Category Archives: Chronic leukaemia

Case 88 – summary

Morphology week summary. Case A     Our followers were correct in suggesting these were plasma cells, one of which is binucleate on the second picture.  Thrombocytopenia was also noted.  This would be in keeping with a diagnosis of plasma … Continue reading

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Case 88 – part E

Last slide of the week. Spot diagnosis – patient presented with a vasculitis

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Case 88 – parts C and D: update

Flow cytometry results. Not true to life I know but just for a bit of fun and test our morphology and flow skills….. The following results are for our two patients- what is the diagnosis for each? Which results goes … Continue reading

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Case 88 – parts C and D

You are reviewing the blood film tray and a further two patients are noted to have lymphocytosis Case C Hb 96 g/L WCC 34 (10^9/L) Case D Hb 100 g/L WBC 23 (10^9/L) Can you describe the findings? Do they … Continue reading

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Case 88 – part B: update

As requested by some followers Flow cytometry : CD5 + CD23 – SmIg strong FMC7 ++ CD20 ++ CD22 ++ CD19+ CD79b ++ CD200 ++ CD10- Cyclin D1 expression (11:14)(q13:32)negative Splenomegaly noted on examination, with no evidence of lymphadenopathy.   … Continue reading

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Case 88 – part B

84 year old man Hb 111 WBC 24 Describe the findings on the blood film What further clinical information would you wish to know? further investigations?  

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Case 80 – summary

This week we discussed a 65 year old gentleman who was about to undergo curative surgery for gastric carcinoma. His admission blood tests showed pancytopenia and monocytopenia.   The differential diagnosis of pancytopenia includes: Haematological malignancy e.g. myelodysplasia or infiltration … Continue reading

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Case 80 – update 3

The immunophenotype was: CD20+, CD79b+, CD22+, CD5 negative, FMC7+, CD103+, CD11c+, CD25+, CD10 negative, CD38 negative, lambda sIg+ This is consistent with hairy cell leukaemia. If further immunophenotypic evidence is required additional stains on the trephine can be undertaken (e.g. … Continue reading

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Case 80 – update 2

The blood film showed a population of lymphoid cells with ‘hairy projections’. There was absolute monocytopenia. Both of these are consistent with a diagnosis of hairy cell leukaemia. However, hairy cell leukaemia variant and other low grade lymphoma may have … Continue reading

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Case 80 – update 1

Our patient has pancytopenia. On examination there is no specific findings. There is no palpable lymphadenopathy or hepatosplenomegly. There is no rash or gum infiltration. There are no features of chronic liver disease. However review of recent imaging has noted … Continue reading

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Case 80 – the beginning

Welcome to our new case. You are the surgical house officer reviewing a new elective admission. He is 65 years old gentleman and has been admitted for resection of a gastric cancer. He is an ex-smoker, takes ramipril for hypertension … Continue reading

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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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