The results of NEQAS 2301DM came in today - I said:
|
Red
Cells Anisopoikilocytosis |
White cells Blast
cells
|
Platelets Large platelets |
I saw trypanosomes
too…
So… it’s
someone with thalassemia and a leukaemic process who’s got trypanosomiasis.
But…
Closing summary
The diagnosis is HbAE Barts. We were told that this person came from Thailand. The combination of microcytosis, target cells, contracted cells and polychromasia should suggest a thalassaemia syndrome. The absence of nucleated red cells is suggestive of HbH, and the presence of HbE should be considered in people presenting from this region – well done to all those who suggested these diagnoses!
A couple of features are worth additional comment: a significant number of participants correctly identified hemighost (blister) cells. These were certainly present in small numbers and are compatible with haemoglobin instability in this condition. However, this led some participants to consider a possible oxidative cause for the appearances (G6PD deficiency) – overall this is unlikely from the morphology shown (particularly in a female). Interestingly lead poisoning was considered by some (probably based on the basophilic stippling).
And finally, we did note that some participants selected neutropenia – certainly there were no neutrophils in this relatively small image for which we apologise (particularly to those who then considered MDS as a possible diagnosis).
Didn’t they see what I saw… or were they not blast cells and trypanosomes?
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