I got the results of 2601DM this
morning. I did it a month ago when I was presented with an image of a blood
film and this statement:
“A 60-year-old
man had commenced treatment for a serious haematological disorder. His white
cell count was raised, and platelet count reduced. He then became increasingly
anaemic with changed blood film features. You are asked for your opinion. The film
arrives outside of normal hours”
In my notes I wrote “Well,
there’s a bit of everything in this film, isn’t there. The red cells show
echinocytes, microspherocytes, blister cells, nucleated red cells, Howell Jolly
bodies, rec cell fragments.
The white cells are a
bit of a disaster – cerebriform/flower type lymphocytes, toxic granulation,
vacuoles in monocytes and neutrophils, smear cells, target cells, pyknotic
neutrophils, eosinophilia.
The platelet appeared
reduced, but we were told that anyway.
I didn’t fiddle about
trying to get the observations in order… time was pressing.
As this arrived out of
normal hours I would put it for the consultant to review in the morning… they
don’t thank us for being bothered about this sort of thing… this sort of thing
being a patient of which they are already well aware”.
The
expert opinion was rather odd… it waxed on as it so often does but seemed to
completely overlook the fact that this was in a patient with a known haematological
condition.
But
I spotted that which needed spotting and made the right decision
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