27 March 2014 (Thursday) - Iron Deficient Thalassaemic

An interesting case. Today's results looked like a case of thalassaemia, but as always iron status needs to be considered. But look at the history. Today's result was not really anaemic. Compare it with that on May 2013 when there was anaemia. And look at the MCV and MCH then comared with todays. And despite the anaemia on May 2013 look at the red cell count.
An iron deficient thalassaemic has very interesting blood count values...

26 March 2014 (Wednesday) - "Normal" Haemoglobin Level ?

Two interesting cases today - both with historically stable Hb levels; however look at the MCV

One is an inicipient iron deficiency, the other a possible thalassaemia. The lesson here - a "normal" haemoglobin often warrants further investigations


22 March 2014 - Haemolysis

Whilst haemolysis is detected by most clinical chemistry analysers, other analysers don't look for it. Detection can be down to subjective opinion...

for a fuller discussion see http://huaxi.labsky.com/forum/uploads/2010-9/2010-09-09_173848.pdf

19 March 2014 - Jacobsen's Syndrome

A diagnosis of "?bleeding tendency". Coagulation studies were unremarkable; and were so on repeat samples too.
Eventually a diagnosis of Paris-Trousseau syndrome was made; which is a complication of Jacobsen's syndrome.

I'd not heard of either...


8 March 2014 (Saturday) - Medical Laboratory and Biomedical Science: Weekend Haematology Challenge

Weekend Haematology Challenge


CASE: 36 years old, HIV positive woman from Hyderabad, India has been suffering weigh lost and low grade fever during last months.Now she has nontender, erythematous, papulonodular lesions all over her body. Laboratory findings included anemia, leucopenia and hypergammaglobulinemia. Peripheral blood smear findings are in the picture.

Can you identify these leukocytes?
What are the other findings?

 Correct answer will be published here tomorrow morning at 07:00 (GMT+2)

It would be very easy to blag this after the event, but I shall publish before the closing date.

The leucocyte to the right hand side is an early neutrophil, certainly right shifted though probably past the metamyelocyte stage. It is toxically granulated. The leucocyte to the left is a granulated monocyte. Though small for a monocyte it has too much cytoplasm to be a lymphocyte.
The excessive granulation would suggest an acute infection is taking place.

6 March 2014 (Thursday) - Somewhat Apocryphal?

Full Blood Count

MR 21/02/1964 Male 1234567
Specimen No : NCC1701D

HB ^13.5 Q000 | NEUH 3.7 Q000 |
HBG 135 Q000 | LYMPH 2.3 Q000 |
WBC 8.6 Q000 | MONO 2.6 Q000 |
PLT 201 Q000 | EOS 0.0 Q000 |
RBC 4.56 Q000 | BASO 0.0 Q000 |
HCT 0.425 Q000 | ~F1 ^NRBC Q008 |
MCV 93.2 Q000 | ~F2 ^LS Q008 |
MCH 29.6 Q000 | ~F3 ^PCLUMP Q008 |
MCHC ^31.8 Q000 | |
MCHCG 318 Q000 |

This case came to light during a routine authorisation run today and is an example of a prejudice of mine. I am never happy in a case like this in which the automated differential gives values for neutrophils, lymphocytes and monocytes to be about the same.
Frankly I do not beleive such results and will *always* want to check the results visually on a blood film.

The results are (in my experience) invariably wrong; and usually suggestive of the presence of blast cells.

5 March 2014 (Wednesday) - Sjögren's syndrome

Sjögren's syndrome was something I'd never heard of before today. It was the diagnosis in a case for which I was asked to perform a CD4 cell count. On reflection and investigation I cannot see the relevence of such a cell count to the case

Sjögren's syndrome is a chronic autoimmune disease in which the body's white cells destroy the exocrine glands, specifically the salivary and lacrimal glands

The immune-mediated attack on the salivary and lacrimal glands leads to the development of dry mouth (xerostomia) and dry eyes (keratoconjunctivitis sicca), together with lymphocytic infiltration of the associated glands.
That inflammatory process eventually severely damages or destroys these glands.

There are two types of Sjögren's syndrome, primary or secondary form.
Primary Sjögren’s syndrome presents alone, in the absence of other autoimmune or connective tissue disorders and only impacts the salivary and lacrimal glands.
Secondary Sjogren’s syndrome presents along with other autoimmune or connective tissue disorders, such as rheumatoid arthritis, systemic lupus erythematosus or other autoimmune conditions.

Most of the population, as well as many medical providers, know little or nothing about Sjogren's syndrome. Despitre being the second most common form of arthritis, the average time to diagnosis of the syndrome is now 4.7 years


... there was a valid reason for a two year hiatus...