23 december 2020 (Wednesday) - More e-HEMATimage case studies

With a few moments spare today I looked at two e-HEMATimage case studies 

e-HEMATimage case study 20.04

On reading the title “18-Year-Old Man with Sore Throat, Headaches and Low Grade Fever” I immediately thought “Glandular Fever”… it’s the old “horses, not zebras” mantra. And clearly in this case it was a horse… with a zebra in there too.  

My colleague had got to the presentation before me and had done the diff – next time I must get there first – but seeing how she is paying for it and is being good enough to let me play I am in no way complaining. I went through the diff count – I agreed with most of the cells classifications but I think that I would have called more of the “normal” lymphs to be atypical.

It was only on having another look at the atypical/normal lymphs that I spotted the target cells… and the red cells – were they a tad small?
This was a case of glandular fever in a (transfusion-dependent) chap with beta thalasaemia major. 

e-HEMATimage case study 20.05 - “75-Year-Old Man in Poor General Condition”

My colleague had again got to the presentation before me and had done the diff – next time I really must get there first – but seeing how she is paying for it and is being good enough to let me play I am in no way complaining. I went through the diff count – I agreed with most of the cells classifications but I must admit I was a tad vague between what was classified as a plasma cell and what was classified as a lymphocyte. The plasma cell has more cytoplasm, and is darker… Generally…

The questions posed:  

Describe the predominant leucocyte population. Considering the medical history, how would you classify these cells?

 The main leucocyte population is of lymphoid lineage, predominately plasma cells  

Are there any abnormalities in the red blood cell morphology that are useful for diagnosis? .  

Rouleaux seen on the blood film is in keeping with increased plasma proteins.

Are there any abnormalities in the biochemical laboratory tests results that are useful for diagnosis?  

Raised plasma calcium and urea could be in keeping with bone destruction

 

 I think I did OK…