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HEMOPOIETIC CS-OSPE

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Case 1 Z

 1. What is your clinical diagnosis?   Polycythemia

  1. Mention 2 abnormal findings in the CBC of these patients? high hemoglobin, high WBC and platelets

  2. What is the genetic abnormality which causes this condition? JAK 2 Mutation

  3. In this patient, what will be the blood erythropoietin level, high or low? Erythropoietin low

  4. Mention 2 treatment options for this disease? Venesection to remove blood and Aspirin

  5. Mention 1 symptom of this disease? Visual disturbances and Claudication

  6. Mention 2 other etiologies of high RBC count in the blood, besides this condition? Hypoxia and Tumor

Case 2

A 20 years old male comes with fever since 5 days. Fever is episodic. The peripheral blood film is shown below.

  1. What abnormality (Micrograph name) do you see in this smear?

    • Ring form - Malarial parasite inside RBCs Z

  2. What is your diagnosis?

    • Malaria

  3. Mention 2 causes of anemia in this infection? Z

    • **Mechanical destruction of RBCs
    • Reduced erythropoiesis in the bone marrow

  4. Mention 3 features of severe form of this infection? Z

    • **Cerebral malaria
    • Blackwater fever
    • Hypoglycemia
    • Renal involvement DIC

  5. Mention 4 species of the parasite which cause this infection?

    • **Plasmodium
    • P. Vivax, P. ovale, P. Falciparum and P. Malariae**

  6. Mention 3 drugs used to treat this infection?

    • Mefloquin / amodiaquin/ lumifantrire
    • Artemisinin compounds/ Chloroquin / quinine
    • For pregnancy; Hydroxychloroquine
    • To prevent relapse; Primaquine

  7. Name the 4 species of the parasite which cause this infection in humans?

    • **a) Plasmodium Vivax
    • b) Plasmodium Ovale
    • c) Plasmodium Falciparum
    • d) Plasmodium malariae

  8. Name any complication which can occur in severe form of this disease?

    • a) Cerebral involvement / renal involvement DIC/

Case 3

This is the peripheral smear of a 14 year old patient who gets frequently admitted to the hospital due to bone and joint pain

Q1: Describe the abnormal findings in this smear? Sickle cells.

Q2: what’s your diagnosis? Sickle cell anemia.

Q3: Name any type of crisis which can occur in this disease? Aplastic crisis, acute chest syndrome.

Q4: What are the ttt options for this disease? Hydroxyurea, blood transfusion, folic acid (not sure).

Case 4

1- Diagnosis? Iron deficiency anemia.

2- Give 2 investigation? Serum ferritin level, Total iron binding capacity (TIBC).

3- Causes? Decrease iron intake in diet, chronic GI bleeding or heavy menses.

Case 5

A 40 year old man complains of fatigue, tiredness and clumsy walking (ataxia) since few months. He has very pale conjunctiva. Peripheral blood smear is shown above.

Q1: What’s your diagnosis? Megaloblastic anemia.

Q2: What abnormality do you see in this picture? Neutrophil with hyper segmented nucleus.

Q3: Name 2 conditions which can cause this type of peripheral smear? Vitamin B12 deficiency, folic acid deficiency.

Q4: Name the blood test which you will do in this pt to confirm the diagnosis? Vitamin B12 level.

Q5: What treatment will you give to this pt? Replacement of Vitamin B12.

Q6: Name 2 neurological features seen in this condition? Z Peripheral neuropathy, numbness.

Q7: Test to confirm diagnosis? Z - Serum vit b 12 - Serum autoantibodies

Case 6

A 50-year-old male had cervical lymph node enlargement for 2 months. Biopsy of the nodes shows.

  1. Name of the cell? Z Reed-Sternberg cell.

  2. Diagnosis?
    Hodgkin’s lymphoma.

  3. Mention 4 clinical features that may be presenting symptoms of this disease?

    • B Symptoms (Fever, night sweats, and unintentional weight loss)
    • Regional lymphadenopathy
    • Bone pain
    • Pruritus
    • SVC syndrome (Superior Vena Cava Syndrome)

  4. Diagnostics investigations

    • Bone marrow; Cytology and histology
    • CXR
    • ESR

  5. Staging tests

    • PET
    • CT

  6. Mention 2 treatment options for this disease?

  • Regional radiotherapy
  • Chemotherapy; rituximab, methotrexate
  • surgical resection

Case 7

A 48 year old female is concerned about her several episodes of fainting. Brief clinical examination reveals pallor of her skin. Her blood is:

  • Hb 8.7 g/dl
  • MCV 64.5 fl
  • Plt 556 x 109/l
  • WBC 7.7 x 109/l
  • Serum iron 6 ÎĽmol/l (NR: 65-180 ÎĽg/dL )
  • Ferritin 10 ÎĽmol/l (NR: 12-300 ng/mL)
  • TIBC 90 ÎĽmol/l (NR: 45-85 ÎĽmol/L)
  • Vitamin B12 221 ng/l (NR: 130-700 ng/L)
  • Folate 9.2 ÎĽg/l (NR: 7-36 nmol/L

How would you interpret these results?
hypochromic microcytic anemia

How would you proceed with investigations?
a. fecal occult blood test
b. —angiography—

Case 8 Z

Bone marrow aspirate of patient with multiple myeloma

  1. Describe the morphology of the cells shown?
    ---plasma cell tumor---

  2. What other conditions these cells are present?
    ---plasma cell leukemia---

Case 9

A 26 years old female presented with dystonia. O/E is found to have ascites due to portal hypertension & asymptomatic golden brown rings around the corneo-scleral junction (limbus) of the eyes as shown

  1. What you see in Pic ? Kayser Fleischer

  2. Diagnosis?: Wilson’s Disease

  3. Treatment: Z
    Penicillamine

  4. What is the type of inheritance for this disease?

    • Autosomal recessive

  5. Mention 2 recognized hepatic complications of this disease?

    • Chronic active hepatitis
    • Liver cirrhosis

  6. Mention 2 tests commonly used for diagnosis of this disease? Z

    • Serum ceruloplasmin
    • Urine copper

  7. Mention 2 neurological manifestation of this disease? Dystonia, Spasticity, grand mal seizure, wing beating tremor

  8. Name a drug commonly used for the treatment of this disorder? Use of chelating agent for lifelong (penicillamine trientine)

  9. Name a life threatening complication of this disease? Fulminant hepatic failure, Liver cirrhosis

Case 10

A 14 year old boy, who is a known case of hemophilia, presented with acute right knee pain and swelling.

Q1: What’s the likely cause of his knee pain? Z Hemarthrosis

Q2: what’s the mode of inheritance of hemophilia? X-linked recessive.

Q3: what’s the recommended ttt of hemophilia? Z Factor 8 or factor 9

Q4: What’s the likely cause of failure of ttt in some pt? Z Antibodies formation against the factors.

Case 11 Z

  1. Describe and explain radiological changes seen in the X-ray?
    Hair on end appearance

  2. Causes of severe hemolytic crisis?
    1.Acute splenic sequestration 2.Transient Red cell aplasia 3.Hyperhemolysis due to infection

  3. What is best treatment of acute chest syndrome?
    Oxygen – Transfusion – Antibiotic

  4. What investigation will you suggest to prevent stroke in children 2 – 16 years age?
    Doppler US

  5. What drug treatment is commonly recommended for these patients?
    Hydroxycarbamide

Peripheral smear

Note the large RBCs & Large Neutrophil with Multilobed nucleus

Iron deficiency anemia - Hypochromic, microcytic

Normal Peripheral Smear

Anaplastic Large-Cell Lymphoma

Mycosis Fungoides

Angioimmunoblastic Lymhoma

SKin lesions: associated with coetaneous T-cell lymphoma

Graph View

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