Hematology/Oncology Vignettes
African Burkitt Lymphoma
10 yr old 2 weeks post viral infection suspected to be EBV presents with swollen jaw, and no other symptoms. Cells stain CD8+, CD20+, CD10+ and Tdt-. Smear shows "starry sky" pattern with macrophages spotting blue background. Testing shows increased C-Myc expression.
Diffuse Large B cell Lymphoma
40 yr old with HIV, 5 day history acute onset SOB, and chest pain. Singular lymphadenopathy noted on exam. Lymphocytosis in lymph nodes, cells Tdt- and CD19-23+
Acute Promyelocytic Leukemia
50 yr old presents to ER with fatigue, recurrent infection> Acute history of clotting and abnormal bleeding. CBC reveals Hb <10. MCV=85. Blast 20%. Blood smear shows schistocytes and large blasts cells with multiple rod-shaped inclusions in cytoplasm and apple core nuclei.
Non-classical Hodgkin Lymphoma (nodular lymphocyte predeominant)
55 year old male presents with recent history of intermittent fever and night sweats. He notes swelling around his neck. Lymph node biopsy reveals cells that resemble popcorn. Flow cytometry: CD20+, CD30-, CD15-
Waldenstrom Macroglobinemia
65 yr old woman with lower left calf pain and swelling. Skin is hot to touch and pitting LLE edema seen on exam. SPEP shows IgM spike
Primary Myelofibrosis
67 yr old presents with recurrent infections and fatigue as well as abdominal distention and tenderness to palpation over LUQ. Massive splenomegaly noted on exam. CBC shows low counts, BM biopsy shows hypocellularity and fibrous bands. PB has immature cells, dacrocytes. genetic testing reveals JAK2 mutation
B-cell Acute Lymphoblastic Leukemia
7 year old female with 1 month history of uncharacteristic fatigue, recurrent infections, and many nosebleeds. Blast count 25%. High cellularity with large blast cells seen in marrow with visible nucleoli. Immunophenotype TdT+, CD 19+, CD21+, CD23+
Large cell granular lymphocytic leukemia
70 year old presents with recurrent infection, fatigue. Patient notes enlarged, painful upper abdomen despite recent unintended weight loss. CBC reveals elevated WBC and lymphocytosis with low neutrophil count, and RBC of 500,000/ml. Flow: CD56+
Hodgkin Lymphoma
A 25-year-old male presents to his primary care provider with a slowly enlarging, nonpainful right neck mass. He denies recent upper respiratory tract infections, fevers, night sweats or unintentional weight loss. He is otherwise healthy. Social history and family history are unremarkable. On examination he is afebrile with normal vital signs. Pertinent findings include a 3-cm, firm, round, nontender, mobile mass in the mid-right neck. There is no other peripheral lymphadenopathy. The liver and spleen are not enlarged.
ALL
A 4-year-old girl presents with lethargy, dyspnea, fever, and bruising. On examination she has hepatosplenomegaly. CXR shows a mediastinal mass and pleural effusion.
Non-Hodgkin lymphoma
A 55-year-old male farmer presents with worsening shortness of breath, night sweats, fevers, bilateral axillary lymphadenopathy, and a 7.7 kg (12%) total body weight loss over 3 months. Recently, he has not been able to work because of fatigue. Physical exam revealed a 3.5 cm left axillary mass; enlarged cervical, axillary, and inguinal lymph nodes; splenomegaly; and no hepatomegaly.
Non-Hodgkin lymphoma
A 56-year-old woman presents with painless right neck lump that has been slowly enlarging for the last 2 years. She denies fevers, night sweats, or weight loss. Physical exam reveals bilateral cervical and axillary adenopathy and a palpable spleen.
CLL
A 62-year-old man presents at the primary care physician's office for an annual physical. He denies any complaints such as fever or chills, weight loss, or fatigue. Of note, his blood tests show an elevated WBC count. The WBCs are predominantly lymphocytes, with a differential of 80% lymphocytes and an absolute lymphocyte count of 75,000/microliter.
Polycythemia vera
A 62-year-old man, who has always been healthy, arrives for a preoperative check prior to a minor procedure. A routine CBC reveals an elevated Hb level of 19.0 g/deciliter. He is surprised to hear about this abnormal result, as he has not noticed any symptoms or signs that have caused him concern. On exam, the only abnormality is a red facial complexion.
Hypercalcemia of malignancy
A 63-year-old woman is brought in by her family for progressive fatigue and confusion. Past medical history is notable for ovarian cancer. Physical examination reveals dry mucous membranes. Admission labs are significant for an elevated adjusted serum calcium of 12.8 mg/dL, a low-normal albumin level, a low-normal phosphorus level, and elevated alkaline phosphatase. Hypercalcemia workup reveals a suppressed parathyroid hormone (PTH), an elevated parathyroid hormone-related peptide (PTHrP), and a low-normal calcitriol (1,25-dihydroxyvitamin D) level.
Essential thrombocytosis
A 64-year-old woman presents with dizziness and repeated TIAs. A carotid ultrasound shows no significant stenosis. The platelet count is 820,000/microliter.
Superior Vena Cava Syndrome
A 65-year-old man with history of chronic smoking for 40 years, hypertension, and chronic obstructive pulmonary disease presents with anorexia and weight loss for the past 6 months. He had been complaining of increased dyspnea with exertion and orthopnea, and has noticed bilateral arm swelling and facial plethora for the past 3 weeks. At the time of admission, his face and upper extremities were edematous, and there were engorged veins in his neck and upper extremity.
4-y/o boy with a 1-week h/o fever, pallor, headache, and bone tenderness; PE: fever, HSM, and generalized, nontender lymphadenopathy; PBS reveals absolute lymphocytosis with abundant TdT+ lymphoblast
ALL
27-y/o presents with 2-month h/o fatigue, oropharyngeal candidiasis, pseudomonal UTI, and epistaxis; PE: numerous petechiae and ecchymoses of skin, gingival mucosal bleeding, guaiac ⊕ stools; W/U: ↑ WBC; PBS shows >30% myeloblasts with Auer rods.
AML
Smoldering Myeloma
Asymptomatic 67 yr old male with 25% plasma cells in bone marrow.
Monoclonal Gammopathy of Undetermined Significance (MGUS)
Asymptomatic 67 yr old male with shows 8% plasma cells in bone marrow on routine CBC.
T-cell Acute Lymphoblastic Leukemia
14 yr old male with acute history of fatigue, recurrent infection, and nosebleeds. Blasts 30%. Mediastinal swelling. High cellularity noted in marrow with large blast cells with very high nucleus:cytoplasm ratio. Immunophenotype TdT+, CD1-8+.
Anaplastic Large Cell Lymphoma
18 yr old presents with lymphadenopathy and fatigue but no other symptoms. CBC shows increased WBC, peripheral smear with large undifferentiated "Hallmark" cells with embryoid and horseshoe nuclei and lots of cytoplasm. IHC: Tdt-, CD30+. Genetic testing reveals t(2;5) with high tyrosine kinase activity.
50 yo F presents with a painless lump in her right breast. She first noted this mass one month ago. There is no nipple discharge VS: Afebrile, P 70, BP 110/50, RR 12 Gen: NAD Skin: WNL HEENT: WNL Lymph nodes: - Breast: 3-cm, hard, immobile, non-tender mass with irregular borders; no nipple discharge Lungs: WNL CV: WNL Abd: WNL
Breast Cancer
10-y/o African child presents with a 3-week h/o a rapidly enlarging, painless mandibular mass; CBC: mild anemia and leukopenia; cytogenetics reveal a t(8:14) translocation; excisional biopsy: "starry-sky" pattern.
Burkitt Lymphoma
60-y/o man presents with fatigue and anorexia; PE: generalized lymphadenopathy and HSM; W/U: WBC = 250,000, positive direct Coombs test; PBS: small, round lymphocytes predominate with occasional smudge cells.
CLL
8-y/o with a h/o vomiting and diarrhea after eating a hamburger last week presents with fatigue, periorbital edema, and oliguria; PE: purpuric rash; CBC: ↓ platelets; PBS: burr cells, helmet cells; UA: RBC casts, proteinuria, hematuria.
HUS
45 y/o M presents to ER after vomiting bright red blood. Exam: BP 88/46 mmHg and 120 bpm HR
Hemodynamic Instability
60-y/o with headache, vertigo, blurry vision, pruritus, joint pain; PE: ↑ BP, plethoric splenomegaly; W/U: Hct = 60, mild leukocytosis, and hyperuricemia
Polycythemia Vera
Newborn develops jaundice rapidly during the first day of life; PE: HSM; W/U: severe anemia, ⊕ indirect Coombs test in both mother and newborn.
Rh Incompatibility
Connor has renal dx and has begun to experience progressing sx of fatigue, weight loss, dizziness, koilonychia, pallor. What is the dx?
anemia of chronic dx (renal dx) giveaway: renal dx
16-y/o adolescent with a h/o menorrhagia presents with fatigue; PE: multiple cutaneous bruises; guiaic + stools; W/U: ↑ bleeding time, ↓ factor VIII, normal platelet count, PT, and PTT.
von Willebrand Disease
Denise is 55 yo has been feeling tired and noticing extra pallor. She is experiencing some trouble swallowing, along with dizziness, fatigue, weakness, and fever. She is worried because she is experiencing some bone pain now. You notice she experiences some cheilitis, koilinychia, and atrophic glossitis. Recently, she has had a crazy desire to eat ice. How would you tx this?
#1: 1 mg/day of iron PO -3 to 6 mo Vitamin C supplement #2: parenteral iron, 1-1.5g IV
Classical Hodgkin Lymphoma
24 year old female presents with 2 month history of recurrent fevers and night sweats that seem to come and go biweekly. She notes 10 lb weight loss in past month and she notes significant pain after she had 2 beers. Localized cervical lymphadenopathy noted on exam. Peripheral smear shows bi-nucleated cells with visible nucleoli. Flow: CD15+, CD30+, CD20-. CBC shows elevated WBC across all types. Biopsy of lymph node reveals fibrous bands separating nodules of primarily benign WBC.
Matthew has RA and has started to experience increased pallor, fatigue, night sweats, weight loss, and glossitis. How would you tx this?
-tx underlying cause -If needed, transplant of EPO.
Acute Myeloid Leuekmia
48 yr old adult with recent history fatigue, recurrent infection, easy bruising and other abnormal bleeding, including from his gums after brushing his teeth. CBC shows low WBC, RBC, platelets. Blasts 22% Large cells with visible cytoplasm and Auer rods in bone marrow. CD34+
Chronic Myelocytic Leukemia
55 yr old with weakness, weight loss, fatigue, and LUQ dragging. CBC has increased WBC with neutrophilia and basophilia, and low platelets. Smear shows increased blast % (<15%). Chromosomal abnormality seen on FISH, described as translocation between chromosomes 9 and 22..
Follicular Lymphoma
57 yr old with fatigue, infection, generalized lymphadenopathy. Flow: CD19+, CD20+, CD10+, CD5-, CD23-. Genetic testing reveals t(14;18) with high BCL2 expression.
Peripheral T-cell Lymphoma Unspecified
59 yr old with generalized lymphadenopahthy, fever, abnormal weight loss, and red, itchy skin. CBC shows increased WBC, lymphocytosis, eosinophilia. IHC TdT-
Polycythemia Vera
60 yr old with 3 mo. history headaches, nose bleeds, and redness/itchiness after hot showers, abdominal distention, presents with lower leg pain and swelling. Exam reveals splenomegaly. Hb=17.5, Hct high. O2 sat 99%. CBC shows elevated counts, RBC 10M/ml. Blood appears sludgy. genetic testing reveals JAK2 mutation.
Multiple Myeloma
63 yr old with severe gradual onset back pain, fatigue, and urinary problems. Blood work: hypercalcemia; Rouleaux RBC, Russel bodies, Dutcher bodies on smear; 15% plasma cells in BM; SPEP and UPEP show IgG spike. Lytic lesions on Xray, and pink casts bilaterally on kidney on abdominal CT.
Adult T-cell Leukemia/Lymphoma
63 yr old with skin lesions and diffuse M/S pain. Lymphadenopathy noted on physical exam. CBC shows high WBC with lymphocytosis, peripheral smear shows large lymphocytes with cloverleaf nuclei. Other blood work reveals hypercalcemia. Biopsy cells test positive for HTLV1.
Budd Chiari
65 year old with noted polycythemia vera on chart. Presents with severe upper abdominal pain and enlargement. Jaundice noted on exam.
Hairy Cell Leukemia
65 yr old male with frequent infections, fatigue, and easy bruising. Massive splenomegaly noted on exam. CBC shows pancytopenia. Bone marrow tap dry. Flow: TRAP+, CD11C+, CD22+, CD25+, CD103+. Smear shows large cells with leafy projections.
Essential Thrombocythemia
65 yr old with erythromyalgia, abd distention, and repeated DVT. Peripheral smear shows large platelets and hypercellularity. CBC plt 900,000/ml. Hb/Hct normal. genetic testing reveals JAK2 mutation
Marginal Zone Lymphoma
65 yr old with recent history Helicobacter pylori GI infection. Small B cells on BM biopsy. Flow: CD5-, CD23- , CD10-. Patient shows pronounced improvement upon follow up after 2 week antibiotic treatment regimen.
Chronic Lymphoproliferative Leukema/Small Lymphocytic Lymphoma (CLL/SLL)
70 yr old routine CBC: increased WBC, absolute lymphocytosis, low RBC. Mild lymphadenopathy noted on exam.Smear: smudge cells, spherocytes. Flow CD 19+, CD20+, CD23+, CD5+, CD10-
Mantle Cell Lymphoma
70 yr old with GI pain. Lymphocytosis on CBC. polyps seen on GI endoscopy. Flow: CD19+, CD20+, CD5+, Cyclin D+; CD23-. Genetic testing reveals t(11;14).
Tumor lysis syndrome
A 19-year-old man is diagnosed with a highly proliferating non-Hodgkin lymphoma. The disease is bulky, involving lymph nodes above and below the diaphragm, the spleen, and the bone marrow. Serum lactate dehydrogenase is significantly elevated but renal function and electrolytes are within normal limits. Twenty-four hours after initiation of aggressive chemotherapy he complains of nausea, vomiting, diarrhea, and lethargy. He has become oliguric and is hypertensive and tachycardic. Biochemistry demonstrates elevated uric acid, potassium, and phosphate, as well as elevated BUN and creatinine.
ALL
A 38-year-old man presents to his primary care physician complaining of generalized weakness, epistaxis, mouth ulcers, and weight loss. He has unremarkable past medical history and takes no medications. Physical examination reveals mild pallor and petechial hemorrhages over his lower limbs. He has multiple, widespread small lymph nodes that are palpable and mild splenomegaly.
Spinal cord compression
A 40-year-old woman presents with back pain and difficulty with her gait. She has a long history of smoking and has had some hemoptysis recently. Her exam reveals diminished pinprick sensation from the nipple line caudally, power in the lower extremities of 4/5, absent joint position sense in the lower extremities, and diminished vibratory sense. Anal sphincter tone is intact.
Multiple Myeloma
A 45-year-old woman presents to the emergency department with nausea, vomiting, and confusion. She had history of low back pain of 6 months' duration and increasing sciatic pain in the last 2 weeks. On physical exam, the patient was pale and dehydrated with bone tenderness in the lumbar region. Neurologic exam revealed an up-going plantar reflex on the left with intact power in all muscle groups and at all joints. An MRI revealed an L5 compression fracture. This was associated with hypercalcemia and renal insufficiency.
CML
A 50-year-old man presents to his primary care physician for a routine physical. He is asymptomatic at the time of the visit and the physical exam is normal. Routine baseline bloods showed elevated WBC and platelet counts.
CML
A 54-year-old man presents to his primary care physician with a 2-month history of fever, malaise, and weight loss. He also reports frequent epistaxis, abdominal fullness, and early satiety. On exam, he is found to have splenomegaly.
Polycythemia vera
A 55-year-old man has had routine physical exams for several years and has always been healthy, does not smoke, and has no history of pulmonary disease. His primary care physician has noted a gradually increasing Hb level over the past few years (to a current level of 19.5 g/deciliter), mild leukocytosis, and mild thrombocytosis. He has frequent episodes of facial flushing that are associated with slight headaches and a feeling of fullness in his head and neck. He has noted intermittent burning, stinging, and tingling sensations in his fingertips. He has recurrent, often severe, pruritus that is exacerbated by taking a hot bath. On exam, he has a red face and neck and the spleen is mildly enlarged.
Febrile neutropenia
A 57-year-old woman with a history of stage I breast cancer status post-lumpectomy is being treated with adriamycin and cyclophosphamide every 3 weeks. She had her first treatment 8 days ago and now presents with a temperature of 100.8°F (38.2°C). Vital signs are stable and she has no localizing signs or symptoms other than mouth sores. White blood cell count is 550/microliter with an absolute neutrophil count of 200 cells/microliter.
AML
A 58-year-old man presents to his primary care physician with increasing tiredness, accompanied by bruising on his legs. He also complains of aching bones. He has no previous illnesses. On examination, he is pyrexial and pale, has bony tenderness over the sternum and tibia, and has petechiae on his legs. There are no palpable lymph nodes. He has crepitations at the left base. The liver and spleen are not palpable.
CLL
A 60-year-old man presents with swollen lymph nodes in the cervical and inguinal region that have been present for 2 months and are gradually increasing in size. The lymphadenopathy is painless and has not responded to a course of antibiotics prescribed by the primary care physician. The patient denies any recent history of infection, fever, or chills.
Multiple Myeloma
A 60-year-old previously healthy man presents with 2 to 3 months of back pain. Over the last 3 weeks, he has developed a cough and increasing fatigue. On examination he had evidence of pneumonia and was noted on radiography to have osteolytic lesions. Laboratory data revealed anemia associated with the presence of a monoclonal protein.
Essential thrombocytosis
A 60-year-old woman presents with burning pain in her hands and feet, and a headache. Her lower extremities have a dusky discoloration that is consistent with erythromelalgia. Her platelet count is 740,000/microliter.
Amyloidosis
A 62-year-old man is referred for management of atypical multiple myeloma. He has a mild anemia of 12 g/dL, a urinary protein loss of 2.2 g/day with a urinary immunofixation showing free lambda light chains. However, the bone marrow shows only 5% plasma cells and does not fulfill criteria for multiple myeloma.
Waldenström's Macroglobinemia
A 65-year-old white man, whose father died from lymphoma, presents with worsening fatigue, anorexia, and weight loss over the past 6 months. Recently he has noted left-sided upper abdomen discomfort, especially if he leans forward.
Tumor lysis syndrome
A 69-year-old woman with a 2-year history of chronic lymphocytic leukemia presents with a WBC count of 41,000/microliter. She has a past medical history of hypertension and mild renal impairment related to the use of NSAIDs for osteoarthritis. She is started on systemic chemotherapy with fludarabine. At follow-up 7 days after initiation of treatment, she complains of fatigue and weakness. The WBC count has fallen to within normal levels but serum biochemistry reveals hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and a significant deterioration in renal function.
Myelodysplastic syndrome
A 70-year-old man presents with generalized fatigue that has slowly progressed over several months. On physical examination, the patient has pale mucus membranes and mild tachycardia. The remainder of the examination is unremarkable.
Waldenström's Macroglobinemia
A 70-year-old white man with a long history of worsening fatigue, unsteady gait, and intermittent numbness and pins-and-needles sensation in his lower legs, presents to the emergency department with epistaxis, headache, vision problems, and abdominal pain. Recently he has noticed that he requires much less food in order to feel full. He has right-sided upper abdomen pain, especially when he bends forward. Physical exam reveals splenomegaly, hepatomegaly, and axillary and inguinal lymphadenopathy. Fundoscopy reveals a retinal hemorrhage in the right eye.
Superior Vena Cava Syndrome
A 70-year-old woman with a history of ischemic cardiomyopathy, left ventricular ejection fraction of 25%, and prior history of cardiac resynchronization therapy 3 years ago presents with slowly progressive swelling of the face and both arms, as well as prominent veins in the neck and upper extremities. She gives a history of excessive bleeding from the site of venepuncture in the antecubital region after blood draws in the last few months.
Amyloidosis
A 79-year-old man presents with dyspnea on exertion for 1 year and lower extremity edema. As part of a cardiac workup, the echo shows concentric LVH. Cardiac catheterization shows normal coronary arteries and he is referred for further evaluation of noncardiac dyspnea.
Sporadic American Burkitt Lymphoma
Adult patient with history of chronic esophageal reflux and heart burn presents with generalized lymphadenopathy. Cells stain CD8+, CD20-23+, Tdt-. Testing shows increased C-Myc expression.
Richter Sydrome
CLL/SLL transformation to Large Cell Lymphoma in lymph nodes
35-y/o presents with a 3-year h/o mild weight loss, anorexia, worsening DOE; PE: splenomegaly; CBC: mild anemia, WBC = 125,000; PBS: granulocytosis with 10% myeloblasts; cytogenetics reveal a t(9:22) translocation
CML
18-y/o woman develops dyspnea and declining mental status 1 hour after a C-section complicated by excess blood loss; PE: mucosal bleeding, large clot in the vaginal vault; W/U: ↑ D-dimer, ↑ PT/PTT, ↓ antithrombin III, and thrombocytopenia.
DIC
10 yo African-American M presents with sudden onset of jaundice, dark-colored urine, back pain, and fatigue. He was started on TMP-SMX for an ear infection a few days ago. He has a family history of blood disorders VS: T 38°C (99.8°F), P 90, BP 110/50, RR 14 Gen: NAD Skin: Jaundice HEENT: Icterus, pallor Lungs: WNL CV: WNL Abd: WNL Ext: WNL
G6PD Deficiency
50-y/o with h/o bone marrow transplant for chronic myelogenous leukemia (CML) 3 weeks ago presents with severe pruritis, diarrhea, and jaundice; PE: violaceous rash on palms and soles; W/U: ↑ BR, ALT, and AST
GVHD
8-y/o boy presents with a swollen painful knee; FH: maternal grandfather died from hemorrhage after a cholecystectomy; PE: cutaneous ecchymoses; W/U: gross blood in swollen knee joint, ↑ PTT, normal PT and platelet count, ↑ bleeding time.
Hemophilia A
8-y/o with a h/o environmental allergies presents with a painful rash on the legs, abdominal discomfort, joint pain; UA: hematuria and RBC casts; renal biopsy: glomerular mesangial IgA deposits
Henoch Schonlein Purpura
17-y/o man presents with a 2-month h/o fever, night sweats, and weight loss; PE: non-tender, cervical lymphadenopathy, and HSM; CBC: leukocytosis; CXR: bilateral hilar adenopathy; lymph node biopsy: Reed-Sternberg cells.
Hodgkin Disease
7-y/o with h/o viral URI 1 week ago presents with epistaxis; PE: petechial hemorrhages of nasal mucosa and extremities; W/U: ↓ platelets, normal PT and PTT; bone marrow biopsy: ↑↑ megakaryocytes Antiplatelet antibodies
ITP
Sezary Syndrome
Middle aged female with several month history of gradually worsening diffuse red, itchy rash that has begun hardening and flaking. She notes rash is covering nearly all of her body. Blood biopsy taken and lymphocytosis noted. Nuclei appear cerebriform in shape. General lymphadenopathy also noted on physical exam.
Mycosis Fungoides
Middle aged woman with several month history of gradually worsening diffuse red, itchy rash. Swollen lymph nodes and Pautrier abscesses noted on exam. Flow: CD4+
55-y/o with a recent h/o streptococcal pneumonia presents with bone pain and weight loss; W/U: mild anemia, hypercalcemia; PBS: roleau formation; UA: Bence-Jones proteinuria; serum electrophoresis: M spike; XR: cranial "punched-out" lesions.
Multiple Myeloma
Extranodal NK/T-cell Lymphoma
Patient presents with acute onset erosion and necrosis of the nasal septum. Patient denies any history explicit drug use. He has history of mononucleosis as a young adult.
10-y/o with a h/o recurrent chest pain presents with fever and bilateral leg pain; PE: febrile, multiple leg ulcers; PBS shows sickle-shaped erythrocytes; Hb electrophoresis shows HbS band.
Sickle Cell Anemia
Langerhans Cell Histiocytosis
Smear shows birbeck granules with classic "tennis racket" morphology. IHC: SD100+, CDIa+. Present as: Eosinophilic granuloma (adults), Hand-Schuller Christian (kids), Letterer-Siwe (toddlers), Pulmonary LCH
2-y/o boy with a h/o recurrent epistaxis presents with the third episode of otitis media in 4 months; PE: eczematous dermatitis; W/U: thrombocytopenia, ↓ IgM, ↑ IgA.
Wiskott Aldrich syndrome
Your patient comes in for regular blood work, with no concerns. This is a routine checkup. You notice that the MCV and MCHC are low, and there is mild anemia. There are some target cells and acanthocytes, along with ↑ RBC. What do you dx?
alpha thalassemia trait
Brendan is noticing that he is gaining weight and is intolerant to the cold. Then he notices that he is fatigued all the time, has glossitis, episodes of syncope. What would you dx this patient with?
anemia of chronic dx (hypothyroidism)
Matthew has RA and has started to experience increased pallor, fatigue, night sweats, weight loss, and glossitis. What is the dx?
anemia of chronic inflammation (RA is the giveaway, along with any inflammatory dx, like CA, IBD) microcytic, hypochromic
Myasthenia Gravis, Pure red cell aplasia
associated with Thymoma
Myelodysplastic Syndrome
elderly woman with history of chemotherapy-treated breast cancer presents with fatigue and bleeding. BM appears hypercellular with 15% blasts. Hb=9, MCV=105. Ringed sideroblasts, and Auer rods, and bi-lobed Pelger-Huet neutrophils seen on smear.
Your patient is experiencing marked pallor and splenomegaly. You are not sure why because there are few other sx, so you do some routine bloodwork, including a peripheral blood smear. You notice right away that there are target cells and poikilocytes. Weird. You also notice that there is anemia as well, and ↑ RBC. What is your diagnosis?
hemoglobin H dx
Your patient is experiencing marked pallor and splenomegaly. You are not sure why because there are few other sx, so you do some routine bloodwork, including a peripheral blood smear. You notice right away that there are target cells and poikilocytes. Weird. You also notice that there is anemia as well, and ↑ RBC. What diagnostic test would you order next? And what would you expect to see?
hemoglobin electrophoresis 40% fast moving hemoglobin H
Denise is 55 yo has been feeling tired and noticing extra pallor. She is experiencing some trouble swallowing, along with dizziness, fatigue, weakness, and fever. She is worried because she is experiencing some bone pain now. You notice she experiences some cheilitis, koilinychia, and atrophic glossitis. What is the most likely cause of her sx?
malabsorption
Your patient comes in for regular blood work, with no concerns. This is a routine checkup. You notice that the MCV and MCHC are low, and there is mild anemia. There are some target cells and acanthocytes. What is your tx plan?
no tx--just ID condition alpha thalassemia trait
Connor has renal dx and has begun to experience progressing sx of fatigue, weight loss, dizziness, koilonychia, pallor. What kind of anemia is present here?
normocytic, normochromic mild-severe anemia
Connor has renal dx and has begun to experience progressing sx of fatigue, weight loss, dizziness, koilonychia, pallor. What is the tx plan?
tx underlying dx If needed, transfusions of EPO.
Brendan is noticing that he is gaining weight and is intolerant to the cold. Then he notices that he is fatigued all the time, has glossitis, episodes of syncope. How would you tx this patient?
tx underlying dx transfusions of EPO if severe
1-y/o Greek child presents with pallor and delayed milestones; PE: skeletal abnormalities, splenomegaly; peripheral blood smear (PBS): hypochromic microcytic RBCs, target cells, fragmented RBCs; skull XR: "hair-on-end" appearance.
β-Thalassemia
Denise is 55 yo has been feeling tired and noticing extra pallor. She is experiencing some trouble swallowing, along with dizziness, fatigue, weakness, and fever. She is worried because she is experiencing some bone pain now. You notice she experiences some cheilitis, koilinychia, and atrophic glossitis. Recently, she has had a crazy desire to eat ice. What kind of bloodwork do you expect to see?
↑ TIBC, RDW ↓ Hct, Hb, iron
Brendan is noticing that he is gaining weight and is intolerant to the cold. Then he notices that he is fatigued all the time, has glossitis, episodes of syncope. What will labs look like?
↑ ferritin ↓ EPO, RBC, Hct, Hb, transferrin sat
Matthew has RA and has started to experience increased pallor, fatigue, night sweats, weight loss, and glossitis. Many of the classic sx of anemia. What will labs show?
↑ ferritin stores ↓ RBC, Hct, Hb ↓ EPO