Interactive Leukaemia Cases

Question 1

A 5-year-old boy of Indian ethnic origin presented with lymphadenopathy and a mediastinal mass on chest radiology
WBC 180 × 109/l, Hb 93 g/l and platelet count 43 × 109/l
Blood film shows blast cells.

Answer 1

Acute lymphoblastic leukaemia

Question 2

What is a very high WCC in a child indicative of

Answer 2

Leukaemia

Question 3

What does a high WCC, low Hb and platelet count indicate

Answer 3

Bone marrow infiltration

Question 4

What is the most common mediastinal mass in leukaemia

Answer 4

Thymus which is infiltrated by T lymphoblasts

Question 5

What is the best way to confirm a diagnosis of acute lymphoblastic leukaemia

Answer 5

Immunophenotyping

Question 6

48-year-old male – railway engineer
2-week history bleeding gums
Attended dentist - severe bleeding 
1 episode of haematuria 
Minor bruising
Attended Accident and Emergency department
Left subconjunctival haemorrhage
Small bruises over abdomen
No enlarged lymph nodes
No hepatosplenomegaly

What test is most likely to reveal the cause of the problem.

What is the most likely diagnosis?

Answer 6

Blood count, film and coagulation screen

Acute promyelocytic leukaemia.

Question 7

How do you differentiate between myeloid and blast cells

Answer 7

Granules are strongly suggestive of myeloid cells

Question 8

What is the best test to confirm acute promyelocytic leukaemia

Answer 8

Cytogenetic analysysis/FISH/genetic analysis

Question 9

A 68-year-old retired secretary
Gradual onset of fatigue, lethargy and exertional dyspnoea
Non-smoker, not much alcohol, good diet
On examination 
Pallor (conjunctival and nail bed)
Mild ankle oedema 

Blood tests shows low haemaglobin and low MCV, high ferritin.
Blood film shows macrocytes but no oval macrocytes or hypersegmentation of neutrophils

Bone marrow aspirate: 12% blast cells, 45% of erythroblasts were ring sideroblasts

Answer 9

Myelodysplastic syndrome (refractory anaemia with excess of blasts)

Question 10

A 72-year-old Indian woman 
Vegetarian, teetotal, non-smoker
Shortness of breath on exertion
Fatigue
Painful gums and tongue
Unable to eat spicy food
On examination: pallor only

WBC normal
Hb 52 g/l
MCV 122 fl
Platelet count normal  
Vitamin B12 180 ng/l (NR 125‒600) 
Red cell folate 227 pg/l (NR 215‒650)
Thyroid function normal 
Liver function tests mildly impaired (bilirubin 20 μm/l, AST 110 iu/l (NR 40‒135)
Lactate dehydrogenase (LDH) 3870 iu/l (NR 50‒450)

Bone marrow aspirate showed: giant metamyelocyte and megaloblasts

Answer 10

Pernicious anaemia.