1. Hematology RBC/WBC Case Studies
Senior Seminar
Spring 2015
Kristin Palladino, M.S., MLS(ASCP)CM

2. Case 1
Patient History:
15 year old female sent home from summer camp because of fatigue, weakness and sore throat. The physician found that on physical examination she had an inflamed pharynx, enlarged tonsils, several enlarged and slightly tender lymph nodes in the neck, a palpable spleen and a tender palpable liver edge.

3. Case 1 Laboratory Findings: CBC Hgb: 14.9 g/dl WBC: 12,500/mm3
Plt: 282,000/mm3

4. Case 1

5. Case 1 What is the diagnosis in this case?
Infectious mononucleosis
What other laboratory tests may be helpful in confirming the diagnosis?
A serologic test for infectious mononucleosis would confirm the diagnosis

6. Case 2
Patient History:
65 year old male who was in good health except for mild hypertension. At his last check up-, a CBC showed a markedly elevated white blood cell count and physical examination revealed several slightly enlarged lymph nodes in the neck and the axillae and the spleen was palpable.

7. Case 2 Laboratory Findings: CBC Hgb: 12.8 g/dl WBC: 13,000/mm3
Plt: 330,000/mm3

8. Case 2

9. Case 2 What is the predominant white blood cell type present?
Most of the WBCs are small to medium-sized lymphocytes. In addition, there are some larger lymphocytes with abundant cytoplasm and a prominent nucleolus, which are prolymphocytes.
What is the differential diagnosis?
Chronic Lymphocytic Leukemia (CLL)

10. Case 3
Patient History:
52 year old male with gradually increasing fatigue together with discomfort in the left upper quadrant. Physical examination revealed an easily palpable spleen and liver edge. A few slightly enlarged lyph nodes were palpable in the neck.

11. Case 3 Laboratory Findings: CBC Hgb: 13.2 g/dl WBC: 46,000/mm3
Plt: 754,000/mm3

12. Case 3

13. Case 3

14. Case 3 What type of blood cells are present?
The WBC count is moderately elevated, with a wide spectrum of granulocytes at various stages of maturation (rare blasts and promyelocytes, myelocytes, metamyelocytes, bands and polys). Platelets are moderately increased in number and some large forms are seen.
What do you think the diagnosis is in this case?
Chronic Myelogenous Leukemia (CML)

15. Case 4
Patient History:
A 5 year old boy has been too tired to play with his friends for two months. His mother is also worried that whenever he falls or bumps into anything, a big bruise forms. For the past 2 days he had a high fever.

16. Case 4 Laboratory Findings: CBC: Hgb: 9.8 g/dl Hct: 28.2% MCV: 95 fl
Plt: 74,000/mm3
WBC: 2,300/mm3
Diff
23 Polys
15 bands
12 monos
44 lymphs
5 eos
1 baso

17. Case 4 Laboratory Findings:
A bone marrow biopsy shows replacement by primitive cells that have large nuclei with delicate chromatin and indistinct nucleoli. There is scant cytoplasm with no granules and auer rods. These cells mark for CD10 (CALLA) antigen.

18. Case 4

19. Case 4 What type of white blood cells are present?
The WBCs present are predominantly lymphoblasts.
What is the most likely diagnosis?
Acute Lymphocytic Leukemia (ALL)
What is the most likely outcome of this child’s disease with standard therapy?
The most likely outcome of this child’s disease with standard therapy is good-a >90% chance for complete remission following chemotherapy.

20. Case 5
Patient History:
A 51 year old male was seen by his physician for a routine preoperative exam prior to dental surgery. He was found to have a large left upper quadrant mass. Marked splenomegaly was confirmed by CT scan.

21. Case 5 Laboratory Findings: CBC RBC: 3.36 x 1012/L Hgb: 10.9 g/dl
Hct: 31.2%
MCV 92.8 fl
MCH: 32.4 pg
MCHC: 34.9 g/dl
WBC: 9.3 X 109/L
Diff
Polys: 14
Lymphs: 15
Abnormal: 71
Plt: 59 X 109/L

22. Case 5

23. Case 5
What morphologic alterations are seen in this blood smear field?
Abnormal WBCs with round or indented nuclei with a fairly coarse chromatin pattern. They have variable amounts of grainy-blue cytoplasm with irregular ragged borders and numerous projections.
What is the most likely diagnosis?
Hairy Cell Leukemia

24. Case 6
Patient History:
A 15 year old girl complained of fatigue and loss of stamina. Her appetite was poor. Her monthly menstrual flow was heavy.

25. Case 6 Laboratory Results: Hgb: 8 g/dl MCV: 65 fl WBC: 7,000/mm3
Neutrophils: 73%
Lymphocytes: 24%

26. Case 6

27. Case 6 What type of anemia does this patient have?
Microcytic, Hypochromic
List 4 possible underlying causes of the disease
Iron deficiency, thalassemia, anemia of chronic disease, sideroblastic anemia or Pb toxicity
What additional tests could be done to confirm diagnosis?
Serum ferritin, serum iron, TIBC, Hemoglobin electrophoresis, bone marrow examination, lead level

28. Case 7
A 37 year old male is complaining of weakness. He is pale and gave a history of petechiae and hematuria

29. Case 7 Laboratory Findings: CBC Hgb: 7 g/dl WBC: 2,200/mm3
Neut: 23%
Lymph: 70%
Mono: 3%
Eos: 3%
Baso 1%
Plt: 30,000/mm3
The peripheral blood smear showed normocytic/normochromic RBCs

30. Case 7 What is your diagnosis? A. Aplastic anemia
B. Drug induced neutropenia
C. Accelerated destruction of neutrophils