I finally got the
result of 2603DM today… “a 43-year-old man who regularly attends
Haematology outpatients. The blood film was prepared after new features were
noticed in his blood count. Your opinion is requested”.
I can’t remember it at
all, but at the time I said: “I’d say he regularly attends haematology
outpatients because of a haemoglobinopathy. There’s target cells, sickle cells,
nucleated red cells, polychromasia and Howell-Jolly bodies there.
And there’s blast cells
and smear cells.
And there’s an
eosinophilia too.
The platelet count is
down as well
I’d say this is someone
with sickle cell disease (possibly HbSC or with a co-existing thalassaemia
because of the target cells) who has suddenly developed leukaemia”.
The expert opinion was “This is a
case of sickle cell disease (HbSS) with typical red cell features including
sickle cells, boat-shaped cells, hyposplenic features and nRBCs. However, in
this case there are also blast cells which should not be present and indicate
the additional presence of an acute leukaemia. The important principle here is
to recognise that we like to consolidate all features of a diagnostic blood
film into a single diagnosis (e.g. sickle cell anaemia with
reactive/hyposplenic features, or an acute leukaemia or myelofibrosis with
associated red cell change). The key is sometimes to focus on the really key
findings – in this case the blast cells, thrombocytopenia and typical sickle
cells. Then ask whether this is really compatible with a single disorder”.
So… I’d spotted all the salient
features. I got it right.
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