Would you
look at that !! This appeared in a
Facebook group I follow – the patient has a quite amazing combination of
factors creating the above blood picture.
“87 y-o-m had a history of cardiac disease
was followed up at the cardiology clinic because of increasing tiredness. CBC
and blood film was ordered and presented in the images shown.
WBC: 6.4 giga/L, RBC: 4.55 tera/L, Hgb: 49
g/L, MCV: 44 fL, MCH: 10.8 pg, MCHC: 245 g/L
Impedance platelet: 3999 giga/L, Optical
platelet: 403 giga/L, Manual platelet: 154 giga/L.
This patient was previously investigated for
hemoglobinopathy and found to have alpha thalassemia trait. He also had a
mechanical heart valve installed many years ago and now is not working. This
may have contributed to the schistocytes seen in many of the images.
Co-existing iron deficiency cannot be ruled out until iron studies (serum
ferritin, TIBC) are performed as this maybe another contributing factor to his
severe hypochromic state.
Another interesting lab finding on this
patient: Three units of blood was ordered and on his transfusion record it was
noted: "Atypical antibodies present." Sorry I don't have a follow-up
on this.
Also note the platelet count by three
different methods. The manual platelet count of 154 giga/L matches better with
the blood film platelet estimation. So the impedance and optical platelet did
not provide the best count.”
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