24 December 2020 (Thursday) - e-HEMATimage case studies

e-Hematimage 20.06 A 74-Year-Old Man with Pale Skin and Mucosa

The white cell differential  was unremarkable, but the red cell morphology showed hypochromia  and microcytosis with pencil cells and occasional target cell seen  

To answer the questions asked:

1 Describe the results of the blood count. 
Hypochromic microcytic anaemia

2 What cytological abnormalities on the blood film do you think are useful for diagnosis?
Hypochromic microcytic red cells with pencil cells and occasional target cell seen

3 In this context, do you think it is relevant to add a reticulocyte count?
Yes

4 The patient was not in a fasting state and must return to the laboratory the next morning to complete the check-up tests. Would you advise his treating physician to request further tests? If so, what tests would you suggest?
Iron studies – serum iron, TIBC (I’m old-skool!) and ferritin. It’s always worth checking the B12 & folate in these cases as a deficiency of those may well be masked by the iron deficiency

I did good…

e-Hematimage 20.07 A 2-Year-Old Male Child with Down Syndrome and a High White Blood Cell Count  

The white cell differential was horrible – loads of blast cells with just a few lymphocytes and only  a single neutrophil there

To answer the questions asked:  

1 What are the most significant findings associated with this patient’s full blood count and differential?
Leucocytosis – loads of blast cells with thrombocytopenia and anaemia

2 Describe the predominant leucocyte population. Considering the patient´s genetic condition, how would you classify these cells and what diagnosis seems more likely?
Blast cells - AML

3 How would you classify the cells presented in the image wall (continued)?
Yuk ! (in all honesty)

The diagnosis was either 
1. Myeloid leukaemia associated with Down syndrome
2. Acute megakaryoblastic leukemia (WHO) = M7 (FAB)  

I think I did OK – in such a case I would know to sound the “Red Alert” (!) I’d spotted the cytoplasmic blebs – I hadn’t realised that these are a feature in acute megakaryoblastic leukemia… but I do now.  I’ve learned something here, and as it says at the top of this page, a day when you learn nothing is a day wasted.