WBC tutorial Case 1 A 17-year-old boy with flu-like symptoms and a follicular tonsillitis and cervical lymphadenopathy was treated with amoxicillin by GP. He now presents with a maculopapular rash on arms, face, and trunk. Other findings on examination is mild icterus with mild hepatosplenomegaly. Hb 10.5 g/dl, WBC 15 x 10 9/l, 10 % neutrophils, 85% lymphocytes and 5% monocytes. Peripheral blood film is shown. a. b. c. d. What is the most likely diagnosis? What significant findings are seen on the peripheral blood film? What further investigations should be done? What complications can arise from this disease? Case 2 A 10-month-old baby presents with a history of frequent infections every 3-4 weeks; the infections vary from otitis media, tonsillitis and pneumonia usually accompanied by fever and require antibiotics. His current presentation reveals very erythematous and bulging tympanic membranes. Hb 11.5g/dl, WBC 3.0 x 109/l, neutrophils 5%, lymphocytes 90%, monocytes 5%. A plot of his WBC counts are shown: a. What further information do you need? b. What is the probable diagnosis? c. What is the treatment plan? Case 3 The patient is a 10-month-old Caucasian male with a history of recurrent upper respiratory infections and otitis media since birth. His CBC at this time: Hb10.9g/dl, Hct32.4%, platelet count 280x109/l, WBC of 3.84 x 109/l; differential of 25% monocytes, 70% lymphocytes, 4% eosinphils, 1% basophils and 1% neutrophils. Peripheral blood film, bone marrow aspirate and a plot of his counts over time are shown: a. b. c. d. What does the peripheral film and bone marrow show? What does the WBC plot indicate? What is the probable diagnosis? What is the treatment plan? Case 4 A 5 year old boy has been noticed to be lethargic. He complains of a painful mouth and mom has noticed some bruising with one large one on his thigh which seem to be getting bigger. He comes home from school and he goes straight to bed. On Examination he is pyrexic with generalised lymphadenopathy and mild hepatosplenomegaly. He has some blood around the gumline and as seen before. Hb 6.7g/dl, WBC 120 x109/l, platelets 50x109/l, ESR 100mm/hr, This is his peripheral blood film. a. What does the peripheral film show? b. Immunohistochemistry shows CD10, CD19, CD20 and CD 24; What is the immunological type? c. What is the most probable diagnosis? His cytogenetics show hyperdiploidy. d. With the given information what is the prognosis? e. What are the principles of treatment in this patient? Case 5 This 53-year-old male had noticed the onset of easy fatigability and bruising. He saw his doctor when he developed a boil in the perianal area. His CBC and subsequent bone marrow exam (shown) were abnormal. Lab data: WBC 78.0 x109/l; Hgb 7.3 g/dL, PLT 59 x109/l a. What is the most likely diagnosis? b. What further testing would you suggest c. Which of the following marker panels do you expect will be positive in this case? i. CD13, CD33, CD34 ii. CD2, CD3, CD4 iii. CD10, CD19, CD20 Case 6 A 24 year old woman was admitted due to weakness and a severe nosebleed that she could not stop. Lab findings revealed anemia and severe thrombocytopenia (PLT 18 x109/l). Her WBC was normal but her diff had 2% neutrophils, 40% blasts and 58% blast-like cells with intense granulation. Some cells had bundles of ‘bodies’ in the cytoplasm. Coagulation results showed prolonged PT/APTT tests, a low fibrinogen level, and a positive Dimer test. Bone Marrow a. b. c. d. e. Which type of acute leukemia do you suspect? What do you think the ‘bodies’ are? What is the significance of her coagulation results? What cytogenetic abnormality would you expect? What would be the treatment plan? Case 7 This is the film of a newborn with Down syndrome: a. What is the probable diagnosis? b. What is the natural course of the disease? Case 8 A 46 year old lady presents with weight loss and abdominal enlargement. She has history of drenching night sweats and has been having fevers of 38-39OC. Significant findings on examination was hepatosplenomegaly but no lymphadenopathy. Hb 9.8g/dl, WBC 98x109/l, differential 15% neutrophils, 5% bands, 15% myelocytes, 40% metamyelocytes, 15% basophils , 5% oesinophils and 5% lymphocytes, no blasts; platelets 566x109/l. Peripheral blood film shown: a. b. c. d. What does the peripheral blood film show? What further test should be done? What is the probable diagnosis? What is the treatment of choice?
