Chronic myeloid leukaemia

Question 14

Case 10:

• 57 M severe pneumonia and bruising
• within 3 hours admission, begins to bleed from around the IV cannula site
• Hb 7.1g/dl, WCC 22X10^9/L, plts 18x10^9/L
• PT 22s
• APTT 55s
• blood film - there are few platelets

What complication has developed in this patient?

In addition to antibiotics what blood products should this patient receive?

Answer 14

disseminated intravascular coagulation (DIC)

• anaemia and thrombocytopenic
• microcoagulation triggered by infection=> fibrin formation => red cell fragments

red cells, platelets and cryoprecipitate transfusions

Question 15

Case 11:

• 18 F afrocarribean origin has chest pains, breathlessness and profoundly hypoxic
• known to have longstanding anaemia
• Hb - 7.9g/dl, MCV - 89fl, WCC 9x10^9/L, plt 335x10^9/L

What medical emergecy is this patient likely to have ?

Answer 15

sickle chest crisis - needs an exchange transfusion

Question 16

On a post mortem the spleen is taken out and found to be 5cm long what is the consequence of this abnormality?

Answer 16

likely infection - a normal spleen is 10-12 cm

Question 17

Case 12:

• 40 F lethargy and bruising
• Hb 7.9g/dl, WCC 21x10^9/L, plts 57x10^9/L
• blood film shows auer rod

What is the most likely diagnosis?

Answer 17

Acute myeloid leukaemia - auer rods are pathopneumonic of AML

Question 18

Case 13:

• 54 vegan, tiredness and SOB
• abnormal neutrophils
• Hb 8.1g/dl, MCV - 115fl, WCC 3x10^9/L, neutrophils 1x10^9/L, plts 110x10^9/L

What is the most likely diagnosis?

Answer 18

folate deficiency
- macrocytic anaemia= could also be a b12 deficiency
it isnt iron deficiency anaemia as this would give you a low MCV

Question 19

Case 14:

• 67 M anaemia and abdominal pain
• blood film shows leucoerythroblastic picture
• bone marrow shows extensive fibrosis
• Hb 8.6g/dl, MCV 84fl, WCC 1.2x10^9/L, neutrophils 0.7x10^9/L, plts 36x10^9/L

What is the likely diagnosis?

Answer 19

myelofibrosis

- enlarged spleen and extramedullary fibrosis