Category Archives: Laboratory morphology

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 77 – the beginning

  Let’s start this case with a blood film. Can you describe the findings on the film? What information would you like as the registrar reviewing the film?   Please reply to us (@TeamHaem) on Twitter and always include #TeamHaem … Continue reading

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Case 54 – summary

Case A Our first case looked at a blood film of a 48 year old gentleman who had presented with neutropenia and monocytopenia.  This is a common presentation for patients with hairy cell leukaemia and this leaves them susceptible to … Continue reading

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Case 54 – case C

  Quick morphology case whilst comtemplating case B!!!! 19 year old boy gives a 5 day history of feeling generally unwell (fever and malaise). He presents to a&e with LUQ pain.   blood film: Describe the blood film above.   … 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 50 part 5 – summary

This case was an interesting one! As haematologists we have a privileged position of being able to get to know our patients extremely well and also have the skills to review their marrow under the microscope in order to reach … Continue reading

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Case 50 part 5 – update

You have a 41 year old female with night sweats, splenomegaly and pancytopenia.   Differential diagnosis from #teamhaem are: Lymphoma e.g. splenic marginal zone lymphoma or hairy cell leukaemia or even a high grade lymphoma Myeloproliferative neoplasm e.g. myelofibrosis Metastatic … Continue reading

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Case 50 part 5 – the beginning

You are the haematologist in a busy clinic. You are referred a patient with splenomegaly and pancytopenia. She has been suffering from night sweats. A full blood count shows: Hb 92g/L (115-160) MCV 89fL (79-98) WCC 2.5×10*9/L (4-11) Neuts 1.0×10*9/L … Continue reading

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Case 50 part 4 – summary

The laboratory data of anaemia, thrombocytosis, a leucoerythroblastic film and tear drop poikilocytes point towards a diagnosis of myelofibrosis. Other causes of a leucoerythroblastic film with tear drop poikilocytes may include: Beta thal intermedia/major (this should be obvious from the … Continue reading

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Case 50 part 4 – update

#TeamHaem correctly identified the main abnormalities in the film: Tear drop poikilocytes Leucoerythroblastic features (left shifted granulocytes and nucleated red cells) The patient had splenomegaly and was suffering from weight loss and subjective fevers.   Questions: Name three possible causes of … Continue reading

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Case 50 part 4 – the beginning

You are the GP reviewing a patient. He has indigestion and looks pale. A FBC is done: Hb 92g/L (115-160) MCV 76fL (79-98) WCC 15.6×10*9/L (4-11) Neuts 12.6×10*9/L (2-7) PLT 578×10*9/L (150-400) Here is the blood film:   Questions: Describe … Continue reading

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Case 50 part 3 – summary

It just goes to show that picking up on simple signs can lead to the start of a diagnostic journey. The patient with the film below (second from left) had a FBC as she had suffered from back pain and … Continue reading

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Case 50 part 3 – the beginning

You are reviewing the blood films from today. Can you make a diagnosis without a microscope?     Please reply to us (@TeamHaem) on Twitter and always include #TeamHaem to allow others to follow your comments. Please join in the … Continue reading

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Case 50 part 2 – summary

In haematology it is important integrate laboratory investigations to clinical presentations. A blood transfusion was requested in a young patient with macrocytic anaemia with no previous blood count information. The blood film was reviewed rapidly:   The diagnosis of a … Continue reading

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Case 50 part 2 – the beginning

A 21 year old female presents with chest pain. You are asked to authorise a blood transfusion as she is anaemic. Hb 69g/L (115-160) MCV 111fL (79-98) WCC 12.6×10*9/L (4-11) Neuts 10.6×10*9/L (2-7) PLT 578×10*9/L (150-400) Here is her blood … 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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