Category Archives: Chronic leukaemia

Case 78 – Summary

Thanks for your help this week. We had a case of T-LGL associated with rheumatoid arthritis. In our case her planned surgery was postponed. She was given GCSF and responded to this and this was used pre operatively for optimisation. … Continue reading

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Case 78 – update 2

Flow results are back: CD 3 pos, CD 8 pos, CD 4 neg, CD 56 neg, CD 16 neg, CD 5 neg, CD7 wk/variable, TCR alpha/beta pos PCR TCR studies confirm clonality A Diagnosis of T Large Granular Lymphocytic leukameia is … Continue reading

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Case 78 – Update 1

Thank for all the suggestions so far. We followed your advice and the lady has had her surgery postponed and we have established the following: History: Chronic anaemia since 2011 stable at around 90. No history of bleeding/Malena No weight … Continue reading

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Case 78 – the Beginning

A 72 year old lady has attended pre- assessment clinic for an elective hip replacement and had routine bloods taken. Blood results: Hb 93, MCV 97, Plt 220, Wcc 7.5,  Neu 0.9, lymph 6.0. Normal Liver and Renal function  Blood … Continue reading

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Case 72- summary

Answers A – hereditary elliptocytosis B – hairy cell leukaemia C – metastatic prostate cancer Case A The first case, we started with something relatively straightforward: This was a blood film of a 21 year old pregnant women who was … Continue reading

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Case 72 – case B

A 40 year old gentleman present with the following FBC: WCC 2.9×109/L (4-11) Neuts 0.9×109/L (1.7-7) Lymphocytes 1.4×109/L (1.5-4.5) Monocytes 0.2×109/L (0.2-1) Eosinophils 0.3×109/L (0-0.5) Basophils 0.1×109/L (0-0.1) Hb 55g/L (130-180) MCV 88fL (82-98) Platelets 31×109/L (150-450) His bone marrow … Continue reading

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Case 59 – summary

This case was focussed on the investigation of splenomegaly, rather than the ultimate diagnosis (though we did make one). So what did we learn? DEFINITION This varies, but 14cm is generally considered to be the upper limit of normal. DIFFERENTIAL … Continue reading

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Case 59 – update 2

Mr Q has become pancytopenic over the last two years. His spleen remains palpable and is clinically larger – approximately 8 cm below the costal margin. His bone marrow aspirate was acellular and somewhat difficult to obtain. The trephine looks … Continue reading

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Case 59 – update 1

Welcome back. The learning points from our first section are outlined below. If you want to skip to the bottom to find out what is now happening with the patient and respond to the next question, please do! The case … Continue reading

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Case 59 – the beginning

Welcome to case 59. Today we’re reviewing Mr Q, who was referred to the outpatient clinic with the following letter: ‘Dear Colleague, Please see Mr Q (DOB 01/01/1945) who was noted to have splenomegaly (16cm) on a recent ultrasound scan. … Continue reading

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Case 55 – Summary

This week we met Mr Jones, a 77 year old man who had an abnormal result when he attended his GP for annual well man bloods. His FBC revealed a moderate thrombocytopenia, a slight lymphocytosis and a normochromic anaemia. When … Continue reading

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Case 55 – Update

The film for this patient showed moderate sized lymphocytes with frequently clefted nuclei and nucleoli. There were no smear cells. The laboratory staff decided to send the specimen for flow cytometry and obtained the following results: CD5+ CD10- CD19+ CD20+ … Continue reading

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Case 55 – the beginning

Good evening. This week we’re going to work together to manage an elderly  patient with a leukocytosis.  Mr Jones is 77 and attends his GP practice for his annual ‘birthday bloods.’ The following results were obtained:  Hb 110 g/dl WCC … Continue reading

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Case 54 – case A

This week we are going to look at a range of short cases, some of which are morphology based, and most will include MCQ questions.  The discussion does not have to be limited to the basic answer – please feel … Continue reading

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Case 52 – summary

Our case was based on a 34 year old lady with a new diagnosis of CML. Diagnosis CML in a proportion of patients is diagnosed on routine blood tests prior to onset of symptoms.  However, symptoms can include: lethargy shortness … Continue reading

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Case 52 – update 2

Great discussion so far regarding staging and options for treatment. Overall I think the consensus is to treat this lady with imatinib. The patient commences treatment and BCR-ABL1 shows a major molecular response at 18 months. At this clinic appointment … Continue reading

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Case 52 – update 1

This patient gives a history of palpitations for the past two days.  On questioning she has noted occasional night sweats, and describes some abdominal fullness, but otherwise is usually fit and well with no significant past medical history.  She is … Continue reading

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Case 52 – the beginning

A 34 year old female presents to A&E with a 2 day history of palpitations.   Full blood count shows: Hb 84 g/l (135-180) MCV 91 fl (78-100) MCH 29 pg (27-32) Plts 649 x10*9 (150-400) WCC 88 x10*9 (4-11) Differential … Continue reading

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Case 50 part 1 -summary

Thanks for all of the contributions. The marrow showed erythrophagocytosis. This can be a sign of autoimmune haemolytic anaemia. In particular it can be seen in paroxysmal cold haemoglobinuria. We were slightly mean and didn’t show the rest of the … Continue reading

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Case 50 part 1 – update

We were reviewing the marrow smear from an elderly gentleman with weight loss and macrocytic anaemia. Further results include: Reticulocyte count 276×10*9/L Bilirubin 54ug/L LDH 1056U/L DAT IgG 4+   The above is consistent with warm autoimmune haemolytic anemia. The … Continue reading

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