Clinical Cases
Case Scenario
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A 4 – year-old boy is presented with his mother with the complaint of that he is lazy all the time, and his appetite has reduced for the last two months.
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He eats less food compared to his other three brothers.
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He does not like to play with children, and he gets tired easily.
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Social history:
The father died one year ago in RTA. Mother is uneducated and unemployed. The family is living on charity and getting helps from the relatives. -
Examination:
The child is underweight, alert but slightly irritable. He looks pale, with pale conjunctivae, tongue and oral mucous membrane.
V/S: Temp. 37.2 °C,
RR 55/min.
HR 110/min.
Case 1
A 37-year-old lady presents with 3 months history of dizziness and easy fatigue. The following CBC is shown below:
- WBC: 7.0 (4 - 11 x10^9/L)
- RBC: 3.68 L (4.2 - 5.5 x10^12/L)
- HGB: 87 L (120 - 160 g/L)
- HCT: 27.1 L (42 - 52 %)
- MCV: 73.6 L (80 - 94 fl)
- MCH: 23.6 L (27 - 32 pg)
- MCHC: 321 (320 - 360 g/L)
- RDW: 15.5 H (11.5 - 14.5 %)
- PLT: 445 H (140 - 450 x10^9/L)
Diagnosis
- Hypochromic Microcytic Anemia (IDA)
On systemic enquiry, she added that she has menorrhagia for the last 4 months.
🔴 Mention one investigation of importance to reach the diagnosis.
- TSH: 89 mIU/L (0.25 - 5)
- FT4: 8.6 pmol/l (10.3 - 25.8)
Case 2
Patient Information: A 55-year-old man, who is a known case of hypertension controlled on 25 mg hydrochlorothiazide. He is a smoker of 20 cigarettes per day for >20 years.
- WBC: 6.5 (4—11 x 10^9/L)
- RBC: 7.1 H (4.7—6.1 x 10^12/L)
- HB: 197 H (130—180 g/L)
- HCT: 56.3 H (42—52 %)
- MCV: 88 (80 - 94 fl)
- MCH: 30.3 (27 - 32 pg)
- PLT: 305 (140 - 450 x 10^9/L)
- ESR: 4 (0 - 10 mm/hr)
Diagnosis
- 2nd Polycythemia as WBCs and Platelets are normal
- Mostly due to smoking (screen for other causes)
Management
- Blood Donation, Stop smoking, Aspirin, shift to another antiHTN
Case 3
A 44-year-old man, who is a known case of HCV positive.
- WBC: 2.0 L (4—11 x 10^9/L)
- RBC: 2.95 L (4.7—6.1 x 10^12/L)
- HB: 110 L (130—180 g/L)
- HCT: 31.9 L (42—52 %)
- MCV: 108.1 H (80—94 fl)
- MCH: 37.3 H (27—32 pg)
- RDW: 19.5 % (11.5—14.5)
- PLT: 92 L (140—450 x 10^9/L)
HEPATITIS C RNA QUALITATIVE ………… Positive HEPATITIS C RNA QUANTITATIVE ……….. 389744 IU/ML
Diagnosis
- Pancytopenia 2nd to therapy like interferon.
Case 4
Patient Information: A 57-year-old man presents with 5 weeks history of numbness and weakness of the lower limbs. He was looked pale with signs of peripheral neuropathy.
- WBC: 3.20 L (4 - 11 x 10^9/L) L
- RBC: 1.90 L (4.7 - 6.1 x 10^12/L) L
- HGB: 53 L (130 - 180 g/L) L
- HCT: 15 L (42 - 52 %) L
- MCV: 118 H (80 - 94 fl) H
- MCH: 40 H (27 - 32 pg) H
- MCHC: 134 L (320 - 360 g/L) L
- RDW: 24.6 H (11.5 - 14.5 %) H
- PLT: 39 L (140 - 450 x 10^9/L) L
Blood Film
- Hypersegmentation of neutrophils.
Diagnosis Inquiry
- WHAT IS THE MOST LIKELY DIAGNOSIS?
- Vitamin B12 Deficiency / Pernicious Anemia
Case 5
Clinical Case Summary: A 12-year-old boy presented with two days history of lethargy. His mother has noted him to be jaundiced. He was usually well.
- His PMH is unremarkable. O/E, he was pale and obviously jaundiced, no hepatomegaly.
The following investigations are shown below:
- HB: 76 L (130 - 180 g/L) L
- WBC: 6.90 (4 - 11 x 10^9/L)
- PLT: 413 (140 - 450 x 10^9/L)
- Retic.: 5.4 % H (3- 17 umol/L) H
- Total bilirubin: 94 H
- Direct bilirubin: 5
- Alanine aminotransferase: 35 (20-65 u/L)
- Urine urobilinogen: +ve
Diagnosis
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G6PD deficiency
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What additional details in history and further investigations?
- ● H/O exposure to Fava Beans / Drugs
- ● Screening test for G6PD, when hemolysis is not present.