CASE STUDY

Ellah Saab, Jamilah Latip, Jenny Bacomo, Gaylle Gonzaga, Martha Suyao,
Jezza Leigh, Gwen Lagnason
 BLOOD CASE I
• A 30-year-old woman complains of fatigue, always experiencing
feeling of faintness, and numbness of her arms and legs for 1
month. She has a history of hypothyroidism and takes thyroid
replacement therapy. Due to her history she became very health
conscious and decided to be a vegan. Her complete blood count
(CBC) shows white blood cells (WBC) 400/mm3 (normal: 4800 to
10,800/mm3), hemoglobin (Hgb) 9 g/dL (normal:12 to 16 g/dL),
hematocrit (Hct) 27 percent (normal: 36 to 46 percent), mean
corpuscular volume (MCV) 120 fL (femtoliter) (normal: 80 to 100 fL),
and platelets 150,100/mm3 (normal: 150,000 to 400,000/mm3)
Data Significance
• WBC is below normal level.
• Decrease in Hemoglobin and Hematocrit
• Mean corpuscular volume is above normal level.
• The patient has moderate anemia as moderate anemia corresponds
to a Hemoglobin level of 7.0 – 9.9 g/dL
• The patient only consumes vegetables
• The patient has experienced thyroid medications.
Anatomy, Physiology, and Pathological
Background
• Blood – specialized body fluid. It runs through the veins, arteries, and
capillaries is known as whole blood, a mixture of about 55 percent
plasma and 45 percent blood cells. About 7 to 8 percent of your total
body weight is blood.
Anatomy, Physiology, and Pathological
Background
• Plasma – clear, straw colored liquid portion of blood that remains
after red blood cells, white blood cells, platelets and other cellular
components are removed. It is the single largest component of
human blood, comprising about 55 percent, and contains water, salts,
enzymes, antibodies and other proteins. It contains proteins that
helps blood to clot, transport substances through the blood, and
perform other function
Anatomy, Physiology, and Pathological
Background
• RBC - round with a flattish, indented center, like doughnuts without a
hole. They carry fresh oxygen throughout the body. Hemoglobin is the
protein inside the RBC, it carries oxygen.
• WBC - also called leukocyte, a cellular component of the blood that
lacks hemoglobin, has a nucleus, is capable of motility, and defends
the body against infection and disease by ingesting foreign materials
and cellular debris, by destroying infectious agents and cancer cells.
• Platelets – tiny blood cells that help the body form clots to stop
bleeding.
GENERAL PATHOLOGY
Overview
• One of the vitamin B-12 deficiency anemias.
• Caused by an inability to absorb the vitamin B-12 needed for your body to make enough healthy red
blood cells.
• This type of anemia is called “pernicious” because it was once considered a deadly disease.
• Pernicious anemia is a type of macrocytic anemia. It’s sometimes called megaloblastic anemia
because of the abnormally large size of the red blood cells produced.
• An autoimmune disorder
GENERAL PATHOLOGY
2.1. Commonly overlooked symptoms include:

• weakness

• headaches

• chest pain

• weight loss

2.2. Neurological symptoms include:

• an unsteady gait

• spasticity, which is stiffness and tightness in the muscles

• peripheral neuropathy, which is numbness in the arms and legs

• progressive lesions of the spinal cord

• memory loss

2.3. Other symptoms of a B-12 deficiency, which can overlap with pernicious anemia, include:

• nausea and vomiting

• confusion

• depression

• constipation

• loss of appetite

• heartburn
GENERAL PATHOLOGY
Lack of vitamin B-12
• People with anemia have low levels of normal red blood cells (RBCs). Vitamin B-12 plays a role in creating RBCs, so the body requires an adequate intake of vitamin B-12.
• Vitamin B-12 is found in:
• Meat
• poultry
• shellfish
• eggs
• dairy products
• fortified soy, nut, and rice milks
• nutritional supplements

Lack of Intrinsic Factor (IF)

• Your body also needs a type of protein called intrinsic factor (IF) to absorb vitamin B-12. IF is a protein produced by cells in the stomach. After you consume vitamin B-12, it
travels to your stomach where it binds with IF. The two are then absorbed in the last part of your small intestine.
• In most cases of pernicious anemia, the body’s immune system attacks and destroys the cells that produce IF in the stomach. If these cells are destroyed, the body can’t make
IF and can’t absorb vitamin B-12.
GENERAL PATHOLOGY
Macrocytes
• Without enough vitamin B-12, the body will produce abnormally large red blood cells called macrocytes.
Because of their large size, these abnormal cells may not be able to leave the bone marrow, where red
blood cells are made, and enter the bloodstream. This decreases the amount of oxygen-carrying red
blood cells in the bloodstream and can lead to fatigue and weakness.
• Other causes of abnormally large red blood cells include:
• long-term use of certain medications and antibiotics, such as methotrexate and azathioprine
• chronic obstructive pulmonary disease (COPD)
• chronic alcoholism
• folate (vitamin B-9) deficiency caused by poor diet or conditions that affect absorption
GENERAL PATHOLOGY
Risk factors

• having a family history of the disease

• being of Northern European or Scandinavian descent
• having type 1 diabetes, an autoimmune condition, or certain intestinal
diseases such as Crohn’s disease
• having had part of your stomach or intestines removed
• being 60 years or older
• being strictly vegetarian and not taking a B-12 supplement
DIAGNOSIS
• Delving into the result, it can be said that the patient is experiencing
Macrocytic and Pernicious Anemia. An evidence for this is shown in
her Peripheral Blood Smear, where her red blood cells are larger than
the normal value. Pernicious anemia is a condition in which the body
can’t make enough healthy red blood cells because it doesn’t have
enough vitamin B12.
• Intrinsic Factor
Conclusion
• In conclusion, the only way for her to gain enough vitamins is for her
body to intake products the gives enough vitamins or nutrients.
Although vitamin injections are what most doctors use for patients
that has anemia. The patient will most likely be asked for their
medical and family history and to perform a physical exam and
running of the ff tests such as CBC and a test to determine the size
and shape of their red blood cells. People that observes risks of them
having anemia, a family history of anemia should immediately seek
for doctor's help.
Q.1 Explain the data presented in the case.
• WBC is below normal level.
• Decrease in Hemoglobin and Hematocrit
• Mean corpuscular volume is above normal level.
• The patient has moderate anemia as moderate anemia corresponds
to a level of 7.0 – 9.9 g/dL
• The patient only consumes vegetables
• The patient has experienced thyroid medications.
Q.2 What is the most likely diagnosis?
• Delving into the result, it can be said that the patient is experiencing
Macrocytic and Pernicious Anemia. An evidence for this is shown in
her Peripheral Blood Smear, where her red blood cells are larger than
the normal value. Pernicious anemia is a condition in which the body
can’t make enough healthy red blood cells because it doesn’t have
enough vitamin B12.
 BLOOD CASE II
• Theo, a 4-year-old boy, is seen by his pediatrician for easy bruising,
joint pain, and leg pain; red dots on the skin that do not blanch; and
hepatosplenomegaly. The complete blood count (CBC) reveals an
elevated white blood cell count (50,000/mm3), a low hemoglobin
level (anemia), and thrombocytopenia (low platelet count). The
complete blood count shows anemia and thrombocytopenia.
Data Significance
• Decreased production of platelets
• Abnormality in the bone marrow is observed as the BM makes too
many white blood cells and decreases the red blood cells.
Anatomy, Physiology, and Pathological
Background
• Bone marrow – tissue comprising the center of large bones. It is a
place where new blood cells are produced. Contains two types of
stem cells which are: hemopoietic and stromal.
• Two types of bone marrow are red and yellow marrow
• RBC, platelets and most WBS arise in the red marrow; some white
blood cells develop in the yellow marrow.
Anatomy, Physiology, and Pathological
Background
• Lymphocyte – type of white blood cells that determine the specifity of
the immune response to infectious microorganisms and other foreign
substances.
• Two primary types of lymphocytes are B and T lymphocytes, they
both originate from stem cells in the bone marrow are initially similar
in appearance. Some lymphocytes migrate to the thymus, where they
mature into T cells, while others remain in the bone marrow, where
(in humans) they develop into B cells.
DIAGNOSIS
• Blood tests
• Bone marrow tests
• Imaging tests
• Spinal fluid test
Conclusion
• Upon observing the symptoms manifested by the patient, it can be
said that the patient is experiencing lymphocytic leukemia, more
likely acute lymphocytic leukemia. Acute lymphocytic leukemia is a
type of cancer of the blood. The word “acute” in acute lymphocytic
leukemia comes from the fact that the disease progresses rapidly and
creates immature blood cells, rather than mature ones.
Q.1 Explain all the data presented

• Decreased production of platelets

• Abnormality in the bone marrow is observed as the BM makes too
many white blood cells and decreases the red blood cells.
Q.2 What is the most likely diagnosis?

• Acute Lymphocytic Leukemia

Q.3 What component of the blood is greatly
affected?
• Platelets
• RBC
 Blood Case III
• Toby, a 4-year-old boy is seen by his pediatrician for a marked bruising
tendency of the arms and legs. His mother says that the bruising
often appeared without any apparent trauma. The mother also
reports that there was no bleeding at the time of circumcision or in
association with separation of the umbilical cord. When he was 3
years old, the patient had an episode of epistaxis that required
transfusion of one unit of blood. There is a history of bleeding on the
maternal side of the family. The patient’s mother and maternal
grandmother and great-grandmother had experienced episodes of
abnormal bleeding with recurrent epistaxis and menorrhagia.
Data Significance
• The bruising of arms and legs is marked.
• His mom claims the bruising often occurred without any seeming
trauma.
• Also the association of the umbilical cord separation was not
bleeding as well as on circumcision.
• At the age of 3, the patient had an episode of epistaxis that
needed to transfuse one unit of blood.
• Family history- mother, grandmother and great grandmother had
experience of excessive bleeding with recurrent epistaxis and
menorrhagia.
 Anatomy, Physiology, and Pathological Background
• Hemophilia – rare disorder in which your blood doesn’t clot
normally because it lacks enough blood-clotting proteins
(clotting factors) two most common types of hemophilia are
factor VIII deficiency (hemophilia A) and factor IX deficiency
(hemophilia B, or Christmas disease).
• Hemophilia A – patient may pass circumcision without
bleeding.
• Hemophilia B – caused by spontaneous mutation, a change in
gene.
 Anatomy, Physiology, and Pathological Background

• Hemophilia is normally an inherited disorder. A person is

born with it.
• It happens because of a defect in one of the clotting
factor genes on the X chromosome
• Hemophilia tends to occur in males, since the gene can
be passed from mother to son.
 Diagnosis
• Hemophilia is diagnosed by taking a blood sample and
measuring the level of factor activity in the blood.
• Hemophilia A is diagnosed by testing the level of factor
VIII activity.
• Hemophilia B is diagnosed by measuring the level of
factor IX activity.
 Conclusion
• To sum it up, the 4-year-old boy who is experiencing bruising
tendency of the arms and legs without any apparent trauma
and legs without any apparent trauma and also had an
episode of epistaxis when he was 3 year old that required
transfusion of one unit of blood is presumably diagnosed to
have blood disorder. In addition, the boy’s family background
has a history of having abnormal bleeding or blood disorder.
With all these data given, these seem to point out that the
child is suffering hemophilia A.
 Q.1 Explain all the data presented in the case.

• The bruising of arms and legs is marked. His mom

claims the bruising often occurred without any
seeming trauma. The mom reports that the umbilical
cord was not bleeding nor on circumcision. At the age
of 3, the patient had an episode that needed to
transfuse one unit of blood, because he was lacking
blood from excessive bleeding.
Q.2 What are the possible diagnosis for this
patient?
• Hemophilia A
 Q.3 What component of the blood is greatly
involved?
• The reason why Toby underwent blood transfusion
when he was a baby was to provide the blood he was
lacking due to severe bleeding without stopping or
clotting. Which is why we can say that the blood
component that was involved in his case is the
clotting factors of the blood.