Good afternoon

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Good afternoon
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Haemopoiesis in Bone Marrow
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• Clinical Correlation Interpretation

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Case No.1

• 13/F Generalised weakness
• Fatigue
• Pedal edema
• O/E Pallor Tongue Conjunctiva
• Spoon shaped nails

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Clinical findings
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Lab Tests

• Hb 5.4g
• Total RBC count 2.1millions/cumm
• Total WBC count 6000 cells/cumm
• DC - P57 L33 E6 M4 B0
• PCV 18
• MCV 60
• MCH 22
• MCHC 26
• RDW 17
• Platelet count 2.5 lakhs/cumm
• Peripheral smear
• Reticulocyte count 1

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Lab Tests

• Hb 5.4g
• Total RBC count 2.1millions/cumm
• Total WBC count 6000 cells/cumm
• DC - P57 L33 E6 M4 B0
• PCV 18
• MCV 60
• MCH 22
• MCHC 26
• RDW 17
• Platelet count 2.5 lakhs/cumm
• Peripheral smear
• Reticulocyte count 1

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Microcytic Hypochromic - IDA
Microcyte
Ovalocyte
Hypochromic
Lymphocyte
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Biochemical Studies

• Serum Iron?
• Serum Ferritin?
• Iron Binding Capacity?
• Transferrin Saturation ?
• BM Iron study

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Microcytic Anaemias
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Normal BM High Power
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BM Erythroid Hyperplasia -
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Perls stain - Normal marrow -Prussian blue
reaction
Absence of stainable Iron in bone marrow
aspirate
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Differential Diagnosis

• Iron Deficiency Anaemia
• Thalassemia
• Anaemia of Chronic disease
• Sideroblastic Anaemia

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Diagnosis

• Iron Deficiency Anaemia by Ferritin HbA2

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Case No 2

• 50 / F - Fatigue
• H/O Abdominal Pain
• Vegetarian

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Lab tests

• Hb 8.4g
• Total RBC count 2.6millions/cumm
• Total WBC count 2000 cells/cumm
• DC - P57 L33 E6 M4 B0
• PCV 22
• MCV 112
• MCH 26
• MCHC 32
• RDW 13
• Platelet count 3.2 lakhs/cumm
• Peripheral smear
• Reticulocyte count 1

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Lab tests

• Hb 8.4g
• Total RBC count 2.6millions/cumm
• Total WBC count 2000 cells/cumm
• DC - P57 L33 E6 M4 B0
• PCV 22
• MCV 112
• MCH 26
• MCHC 32
• RDW 13
• Platelet count 3.2 lakhs/cumm
• Peripheral smear
• Reticulocyte count 1

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PS - Macrocytosis
Hypersegmented Neutrophil
Macrocytes
Macrocytes
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Peripheral smear
Macrocyte
Hypersegmented Neutrophil
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BM- Megaloblast
Giant Metamyelocyte
Megaloblast
Giant band form
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BM- Megaloblast
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Biochemical Tests

• Serum B12 levels- ?
• Serum Folate levels- ?
• Schilling Test

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Differential Diagnosis

• Chronic Alcholism
• Liver Disease
• Megaloblastic anaemia

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Diagnosis

• Megaloblastic Anaemia

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Case No 3

• 13/F Presented with Fever on off 8years
• H/O Jaundice - 8 years
• H/O passing high colored urine

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Lab Tests

• Hb 7.2g
• Total RBC count 2.8millions/cumm
• Total WBC count 6000 cells/cumm
• DC - P57 L33 E6 M4 B0
• PCV 2.4
• MCV 52
• MCH 27
• MCHC 26
• Platelet count 2.3 lakhs/ cumm
• RDW - 13
• Peripheral smear

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Lab Tests

• Hb 7.2g
• Total RBC count 2.8millions/cumm
• Total WBC count 6000 cells/cumm
• DC - P57 L33 E6 M4 B0
• PCV 2.4
• MCV?
• MCH ?
• MCHC ?
• RDW 13
• Platelet count 2.3 lakhs/ cumm
• Peripheral smear

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PS - Sickle cells Target cells
Target cells
Sickle cells
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Other Tests

• Reticulocyte count 6
• Serum bilirubin 8 mg
• Direct Bilirubin 2mg
• Indirect Bilirubin- 6mg
• Hb Electrophresis

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Reticulocytes
Supravital
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Diagnosis

• Sickle cell Anaemia

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Autosplenectomy - SS
Normal spleen is 8 to 12 cm
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Case No 4

• 10 / F Puffiness of Face 6 months
• Pedal edema
• H/O Fatigue
• O/E Pallor of Conjunctiva, mouth Nails
• USG - Hepatosplenomegaly

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Frontal bossing
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Lab Tests

• Hb 4.6g
• Total RBC count 4.2millions/cumm
• Total WBC count 8000 cells/cumm
• DC - P57 L33 E6 M4 B0
• PCV 18
• MCV 52
• MCH 27
• MCHC 26
• RDW 16
• Platelet count 1.5 lakhs/cumm
• Peripheral smear

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Lab Tests

• Hb 4.6g
• Total RBC count 2.8millions/cumm
• Total WBC count 8000 cells/cumm
• DC - P57 L33 E6 M4 B0
• PCV 18
• MCV 52
• MCH 27
• MCHC 26
• RDW 16
• Platelet count 1.5 lakhs/cumm
• Peripheral smear

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PS Polychromasia, Target cells, Tear drop cells
Nucleated RBC
Target cells
Polychromasia
Normoblast
Tear drop cell
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BM Erythroid Hyperplasia -
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Differential Diagnosis

• Iron Deficiency Anaemia
• Thalassemia
• Anaemia of Chronic disease
• Sideroblastic Anaemia

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Other tests

• Reticulocyte count 10
• Serum Bilirubin 5mg
• Direct Bilirubin 1mg
• Indirect Bilirubin- 4mg
• Skull XRay
• Hb Electrophrosis HbA2? HbF ?

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RETICULOCYTOSIS
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Hair on end -
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Diagnosis

• Thalassemia Major

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(No Transcript)
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Case No. 5

• 50/F Pain Abdomen -2years
• H/O Fever
• O/E Pallor
• Massive Splenomegaly
• USG - Splenomegaly

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Clinical Examination
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Lab Tests

• Hb 7.0g
• Total RBC count 2.2millions/cumm
• Total WBC count 2.1lakhs cells/cumm
• DC - P80 L10 E10Myelocytes,Metamyelocytes
  Band forms
• PCV 22
• MCV 90
• MCH 34
• MCHC 36 26
• RDW 13
• Platelet count 80,000/ cumm
• Peripheral smear

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Lab Tests

• Hb 7.0g
• Total RBC count 2.2millions/cumm
• Total WBC count 2.1lakhs cells/cumm
• DC - P80 L10 E10 Myelocytes,Metamyelocytes
  Band forms
• PCV 22
• MCV 90
• MCH 34
• MCHC 36 26
• RDW 13
• Platelet count 80,000/ cumm
• Peripheral smear

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PS - Myelocytes,Metamyelocytes Band forms
Mature neutrophils ,Eosinophils Basophils
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Diagnosis

• Myeloproliferative disorder
• Chronic Myeloid Leukemia

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• Myeloid cells of CML are also characterized by
  the Philadelphia chromosome (Ph1) on karyotyping.
  This is a translocation of a portion of the q arm
  of chromosome 22 to the q arm of chromosome 9,
  designated t(922).

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Case No. 6

• 22 / F Presented with Small purpuric spots
• H/O Bleeding gums after Brushing
• H/O Nasal Bleeding
• O/E Small red Purpuric spots

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O/E Purpuric spots
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On Examination
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Lab Tests

• Hb 11.0g
• Total RBC count 4.2millions/cumm
• Total WBC count 9000 cells/cumm
• DC - P53 L37 E6M4B0
• PCV 22
• Bleeding Time 16 minutes
• Clotting Time 10 minutes
• MCV 90
• MCH 34
• MCHC 36 26
• RDW 13
• Platelet count 40,000/cumm
• Peripheral smear

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Lab tests

• Hb 11.0g
• Total RBC count 4.2millions/cumm
• Total WBC count 9000 cells/cumm
• DC - P53 L37 E6M4B0
• PCV 22
• Bleeding Time 16 minutes
• Clotting Time 10 minutes
• MCV 90
• MCH 34
• MCHC 36 26
• RDW 13
• Platelet count 40,000/cumm
• Peripheral smear

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PS Giant PlateletsPlatelet number ?
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PS

• RBCS Normocytic Normochromic
• WBCS Normal in number
• Platelets Reduced
• Giant platelets

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Bone Marrow Megakaryocytes?
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Diagnosis

• Idiopathic Thrombocytopenic Purpura

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Case No .6

• 50/M Pain in the Back 1 year

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Lab Tests

• Hb 11.8g
• Total RBC count 4millions/cumm
• Total WBC count 12,000/cumm
• DC P51L42E3M4B0
• PCV 35
• ESR 80mm 120mm
• Platelet count 2 lakhs/cumm
• Peripheral Smear

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Lab Tests

• Hb 11.8g
• Total RBC count 4millions/cumm
• Total WBC count 12,000/cumm
• DC P51L42E3M4B0
• PCV 35
• ESR 80mm 120mm
• Platelet count 2 lakhs/cumm
• Peripheral Smear

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• Rouleaux Formation

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Bone Marrow ?Plasma cells
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Diagnosis

• Multiple Myeloma

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Skull X Ray Punched out Osteolytic lesion
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ESR? Urine Protein Heat test
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Serum Electrophrosis M-spike
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Case No 7

• 16 / M Fever 1 Month
• H/o Rigor
• O/E - Spleen enlarged

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Lab tests

• Hb 8.6g
• Total RBC count 3.0 millions/cumm
• Total WBC count 12,000/cumm
• DC P51L42E3M4B0
• PCV 27
• ESR 20mm 40mm
• Platelet count 2 lakhs/cumm
• Peripheral Smear

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• Hb 8.6g
• Total RBC count 3.0 millions/cumm
• Total WBC count 12,000/cumm
• DC P51L42E3M4B0
• PCV 27
• ESR 20mm 40mm
• Platelet count 2 lakhs/cumm
• Peripheral Smear Thin Thick

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RBC MORPHOLOGICAL ABNORMALITIESMALARIAL PARASITE
(P. falciparum)
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Other Stains

• Jaswant Singh Battacharya (JSB) Stain for thick
  and thin films
• In the Quantitative Buffy Coat (QBC) method,
  blood samples are collected in a special tube
  containing acridine orange, an anticoagulant, and
  a float, and then are centrifuged in a
  microhematocrit centrifuge. 
• After centrifugation, the tubes are examined
  using a fluorescence microscope with a stage
  adapter, or a light microscope with a customized
  fluorescence attachment. 
• Malaria parasites concentrate below the
  granulocyte layer in the tube.  The QBC method is
  reported to have a good sensitivity for detection
  of malaria parasites, and other parasites such as
  trypanosomes, microfilaria and Babesia spp.

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Diagnosis

• Positive for Plasmodium Falciparum

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Other Parasites
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Thank You

• THANK YOU