Tag Archives: pancytopenia

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 72 – case C

Sticking with bone marrow trephine! What do you think of this one? 58 yr old gentleman presents to GP feeling tired.  Bloods show Hb 78, wcc 2.1, platelets 52. Blasts were seen on film, aspirate dry tap.  What other investigations … 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 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 28 – summary

Case 28 explored the differential diagnoses to be considered when faced with  a patient with pancytopenia. We worked through a number of differentials during the case – see the previous update. However we concluded that our patient seemed to have … Continue reading

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Case 28 – update 1

So our young woman is in A&E/ED. We have established the following: She has been a little tired and anorexic lately. She had a sore throat 2 weeks ago and received amoxicillin. She only took the pills for 4 days … Continue reading

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Case 28 – the beginning

A 25 year old woman attends A&E complaining of lethargy and dyspnoea. She denies any cough or sputum and examination and CXR are clear. She has a temperature of 39 and small lymph nodes are palpable throughout the cervical chains … Continue reading

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Case 25 – update 2

You have a patient awaiting a two week wait appointment for weight loss, fever and pancytopenia. He is rather obese so examination is difficult.  He has a history of diffuse large B cell non-Hodgkin lymphoma treated to complete remission ten … Continue reading

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Case 25 – the beginning

Welcome to #teamhaem! For those of you who are new – welcome! The case will evolve over the next week or so, depending on the information you want and suggest.  Just follow us and the hashtag #teamhaem on twitter – … Continue reading

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Morphology – case 5 (summary)

Thanks for all of your responses. The full blood count of our patient showed Hb 82g/L, PLT 34×10*9/L, WCC 6.2×10*9/L, neuts 0.34×10*9/L. The film showed abnormal leukaemic blast cells which are occasionally bilobed and heavily granulated with stacks of Auer … Continue reading

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