Presentations

Question 1

Presentation: short stature, jaundiced

FH: father had splenectomy as child

Blood film shows: spherocytes polychromasia

Blood results: normal Hb, thrombocytosis, normal Fe

Answer 1

Hereditary spherocytosis

Question 2

Presentation: recent trip to Malawi

Blood film shows: reticulocytosis haemolysis

Blood results: anaemic

Answer 2

Malaria

Question 3

Presentation: weight loss, abdominal pain, rash

Blood film shows: target cells, Howell Jolly bodies, thrombocytosis, acanthocytes, +- mild lymphocytosis

Blood results: decreased folate, decreased B12, decrease serum Fe / ferritin

Answer 3

Celiac disease with hyposplenism

Question 4

Presentation: African man admitted with severe right hand pain

Blood film shows: sickle cells, polychromasia, target cells

Blood results: anaemic

Answer 4

Sickle cell anaemia

Dactylitis

Question 5

Presentation: acute confusion, febrile

Blood film shows: toxic neutrophil (hypergranulation), burst red cells / acanthocytosis

Blood results: leukocytosis, thrombocytosis, raised HCT - reactive features

Answer 5

Sepsis

Question 6

Presentation: 55 year old female, history Addison’s disease

Blood film shows: macrocytosis oval macrovalocytes + hypersegmented neutrophils polychromasia, anisopokilocytosis, circulating megaloblasts

Blood results: pancytopenia

What is the diagnosis?

What is the next best test if you could pick only 1?

Answer 6

Pernicious anaemia

Check B12 and folate

Question 7

Presentation: alcoholic TATT

Blood film shows: macrocytosis oval macrovalocytes + hypersegmented neutrophils polychromasia

Answer 7

Folate deficiency

Question 8

Presentation: menorrhagia 20 year old female

Blood film shows: hypochromic microcytic anaemia with rod / pencil cells

Answer 8

Fe deficiency anaemia

Question 9

Presentation: 20 year old male, pharyngitis, tender anterior cervical lymphadenopathy

Blood film shows: atypical lymphocytes

Blood results: presence of EBV

Answer 9

Glandular fever

Question 10

Presentation: 70 year old male, PMH valve replacement, SOB

Blood film shows: normocytic normochronic haemolytic anaemia with red cell fragments

Answer 10

Mechanical MAHA

Question 11

Presentation: SOB, fatigue

Blood film: polychromasia, spherocytes, macrocytic anaemia

Strongly positive Coombs direct antiglobulin test

Answer 11

Autoimmune haemolytic anaemia

Question 12

Presentation: elderly woman, easy bruising, infections

Blood film: anaemia, thrombocytopenia, myeloid blasts, auer rods

Answer 12

Acute myeloid leukaemia