A 27-year-old male patient was admitted to hospital, flowing evidence of petechial
haemorrhaging and hepatosplenomegaly. The patient stated that he experienced
fatigue and exhaustion over the last few weeks. On physical examination the patient
was also very pale.
The patient’s blood was collected and sent to the laboratory for analysis (FBC).
Parameter
Result
3.5 x1012/L
8g/dL
0.3 L/L
80fl
27pg
29g/dL
16%
2.9x109/L
85 x109/L
Red cell count
Hb
Hct
MCV
MCH
MCHC
RDW
White cell count
Platelet count
Diff count: Automated
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
Blasts
3%
2%
1%
0%
0%
94%
Peripheral smear:
1. Comment on the patient’s FBC results (RBCs, WBCs and platelets).
(4)
2. Calculate the Absolute blast count.
(3)
3. Please observe the peripheral smear. Identify the cells present, inclusions
present and suggest a possible diagnosis, using both the FAB and WHO
classifications.
(4)
Coagulation:
INR
Aptt
D-dimer
2.5 (High)
61 secondes (Prolonged)
4 mg/L (High)
4. Based on the diagnosis proposed, the doctor requested coagulation studies.
What type of coagulopathy is commonly developed by these patients?
(1)
5. Based on the coagulation results is this patient currently experiencing the
complication identified in question 4?
(2)
Based on the above results and findings the doctor further requested flowcytometry
and cytogenetics.
Patient’s karyotype
Flowcytometry results
6. Identify the mutation present on the karyotype
(1)
7. Name the mutated gene
(1)
8. Comment on the flowcytometry results
(3)
9. Name 3 cytochemical stains and their reactions to support the diagnosis (3)
10. What drug is used to treat this condition?
11. Name 2 test we can use to monitor minimal residual disease on these patients.
(2)
ALL questions:
1.
2.
3.
4.
Tabulate the FAB classification of ALL
Identify 4 Mutations capable of causing B-ALL
Provide the flow results for B-ALL and indicate which markers show B cell origin
Identify 2 cytochemical stains used to identify ALL.