6 January 2018 (Saturday) - Morphology

Would you look at that !! This appeared in a Facebook group I follow – the patient has a quite amazing combination of factors creating the above blood picture.

87 y-o-m had a history of cardiac disease was followed up at the cardiology clinic because of increasing tiredness. CBC and blood film was ordered and presented in the images shown.

WBC: 6.4 giga/L, RBC: 4.55 tera/L, Hgb: 49 g/L, MCV: 44 fL, MCH: 10.8 pg, MCHC: 245 g/L
Impedance platelet: 3999 giga/L, Optical platelet: 403 giga/L, Manual platelet: 154 giga/L.

This patient was previously investigated for hemoglobinopathy and found to have alpha thalassemia trait. He also had a mechanical heart valve installed many years ago and now is not working. This may have contributed to the schistocytes seen in many of the images. Co-existing iron deficiency cannot be ruled out until iron studies (serum ferritin, TIBC) are performed as this maybe another contributing factor to his severe hypochromic state.

Another interesting lab finding on this patient: Three units of blood was ordered and on his transfusion record it was noted: "Atypical antibodies present." Sorry I don't have a follow-up on this.

Also note the platelet count by three different methods. The manual platelet count of 154 giga/L matches better with the blood film platelet estimation. So the impedance and optical platelet did not provide the best count.

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