Question

Hematology Case   a 65- year-old African-American male, was previously healthy but went to his physician complaining...

Hematology Case  

a 65- year-old African-American male, was previously healthy but went to his physician complaining of abdominal discomfort, tiredness, unexplained weight loss, on the advice of his wife. The physical examination confirmed the patient’s complaints and he also noted splenomegaly. The physician ordered a CBC and the results are below: (see Table 2A).

Table 2A: Complete Blood Count

readings

Adult Male Reference Range

Reference Range for Absolute Values (x109/L)

WBC count

112

5-10 x 109/L

RBC count

2.10

5-6 x 1012/L

Hb

70

135-175 g/L

Hct

.20

.41-.53 L/L

MCV

?

80-100 fL

MCH

?

26-34 pg

MCHC

?

31-37 g/dL

RDW-CV

12

11.5-14.5%

Platelets

543

150-400 x 109/L

Differential

Neutrophils

35

25-60%

1.10-6.05

Bands

25

0-10%

0.10-2.1

Lymphocytes

1

20-50%

1.50-4.00

Monocytes

1

2-11%

0.20-0.95

Eosinophils

8

0-8%

0-0.70

Basophils

5

0-2%

0-0.15

Metamyelocytes

3

0

0

Myelocytes

5

0

0

Promyelocytes

10

0

0

Blasts

7

0

0

Morphology

Unremarkable

Questions

  1. Calculate the MCV, MCH, and MCHC

  2. Describe blood picture using proper hematologic terminology.


  1. The differential diagnosis of granulocytosis should include consideration of bacterial infection. Is this likely based on the CBC or not?

  1. Considering the CBC findings and his age, what condition is most likely?

  1. The promyelocytes and blasts outnumber the myelocytes and metamyelocytes, what is this called?

  1. What additional testing is needed, and what results would confirm Denzel’s diagnosis that you gave in question #4?


  1. What is the Philadelphia chromosome, and what is the effect?


  1. Questions:

    1. To what larger group of diseases does chronic myelogenous leukemia belong?

  1. What other diseases belong to this group, and give a brief description of each.

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Homework Answers

Answer #2

ANSWER 1

MCV = Hematocrit (%) x 10 / RBC count

Here,

Hematocrit: .20 L/L = 20%

RBC Count = 2.10 millions/ mm3 Blood

So

MCV = 20 x 10 / 2.1

= 45 .35 fl

MCHC = Hemoglobin (g/dl) x 100 / Hematocrit (%)

Here

hemoglobin= 70 g/ L = 7 g/dl

Hematocrit= 20%

MCHC = 7x100/ 20

= 35 pg

MCH = Hemoglobin x 10 / RBC

= 7 x 10 / 2.1

15.8 pg/cell

Answer 2

Leukocytosis, Thrombocytosis, Microcytic Iron Deficiency Anemia, Acute Promyelocytic Leukemia

Answer 3

One of the reason for granulocytosis is bacterial infection, but it may also seen in autoimmune diseases and blood cell Cancer. So in order to confirm it bacterial culture and sensitivity test to be done. Because CBC alone is not enough to confirm it

Because of time limit, Rest of the Answers You can ask seperately

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