6 June 2017 (Tuesday) - Megaloblastic?

This case appeared in a Facebook group I follow:

90 y-o widower has been living by himself since his wife of 68 years passed away. He has been feeling weak. The following are his lab results:

WBC: 9.3 G/L;

RBC: 2.94 T/L;

Hgb: 114 g/L;

MCV: 118 fL,

Plt: 287 G/L.

Bili: 27 umol/L (RR: 0-18),

LDH: 222 U/L (RR: 210-290)

Included here are his peripheral blood images. What do you think his follow-up tests should be? What presumptive diagnosis can you make from the current results?

Well, there’s a hypersegmented neutrophil and macrocytosis. The chap fits the classic B12/folate deficient sort of person.

But the liver function… what’s going on there? Is that part of the megaloblastic process?

5 June 2017 (Monday) - Case Study

The Lablogatory people emailed me with a case study today. A 24-year-old female at 34 weeks of gestation was transferred from an outside hospital with history of nephrolithiasis and right side pyelonephritis, for which she underwent stent placement 2 weeks ago. She started experiencing severe pain and muscle spasms in her hip and was unable to move her leg due to the pain. …

Whilst I don’t do clinical chemistry any more (at the moment) I like to keep my hand in (as it were). After all, I l always wanted to be a chemist…

2 June 2017 (Friday) - IBMS Newsletter

The IBMS newsletter arrived in my in-box this morning:

http://e-news.thebiomedicalscientist.net/q/17I2PLeFZksTnoHCE7FnzF/wv

1 June 2017 (Thursday) - What *is* that ?

This came up on a Facebook group I follow today.

“An 11 month old boy presented to ED with tiredness, temperature of 38.8°C, rashes to both thighs and arms, inactiveness. Routine Haematology, Biochemistry including VBG and CRP, and blood cultures were done.

WBC 13.6, Neuts 7.0 Lymph 4.9 Mono 1.5

Hb 122g/L, MCV 76.6 RDW 16.2 Plt 299 - essentially normal, with slightly raised neutrophils. All Biochemistry results were unremarkable, CRP 4mg/L (Normal <5). Blood cultures - negative.Now, check out the blood films  See if you can identify the abnormal cells and an explanation for them.”

Well, these are nucleated red cells…. Aren’t they…. ?

No

They are not….

What are they? They are most odd. It turned out that due to some most unusual combination of circumstances the patient’s blood sample got contaminated with QC material. It is not unusual for fixed avian or reptilian blood to be used as QC material.

It never occurred to me that this might happen. Admittedly this is probably a once-in-a-lifetime occurrence, but it is one to bear in mind nonetheless.

I had thought about telling my colleagues about this… I probably shall, but part of me wants to keep quiet in the hope that this amazingly unlikely event might take place and then I can look clever.

In the meantime I’m going to make a blood film on the QC material…