bdes of red-s with CLINICAL CASE 3/2 Lymphatic System and Immunity A 61-year old
ID: 3481332 • Letter: B
Question
bdes of red-s with CLINICAL CASE 3/2 Lymphatic System and Immunity A 61-year old male with a past medical history of chronic obstructive pulmonary disorder (COPD) was recently admitted fo placement and pleurodesis and was discharged home. Three days later, he returned to the Emergency Room with shortness of breath, cough, and left-sided pleuritic chest p A CT scan of the chest showed left upper lobe pneumonia, a moderate left pleural effusion, and giant bullous emphysema. lung consolidation consistent with Figure 1: Complete Blood Count (CBC) and Differervtial UPMC PUN/SHY Haomi Range 12.s x1oE+9/L 7- 9/a 32-7 204 x1O 9/1 Peripheral Blood PUN/SHY Nornal Range (ABS POLYS 2.38 3.2S) (H NRDC/100 WBC 2. Figure 4: Bone Marrow Aspirate, Manual Differential Count Bone Marrow Difterential Narmal Range Patient Promyelocyte Hyelocyte Metamyelocyte 12.0 17.0 12.0 8.016.0) 2.0 2.0 2.3 2.3 0.3 ( 10.0-25.0) Band PMN Eos Myelo/Meta Eos Band Eos Seg Basopht1 Monocytes Pronormoblasts 9.0-18.0) 7.0 14.0) 1.0 -4.0) 0.0 -3.0) 1.0 2.0) 2.0 ( 0.0-0.2) o.02.0) 0.0 -2.0) 16.032.0 11.0 - 23.0) 0.0-3.0) 1.7 0.7 24.0 16.0 35.0 3.7 0.7 Plagma Cells other Myeloid/Erythroid(ratio) N/A 1.5- 3.3 Tot. of celle counted 300Explanation / Answer
1.a. RBCs are reduced. It could be due to defect in formation or increased RBC breakdown.
b.WBCs are increased. It could suggest an infection or fault in production.
c. Hemoglobin is reduced. It maybe due to faulty production or excessive RBC destruction.
d. Hematocrit is reduced suggesting decreased blood cellularity.
e. Blasts could me increased due to
Myelogenous leukaemia
Vitamin B12/folate antagonist drugs
Infections like HIV
Autoimmune disorders
2. Bone marrow biopsy shows highly increased blast levels typical of malignancy.
3. The above picture most likely suggests the presence of myeloid leukaemia.
Philadelphia chromosome test could be done to rule out CML.
4. Paracentric inversion of the long arm of chromosome 3 AI seen in acute myeloid leukaemia.
5. Myeloperoxidase, Sudan black and non-specific esterase could be positive in AML but are absent in ALL.
Philadelphia chromosome is present in CML, absent in AML.
Patient has high amount of immature blasts. This is not seen in CLL.
6. AML has a poor prognosis with median survival of 18 months.
Treatment consists of
Management of anaemia and hemorrhage
Treatment of infections
Drugs- cytosine arabinoside, daunorubicin, 6-thioguanine generally used together.
Bone marrow transplantation.
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