Having looked at
NEQAS 2405DM on 12 September I get the resuts today.
“A previously fit 34-years old female
attended her GP feeling tired. Her Haemoglobin was found to be 70g/l with
normal white cell count and platelets – a blood film was prepared. What is your
impression?”
I said:
“A previously fit 34-years old female attended her GP feeling tired. Her Haemoglobin was found to be 70g/l with normal white cell count and platelets – a blood film was prepared. What is your impression?”
I said:
|
Red cells Anisopoikilocytosis Fragmented cells Polychromasia Marcrocytosis Target cells Tear drop cells |
White cells Hypersegmented neutrophil Toxic granulation Vacuolated monocyte with cleft nucleus |
Platelets
Unremarkable |
“Something haemolytic, but what are those vacuoles in the white cells. And what's the hypersegmented neutrophil all about?”
The expert comments were:
This blood film shows a severe deficiency of vitamin B12. The features quite distinct with the expected combination of oval macrocytes and hypersegmented neutrophils. If you have not seen a case like this before however, you may be surprised by the features of red cell fragility (fragments and misshapen cells) which can sometimes be mistaken for a fragmentation syndrome or even for microcytes. Also remember that the packed marrow can lead to many typical tear-drop forms being present.
Well… I spotted the salient features but I did mistake them for a fragmentation syndrome. Just as well it’s not up to me to make a diagnosis. I’ve always said it’s unfair to judge us on something we don’t actually do.
And again I’ll make the comment that it is a shame that it took two months to get the result.
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