Question 1
A man with fractured ribs following a fall has the following results:
Hb: 10.9 g/dL
PCV: 39%
MCHC: 30g/dL
WBC: 12.8 x 10 (9)/L
Neutrophils: 64%
Lymphocytes: 27%
Monocytes: 3%
Myelocytes: 2%
Metamyelocytes: 4%
Nucleated RBCs, slight poikilocytosis, slight anisocytosis
1. What is this type of blood picture?
A: Leukoerythroblastic picture
leukoerythroblastic picture on blood film can be the bone marrow response to any irritation including marrow infiltration (causing immature red cells). Marrow infiltrative disorders include myelomas, malignancy, myelofibrosis, Gaucher's disease etc. It can also occur as a response to severe critical illness such as trauma, sepsis, massive hemolysis or severe megaloblastic anemia. Leukoerythroblastic change refers to the presence of nucleated red blood cells and primitve white blood cells.
Peripheral blood smear showing the presence of nucleated red blood cells and immature white cells.
2. List four possible underlying causes?Marrow infiltration, overwhelming sepsis, major blood loss and marrow hypoxia
3. What is meant by the terms anisocytosis and poikilocytosis?
Anisocytosis is excessive inequality in the size of red blood cells
Poikilocytosis is increase in number of abnormally shaped red blood cells on film
Question 2
A 78 yr old man presented after a fall resulting in a bruised hip. His Full blood count is the following:
Hb 12.0 g/dL
WBC: 1.9 x 10 (9) --> low
Platelet: 28 x 10 (9) --low
RBC: 3.01 x 10 (9)--low
HCT: 0.358 --low
MCV: 118.9 fL --high
MCH: 39.9 pg --high
MCHC: 335 G/L --normal
Neutrophils 79.6%
Lymphocyte 17.3%
Monocytes 3.1%
Eosinophils 0.0%
Basophils 0.0%
Moderate anisocytosis, marked macrocytosis
List causes for the raised MCV?
Answer:
-B12 deficiency
-folate deficiency
- myeodysplastic syndrome
- therapy with cytotoxics or immunposuppressants
- alcohol
-hypothyroidism
- alcohol and hypothyroidism do not produce such high levels of MCV usually but anwers accepted.
Note: macrocytosis - describe erythrocyte that are larger than normal, typically reported as MCV greater than 100 fL. Because the amount of Hb in the cell increases proportionately with the increase in size, MCHC remains within normal limits.
Causes of macrocytosis are many and range from benign to malignant; thus a complete work up to determine etiology is essential. Macrocytosis can occur at any age, but it is more prevalent in older age groups because the causes of macrocytosis are more prevalent in older persons.
A man with fractured ribs following a fall has the following results:
Hb: 10.9 g/dL
PCV: 39%
MCHC: 30g/dL
WBC: 12.8 x 10 (9)/L
Neutrophils: 64%
Lymphocytes: 27%
Monocytes: 3%
Myelocytes: 2%
Metamyelocytes: 4%
Nucleated RBCs, slight poikilocytosis, slight anisocytosis
1. What is this type of blood picture?
A: Leukoerythroblastic picture
leukoerythroblastic picture on blood film can be the bone marrow response to any irritation including marrow infiltration (causing immature red cells). Marrow infiltrative disorders include myelomas, malignancy, myelofibrosis, Gaucher's disease etc. It can also occur as a response to severe critical illness such as trauma, sepsis, massive hemolysis or severe megaloblastic anemia. Leukoerythroblastic change refers to the presence of nucleated red blood cells and primitve white blood cells.
2. List four possible underlying causes?Marrow infiltration, overwhelming sepsis, major blood loss and marrow hypoxia
3. What is meant by the terms anisocytosis and poikilocytosis?
Anisocytosis is excessive inequality in the size of red blood cells
Poikilocytosis is increase in number of abnormally shaped red blood cells on film
Question 2
A 78 yr old man presented after a fall resulting in a bruised hip. His Full blood count is the following:
Hb 12.0 g/dL
WBC: 1.9 x 10 (9) --> low
Platelet: 28 x 10 (9) --low
RBC: 3.01 x 10 (9)--low
HCT: 0.358 --low
MCV: 118.9 fL --high
MCH: 39.9 pg --high
MCHC: 335 G/L --normal
Neutrophils 79.6%
Lymphocyte 17.3%
Monocytes 3.1%
Eosinophils 0.0%
Basophils 0.0%
Moderate anisocytosis, marked macrocytosis
List causes for the raised MCV?
Answer:
-B12 deficiency
-folate deficiency
- myeodysplastic syndrome
- therapy with cytotoxics or immunposuppressants
- alcohol
-hypothyroidism
- alcohol and hypothyroidism do not produce such high levels of MCV usually but anwers accepted.
Note: macrocytosis - describe erythrocyte that are larger than normal, typically reported as MCV greater than 100 fL. Because the amount of Hb in the cell increases proportionately with the increase in size, MCHC remains within normal limits.
Causes of macrocytosis are many and range from benign to malignant; thus a complete work up to determine etiology is essential. Macrocytosis can occur at any age, but it is more prevalent in older age groups because the causes of macrocytosis are more prevalent in older persons.
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