CBC

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CBC
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Peripheral Smear
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Reticulocyte count
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Bone Marrow
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Anisopoikylocytosis
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Anisopoikylocytosis
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case

• A 72-year-old man has had increasing fatigue for
  the past 5 months. On physical examination there
  no abnormal findings. Laboratory studies include
  a CBC with peripheral blood smear.

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• What is the diagnosis from these findings?
• Which of the following tests would be most useful
  to determine the etiology
• A. Hemoglobin electrophoresis
• B. Reticulocyte count
• C. Stool for occult blood
• D. Vitamin B12 assay
• E. Bone marrow biopsy
• How is this treated?

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case

• A 48-year-old man has become progressively more
  fatigued at the end of the day. This has been
  going on for the past 6 months. In the past month
  he has noted paresthesias with numbness in his
  hands and feet. On physical examination he has
  decreased vibration and position sensation in
  both hands and feet. Laboratory studies include a
  CBC with peripheral blood smear

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CBC
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Peripheral Smear
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• What is the diagnosis from these findings?
• Which of the following tests would be most useful
  to determine the etiology
• A. Hemoglobin electrophoresis
• B. Reticulocyte count
• C. Stool for occult blood
• D. Vitamin B12 assay
• E. Bone marrow biopsy
• How do you explain the neurologic findings?
• How do treat this condition?

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case

• A 30-year-old woman has the onset of fever,
  abdominal pain, nausea over the past day. On
  physical examination her vital signs include
  temperature 38 C, pulse 102/minute, respirations
  20/minute, and blood pressure 95/50 mm Hg. She
  has scleral icterus. Her spleen tip is palpable,
  but there is no lymphadenopathy or hepatomegaly.
  She has Hgb 11.1 g/dL, Hct 28.8, MCV 77 fL,
  platelet count 273,400/microliter, and WBC count
  8900/microliter. The direct and indirect Coombs
  tests are negative. A month ago, a CBC showed the
  following findings

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• What is the diagnosis from these findings?
• The probable association(s) with this disease
  is(are)
• A. Autosomal dominant, European ancestry
• B. X-linked, Asian ancestry
• C. Autosomal recessive, Middle Eastern ancestry
• D. Autosomal recessive, West African ancestry
• E. Sporadic occurrence
• 3. An aplastic crisis in this patient could be
  initiated by
• A. Quinacrine
• B. Parvovirus infection
• C. Decreased oxygen tension
• D. Exposure to cold
• E. Transfusion

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case

• A 29-year-old woman with a diagnosis of acute
  promyelocytic leukemia has developed petechiae
  and ecchymoses over the skin of her trunk and
  extremities in the past 3 days. On physical
  examination her vital signs include temperature
  37.2 C, pulse 101/minute, respirations 19/minute,
  and blood pressure 85/45 mm Hg. Laboratory
  studies include a CBC showing Hgb 8.7 g/dL, Hct
  24.5, MCV 85 fL, platelet count
  17,000/microliter, and WBC count 8700/microliter.

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Peripheral Smear
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• What is the diagnosis from these findings?
• Discuss the conditions in which this can occur.
• Which of the following tests would be most useful
  to diagnose this condition in this patient with
  acute promyelocytic leukemia
• A. Hemoglobin electrophoresis
• B. Reticulocyte count
• C. Coagulation tests
• D. Vitamin B12 assay
• E. Bone marrow biopsy

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case

• A 20-year-old African-American man comes to the
  emergency room because of the sudden onset of
  severe abdominal pain. On physical examination he
  has diffuse, severe abdominal tenderness. Bowel
  sounds are absent. His sclerae appear icteric. A
  plain film radiograph of the abdomen shows no
  free air, only dilated loops of bowel. Laboratory
  studies include a CBC that shows Hgb 4.8 g/dL,
  Hct 12.8, MCV 80 fL, platelet count
  205,000/microliter, and WBC count 9800/microliter
  with differential count showing 70 segs, 7 bands,
  22 lymphs, and 3 monos, with 12 NRBC's per 100
  WBC's.

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• What is the diagnosis from these findings?
• Which of the following tests would be most useful
  to determine the etiology
• A. Hemoglobin electrophoresis
• B. Reticulocyte count
• C. Stool for occult blood
• D. Vitamin B12 assay
• E. Bone marrow biopsy
• 3. The "crisis" in this patient was initiated by
  
• A. Quinacrine ingestion
• B. Parvovirus infection
• C. Decreased oxygen tension
• D. Exposure to cold
• E. Transfusion therapy

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case

• This CBC demonstrates the findings following
  treatment for one of the conditions given above.

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case

• A 26-year-old woman has had an irregular fever
  with chills, diaphoresis, myalgias, and fatigue
  for the past 2 weeks. On physical examination her
  vital signs include T 37.8 C, P 73/minute, RR
  16/minute, and BP 110/70 mm Hg. She has mild
  hepatosplenomegaly but no lymphadenopathy.
  Laboratory studies show Hgb 12.3 g/dL, Hct 37.1,
  MCV 96 fL, platelet count 217,800/microliter, and
  WBC count 7890/microliter. Her reticulocyte count
  is 3.2. Her serum haptoglobin is 0.8 mg/dL.

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• A 32-year-old man has been bothered by a fever
  for the past 3 weeks. On physical examination his
  vital signs include T 37.5 C, P 76/minute, RR
  15/minute, and BP 125/80 mm Hg. He has an easily
  palpable spleen tip and mildly increased liver
  span. He has mild generalized lymphadenopathy.
  Laboratory studies show Hgb 11.7 g/dL, Hct 34.9,
  MCV 83 fL, platelet count 139,200/microliter, and
  WBC count 2275/microliter.

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• A 9-year-old girl has complained of a headache
  for the past 2 days. She then has the sudden
  onset of convulsions. On physical examination her
  vital signs include T 38.8 C, P 92/minute, RR
  19/minute, and BP 85/50 mm Hg. Her spleen is
  palpable. She remains comatose. Laboratory
  studies show Hgb 5.1 g/dL, Hct 15, MCV 100 fL,
  platelet count 82,000/microliter, and WBC count
  9825/microliter. Her serum creatinine is 2.8
  mg/dL, glucose 39 mg/dL, and total bilirubin 2.9
  mg/dL.

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• A 12-year-old boy has not been eating well for
  the past week and has been listless. On physical
  examination vital signs include T 37.8 C, P
  82/minute, RR 18/minute, and BP 90/55 mm Hg. He
  has periorbital edema and lower extremity edema.
  There is a morbilliform rash over his trunk. He
  has generalized lymphadenopathy. On auscultation
  of his chest lung fields are clear. He has an
  irregular heart rate.

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