I got hold of the
results of 2604DM today. When I looked at it I said:
- Neutrophilia – mature cells
- Howell Jolly Bodies
- Sickle cells
- Target cells
- Polychromasia
- Some Large platelets
Was this someone with
sickle cell disease with some sort of myeloproliferation?
The expert final comment
that I read today was:
“This film showed a
G-CSF-induced neutrophilia in a patient with sickle cell disease (who was
recovering from chemotherapy).
It is often easy to
overlook a second disorder when there is a dominant abnormal feature on a blood
film. In this case, there were clues to a red cell element: red cell
appearances were very abnormal and nucleated red cells and Howell-Jolly bodies
were present, but most of all there were clear sickle cells on the film. If you
missed these, have another look.
Could you have known
the neutrophilia was caused by G-CSF administration? Probably not, but given
the high neutrophil count, it would be unusual for an infective cause not to
have marked toxic features in the neutrophils! A chronic neutrophilic leukaemia
could be considered if G-CSF had not been administered”.
Well, I spotted the
salient features, but my final comment might not appear very
professional, but what a load of bollox. It is utterly inconceivable that a
patient with sickle cell disease who was receiving G-CSF following chemotherapy
would be unknown to the haematology laboratory.
For these exercises to have any validity
they need to have al least a passing relationship with reality.
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