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HEMATOLOGY2
ABDULLAH SAEED ABDULLAH AL-ZHRANI

UNIVERSITY ID: 442004761
A 45-year-old diabetic male with infected wound on his left foot came to the surgery
clinic. On examination there were redness, hotness and presence of pus inside the
wound. The followings are the laboratory investigation:
Cell type Patient Value Normal range

Total leukocyte count (TLC) 15X109/l 4-11X109/l
HB 14 g/dl 13-17g/dl
Platelets 190,000 140,000-400,000X109/l
• Interpret the previous lab finding / neutrophilia
• Which white blood cell do you expect to increase in this condition? /

Neutrophils
A 63-year-old male presents to the emergency department with a bloody cough and
shortness of breath complaints. Chest X-ray showed an infiltrate in the middle of the
left lung, and the Radiologist has confirmed that the patient had a tuberculosis
infection.
Based on patient history, which component of WBC will be affected in CBC result?
Increased lymphocytes and monocytes in the CBC

58-year-old female who was diagnosed with CML positive for the Philadelphia
chromosome by classical cytogenetics, seven months previously. A repeat bone
marrow performed five months after diagnosis, to assess response to interferon and
hydroxyurea treatment findings consistent with CML, with persistence of the Ph
chromosome and less than 1% blasts.
Patient value Normal value

Hb 11.1 g/dl 11.7 -15.7
Plt 246 x10E+9/L 150 -450
WBC 84.2 x10E+9/L 4.5 -11.0
Basophils (4%) 3.68 < 0.2
• The peripheral smear demonstrated increased numbers of neutrophils and

neutrophil precursors, basophilia and occasional blasts.
• The BM analysis demonstrated marked cellularity, with many 19% blasts and 20%
basophile.
• What is the phase of the disease? / accelerated phase

• What is the differential diagnosis of the disease? / blood smear
A 64-year-old male with untreated diabetes, Presented with new-onset decreased

exercise tolerance of two months duration. Physical Examination: pallor and No
splenomegaly • CBC: TLC 2 x109/l (N 4.0-11.0 x 109/L), RBC 1.84 x 1012/L (N 4.35 to
5.65 1012/L), Hb 6.8 g/dL (N 11.7-15.7 g/dl), Platelet 22 x109/L (N 150-400 X109/l), •
Differential: Nutro 0.6 X109/l (N 1.8-7.5X109/l) Lymph 1.5X109/l (1.5-3.5 X109/l),
Mono 0.2 X109/l (N 02-0.8 X109/l), Eos 0.02 (N 0.04-0.4 X109/l).
• Bone marrow aspiration: hypercellular bone marrow with erythroid and myeloid
dysplastic changes and increased iron stores.
• Interpret the previous findings? / myelodysplastic syndrome disease

• What further lab tests can be performed to detect the stage of the disease?
Examination CBC and bone marrow
A 34-year-old man who had been in excellent health until two weeks prior to
admission when he had developed a mild sore throat, a fever and experienced easy
bruising , gingival bleeding.
CBC result:
Patient value Normal range

WBC 3.5X 109/L 4 x 109/L – 11 × 109/L
RBC 3.2 X 1012/L 4.35 to 5.65 1012/L
Hb 9.7 g/dl 14 – 18 g/dL
PLT 31 X 109/L 150 × 109/L – 450 × 109/L
The peripheral blood film and bone marrow aspiration show infiltration by the cells
in the image.
• Describe these cells?
• What is the most probable diagnosis?
• What are the immunophenotypic results of this case?
• What are the cytochemistry staining results of this case?
M4 or M5 AML
Cell : graunolocyte and monocyte or monoblastic -mono cytic
: Cytochemistry stain
Perodic acid shif
Acid phosphate
• A 5-year-old boy presents to the ER with fevers of 1 Week duration. On
examination, both axillary lymph nodes are enlarged, and the spleen is mild
enlarged.
• CBC results shows that:
• WBC 20.0 (N 4.0-11.0X109/l).
• Differential count 90% blasts cells,9% lymphocytes.
• Hb 6 (N 13-17g/dl).
• Platelet count 70.0 (N 150-400 X109/L).
• The immunophenotyping test was performed. It shows a positive for CD10, 19 and
TdT.
• What is the type of leukemia the patient has?
• What are you expecting to see in BM?
• What are other differential diagnosis tests of this patient?
Bone marrow
• cellularity : markedly hypercellular .

• erythropoiesis and myelopoiesis : reduced with 20-95%
lymphoblasts .
• megakaryopoiesis : megakaryocytes gradually decrease .

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HEMATOLOGY2

ABDULLAH SAEED ABDULLAH AL-ZHRANI

Cell type Patient Value Normal range

• Interpret the previous lab finding / neutrophilia

• Which white blood cell do you expect to increase in this condition? /

Increased lymphocytes and monocytes in the CBC

Patient value Normal value

• The peripheral smear demonstrated increased numbers of neutrophils and

• What is the phase of the disease? / accelerated phase

A 64-year-old male with untreated diabetes, Presented with new-onset decreased

• Interpret the previous findings? / myelodysplastic syndrome disease

Patient value Normal range

• cellularity : markedly hypercellular .

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