(1) Patient: 28-year-old pregnant female CBC results: WBC: 4 X10 9 /L RBC: 2 X10

Question

(1) Patient: 28-year-old pregnant female

CBC results:

WBC: 4 X109/L

RBC: 2 X1012/L

HGB: 10.5g/dL

HCT: 32%

MCV:123 fL

MCH: 39 pg

MCHC: 33 g/dL

RDW: 21

PLT: 149 X109/L

RBC morphology: macro-ovalocytes (2+), some Howell-Jolly bodies

Neutrophil morphology: moderate hypersegmented neutrophils

MMA: normal

Homocysteine: elevated

(A) What is a likely diagnosis? Explain

(B) What kinds of dietary adjustments could be a remedy for this condition?

(C) What is the most pressing concern if this patient’s condition is not treated?

(2) Patient: 40-year-old male complains of fatigue, as well as numbness and tingling sensations in fingers and toes.

CBC results:

WBC: 3.9 X109/L

RBC: 3 X1012/L

HGB: 11 g/dL

HCT: 35%

MCV: 126 fL

MCH: 40 pg

MCHC: 32.7 g/dL

RDW: 21.2

PLT: 148 X109/L

RBC morphology: macro-ovalocytes (3+), Howell-Jolly bodies observed

Neutrophil morphology: significant hypersegmented neutrophils

MMA: elevated

Homocysteine: elevated

(A) What is a likely diagnosis? Explain

(B) What kinds of follow-up tests should be done to further determine the underlying cause? Explain

(3) Patient: 6-month-old infant; baby is lethargic and pale.

CBC results:

WBC: 10 X109/L

RBC: 1.2 X1012/L

HGB: 6 g/dL (increased HbF)

PLT: 200 X109/L

Serum iron: slightly above normal

Serum ferritin: slightly above normal

% saturation: 100%

RBC morphology: normocytic

Neutrophil morphology: normal

MMA: normal

Homocysteine: normal

(A) Name two possible diagnoses that are consistent with these CBC results. Explain.

(B) What tests should be performed to distinguish between these two different diagnoses? Explain

(4) A 60-year-old male presents with the following physical characteristics: fatigue, jaundice, slight splenomegaly.

CBC results:

WBC: 4.2 X109/L

RBC: 4 X1012/L

HGB: 12 g/dL

PLT: 145 X109/L

RBC morphology: normochromic, slightly macrocytic; some stomatocytes observed

Neutrophil morphology: normal morphology

MMA: normal

Homocysteine: slightly increased

(A) What is a likely diagnosis? Explain

(B) What other specific tests should be done to confirm the diagnosis?

(C) What kinds of life-style questions would be appropriate to ask this patient?

(5) Patient: 16 year-old female complaining of weakness, fatigue, recurring fevers and easy bruising.

CBC results:

WBC: 1.3 X109/L

RBC: 2.3 X1012/L

HGB: 6.8 g/dL

HCT: 24%

MCV: 98 fL

PLT: 8 X109/L

RBC morphology: normochromic, slightly macrocytic

Neutrophil morphology: normal, but immature band neutrophils also present

(A) What is a possible diagnosis? Explain.

(B) What would you expect a bone preparation to indicate? (What kinds of cells predominate in the bone marrow of this patient?)

(C) Describe some of the possible underlying causes of this ailment.

Explanation / Answer

1.

A. The patient is suffering with hemolytic anaemia as her leukocyte and platelet count lower than the normal range indicating pancytopenia. She is also suffering with Vitamin B12 deficiency. Presence of howell Jolly bodies in the blood indicate the malfunction of spleen.

B. Vitamin B12 must be supplemented ida Pro diet order medicines

C. If the patient is not treated neurological complications may become permanent.

2.

A. Peripheral neuropathy is a normal condition causing numbness tingling sensation of the extremities and Vitamin B12 deficiency causes of weakness numbness and more. Megaloblastic anaemia is also having the about hematological findings with multi segmented neutrophils and presence of howell Jolly bodies.

2 measurement of methyl malonic acid can provide indirect method for differentiating vitamin B12 and folate deficiency direct measurement of blood Calamine is another standard method now she's been largely used to help determine the nature of vitamin B12 deficiency.

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