Slide Interpretation Dr Rosline Hassan Department Haematology, School of Medical Sciences, University Sains Malaysia

Case 1a A 26 year old lady has fever and fatigue. Hb 8.9 g/dl WCC 87 x 109/l Plt 655 x 109/l Q1. What is the differrential diagnosis Q2. What further tests required

Case 1b In this patient the following would be expected A The Philadelphia chrom. B A t(9;22) translocation in cells of granulocytic, erythroid and megakaryocytic lineages C Hyperuricaemia D Transformation to an acute leukaemia as part of the natural history of the disease

Case 2 20 year old man admitted for fever & cough. On exam. he was pink and had bilateral lung crepitation Hb 10.4 g/dl TWBC 29.8 x 109/l Platelet 402 x 109/l

Case 2 The following are features of infection Neutrophilia Toxic granules Vacuolation Dohle bodies Left shift

Case 3 62 year old man was under investigation for chronic back-ache Hb 10.3 g/dl TWBC 3.0 x 109/l Plt 86 x 109/l

Case 3 In this patient with blood film and bone marrow aspirate as shown, it is likely that A erythrocyte sedimentation rate is high B plasma globulin is increased C he has massive hepatosplenomegaly D x-ray shows osteoblastic lesion

Case 4a This 35 year old lady diagnosed as acute leukaemia has marked bruises The possible cause for this lesion thrombocytopenia DIC Haemolytic anaemia Megaloblastic ananemia

Case 4b Bone marrow is as shown A The patient has hypergranular promyelocytic leukaemia (M3 AML) B Cytogenetic is helpful C A high plasma fibrinogen is expected D Anaemia is a feature

Case 5 41 year old lady complained of increased fatigue and increased in menstrual bleed Hb 8.1 g/dl TWBC 20.4 x 109/l Neutrophil 1% Platelet 19 x 109/l

Case 5 Based on blood film and count A possible diagnosis of acute myeloid leukaemia Myeloperoxidase staining is positive Stem cell transplant is the first line of treatment Reticulocytosis is a feature

Case 6 This blood film is from a 15year-old girl who went to her GP with acute tonsillitis and rashes   Urgent bone marrow examination is indicated Epstein-Barr virus could be responsible This abnormal cells are T-lymphocyte Generalized lymphadenopathy is a feature

Case 7a This lady has cervical lymphadenopathy. The possible causes are Lymphoma Chronic lymphocytic leukaemia Essential thrombocytaemia Tuberculosis

Case 7b Her peripheral blood film shows many mature lymphocyte A most likely diagnosis is chronic lymphocytic leukaemia It is a disease of childhood The typical finding is peripheral blood lymphocytosis Autoimmune haemolytic anaemia is one of its complication

Case 8 This blood film is from a two-year-old child with fever and a cough. The likely diagnosis is A Chronic lymphocytic leukaemia B Acute lymphoblastic leukaemia C Tuberculosis D Whooping cough

Case 9 Blood film is from a 6 year old boy Bone marrow is indicated Cervical lymphadenopathy is a feature The cells stain positive for Periodic acid Schiff EBV virus is its possible causative

Case 10 This 55 year old man complained of headache. On examination he looks plethoric Hb 17g/dl HCT 0.57l/l TWBC 17 x 109/l Plt 520 x 109/l Possible cause Ciggarate smoker Polycythaemia vera Megaloblastic anaemia Renal tumour