Here’s
an interesting case. A blood count from the A&E department. Diagnosis:
shortness of breath.
Look
at the white cell count and platelet count.
|
KIRK,CAPTAIN O+ 11/08/2016 16:07
MR 07/02/1939 Male
NCC1701 A&E
21 HIGH
STREET, CANTERBURY Dr Leonard
McCoy
Specimen No :
123456
------------------------------------------------------------------------------
09/08/2016
16:07
Request
Reason : sob.....
Haemoglobin ^9.3 g/dl
( 13 to 18 ) Auth
Haemoglobin 93 g/L ( 130 to 180 ) Auth
White Blood Cells 73.9 10^9/l (
4.0 to 11.0 ) Auth
Platelets 40 10^9/l (
150 to 400 ) Auth
Red Blood Cells 3.61 10^12/l (
4.5 to 6 ) Auth
Haematocrit 0.294 ratio (
0.4 to 0.50 ) Auth
Mean Cell Volume 81.4 fl ( 80 to 100 ) Auth
Mean Cell Haemoglobin 25.8 pg ( 27 to 32 ) Auth
Mean Cell Haemoglobin Concn ^31.6
g/dl ( 32 to 36 ) Auth
MCHC 316 g/L ( 320 to 360 ) Auth
Neutrophils 4.4
10^9/l ( 2.0 to 7.5 ) Auth
Lymphocytes 0.0 10^9/l (
1.5 to 4.0 ) Auth
Monocytes 0.0 10^9/l (
0.2 to 1.0 ) Auth
Eosinophils 0.0 10^9/l (
0.02 to 0.5 ) Auth
Basophils 0.0 10^9/l (
0.0 to 0.1 ) Auth
Metamyelocytes 0.0 10^9/l Auth
Myelocytes 0.0 10^9/l Auth
Promyelocytes 0.0 10^9/l Auth
Blast Cells 69.4 10^9/l Auth
Atypical Mononuclear Cells 0.0
10^9/l
Auth
Plasma Cells 0.0 10^9/l Auth
Blood film ^Referred to consultant
haematologist Auth
Nucleated Red Cells 1.0 /100WBC Auth
|
Alarm
bells rang in my head. A blood film showed rip-roaring leukaemia. I phoned the A&E
department and referred the film urgently to the consultant haematologist.
After
a little while it transpired that this was not news. The patient was well aware
of his leukaemia. He’d been diagnosed a little while ago in Devon and had moved
here in order to be near family during his illness. He’d been told to come to
the local hospital on arrival. That’s what he did. But he didn’t tell anyone
that he’d got leukaemia. He just said he was unwell.
The
moral of the story here is communication…
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