Clinical Case 1:

A 6 year-old-male child presented with features of fever, malaise, nausea and decreased
urination of abrupt onset. On examination, he had periorbital swelling and bipedal oedema. He
had history of infected scabies 2 weeks back. His blood pressure is 140/90 mm of Hg.
a
Blood Biochemical findings:
Blood urea: 80 mgs/ dL.
Sr. creatinine: 2.4 mgs dL.
Urine Examination findings:
Physical and Biochemical findings:
Volume: 300 mL / 24 hours.
Color Smoky
Glucose: Nil
Albumin: ++
Microscopic findings:
Epi. Cells: 2-4/H.P.F
Pus cells: 10-12/H.P.F
RBC: Plenty
Casts: 15-30/5 L.P.F [R.B.C & Puscell casts]
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Department of Pathology, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha
 Clinical Case 2:
A 3 year-old-female child presented with generalized anasarcafor 3 days. On examination the
child is afebrile, abdominal distention+, mild pallor,
no organomegaly and bilateral pedal pitting
edema. Her blood pressure is 103/70 mm of Hg.
Laboratoryfindings:
CBCfindings:
H b : 11.5 gms dL TPC: 3.6lakhsI cmm
TLC: 11,600/ cmm DC: N24, E5, B0, L68, M32
BloodBiochemical findings:
Blood urea: 40 mgs/dL. S r . cholesterol:300 mgs /IdL.
Sr. creatinine: 1 mgs / dL.
Urine Examination findings:
Physical and Biochemical Findings:
Color: Pale yellow, frothy Albumin: ++++
Glucose: Nil 24 hours urine protein: 4.2 Gms.
Microscopic findinggs:
Epi. Cells: 1-2/H.P.F RBC: Nil
Pus cells: 1-2/H.P.F Others: Oval fat bodies
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Department of Pathology, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha
 Clinical Case 3:
A 65 year-old-male patient presented with back pain, anemia and X-ray shows multiple
punchedoutlesions in skull and other bones.
At
SPEP
Aphie Apha
X-ray
o
Bone marrow P. smear
Normal Kidney
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What is the finding shown in the kidney biopsy of the patient?
Department of Pathology, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha
BuRUE

196 IU/L

208 IU/L

30 IU/L
 Clinical Case 5:
A 4-year-old male child presented with weakness, breathlessness and abdominal swelling. On
examination, moderate pallor, jaundice and moderate hepato-splenomegaly. The Liver function
test and urine examination findings are as given below:
C
C
C T C T C T
c uc
UC
BILIRUBIN AST ALT ALP
Urine findings:
Bile salts Bile pigments Urobilinogen
Present in 1:20 dilution
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Department of Pathology, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha
 Clinical Case 6:
A 45-year-old male patient presented with episodes of colicky pain in right hypochondriac
region. On examination, he has jaundice. The Liver function test and urine examination findings
are as given below:
C
T C
UC UC
BILIRUBIN AST ALT ALP
Urine findings:
Bile salts Bile pigments Urobilinogen
++ +++
Present but not inexcess
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What is the color of the stool in this patient?
Department of Pathology, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha
 Clinical Case 7:
A 4-year-old boy presented with fever and lethargy for last week. For past 2 days purpuric
spots appeared all over the body with bleeding from gums.
CBCReport:
Hb: 9.3 gm/dL
PCV: 28.7%
MCV: 96 fL
TPC: 45000/ mm3
TLC: 68000/ mmn3
POO
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Department of Pathology, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha
 Clinical Case 8:
she had
A 22-year-old lady presented with easy fatiguability for last 2 months. On examination,
moderate pallor, mucosal gingival bleeding. No hepatosplenomegaly lymphadenopathy was
noted.
8
CBC Report:
Hb: 9.5 gm/dL
PCV: 28.2%
MCV: 94fL
TPC: 20000/ mm
TLC: 107000/ mm3
? ?
O
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Department of Pathology, Bhima Bhoi Medical College & Hospital, Balangir, Odisha
 Clinical Case 9:
A 38-year-old male patient presented with sudden onset severe headache without any focal
neurological deficit. On examination, purpuric spots over extremities were present, no
organomegaly.
15 der(15) 17 der(17
CBCReport
Hb: 9.6 gm/dL
PCV: 28.9% ?
MCV: 96 fL
TPC: 16400/ mm3
TLC: 75000/ mm3
Stool OBT: Positive
?
PT, aPTT: Prolonged
D-Dimer: lIncreased
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Department of Pathology, Hi-Tech Medical College& Hospital, Bhubaneswar, Odisha
 Clinical Case 10:
A 39-year-old rural lady patient coming from a low SES presented with progressive weakness,
fatigue, lassitude and palpitation for last 1 year. On examination, marked pallor, stomatitis,
glossitis and koilonychia and no organomegaly or lymphadenopathy.
Semple Nt Ward FMW DATE 20 07/201e TI1E 13 40 i
Patent ID 22020 Sex. Female
me AGE 35 Ref.Dr
Positive DIFF WBC/BAS0
Morph Ccunt
Reference Range
W6C 10*3/uL] (4.0-11.0)
RBC 3.55 6/ul] (3.5-5.5)
HGB (11.0- 15.5)
50 9/dL)
HCT 20.0- (37.0-50.0)
MCV
56.3 IL) (80.0 96,0)
MCH 14.1 IP9 (27.0-32.0).
( 30.0 35.0)
MCHC
25.0 I9/dL RBC PLT
213 (10*3/uL] (150-400)
PLT (37-54)
|ROWSD 41.7 [L)
RDW-CV
POW
MPV
P-LCR

21.7
[fL)

(11.5 14.0)
(9.0-17.0)
(6.0-9.5)
(13.0-43 00)
A L
PCT [%) (0.17-0.35)
(2.0-8.0) 65.9 (40-775)
NEUT 3.35 10 3/ul 26.4 (20-45)
09
(1.5-4.0
LYMPH (103uL]
MONO O14 103/uL] (02-0.8) 2.8 17%] (2.0 100) O0
(0.04 0.4) 4.5 %] (1.0-66.0)
EO 0.23 110 3/uL]
0.4 (0.0-1.0)
BAS 0.02 110^3/uL] (o.0-0.1) %
RET 1106/uL]J (0.2-2.0)
IRF [%]
Oo
LFR
MFR
RET PLT-O
HFR
8
Patient Case History
CBC PS BM
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Department of Pathology, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha
 Clinical Case 11:
A 43-year-old vegetarian lady presents with weakness, lassitude and anorexia for last 6
months. She has gradual loss of sensation of both legs and progressive difficulty in walking. On
examination: moderate to severe degree pallor and mild jaundice. No organomegaly - detected.
ampie No H-599 Ward FrW DATE 23/07/2016 TIME 14 58i6
alient D C-30077 Sex Fenale
ee
AGE 70 Rel Or
Ositive
Aorph. Count
Reference Range
DIFF WBC/BASO0
00
BC (4.0-11.0)
BC
315 |1103/uL]
(3.5-55.5)
GB 1 06 1106/uL
4.4 Ip/dl] (11.0-15.5 )
O.0
CT
CV
135 1% (370500)
127.4|(L) (B0 0- 96.0)
ACH 41.5IPp (27.0-32.0 )
CHC 32.6 g/OL) (30.0-35.0) RBC PLT
LT 92 103uL] (150- 400)
OWS 97 5 LJ (37 54)
RoW-Cv 24.1[%] (11.5 140)
DW 198 LI (90 170)
MPV 117 (60-9.5)
LCR
37.1 %] (13.0-43.0)
CT 0.11 (0.17-035)
EUT 1.13 110^3/uL] (2.0-8.0) 35.9 % (40 75)
YMPH
MONO
1.73
0:04
110r3/ul]
10^3UL)
(1.5-4.0)
(0.2-0.8)
54.9
1.3 1%
% (20-45)
(2.0 100) PS
0.24 (10-3/uL] (0.04-04) 7.6 1% (1.0 6.0)
BASO 0.01 10*3/uL] (00-0.1) 0.3 %) (0.0-1.0)
RET 0.0509 (106/ul] (0.2-22.0 4.80
IRF 124 %
LFR 876
MER 10.7
HFR 1.7 7
RET PLT-O
Pauent Case History:
CBC BM
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Department of Pathology, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha
 Clinical Case 12:
A 4% year-old-male child presented with fever, pain abdomen and joint pain for 2 days. On
physical examination: Hepato-splenomegaly present.
T PS
Fositive
DIFF WBC/BAS0
Morph. Count
Reference Range
WBC 23.41 (103/uL] (4.0-11.0)
RBC 2.06 [106/ul (3.5-5.5)
HG8 5.2 lg/dL) (11.0-16.5)
HCT 17.4 (37.0-50.0O)
MCV 84.5 (80.0-96.0)
MCH 25.2 (27.0 32.0)
MCHC 29.9 g/dL (30.0-35.0) RBC PLT
T 459 (10-3/uL] (150-400)
RDW-SD 70.0 TL (37-54)
RDW-CV
POW
MPV
P-LCR
PCT

29.3[%
9.8
S.4
19.8
043
(%]

( 11.5 14.0)
(9.0-17.0)
(6.0-9.5)
(13.0-43.0)
-A
(%) (0.17-0.35 )
NEUT 1103/uL (2.0-8.0) (40-75)
LYMPH
[103/uL (1.5-4.0) (20 45)
MONO [103/uL] (02-0.8) [%] (2.0-10.0)
EO [10 3/uL] (0.04-0.4) (1.0-6.0)
BASO 0.1810^3/ul] (0.0-0.1) 0.8 % (0.0-1.0)
RET 0.6196 (10^6/uL (0.2 2.0) 30.081)
IRF 51.01%1
LFR
MFR
49.0
24.6
(%] 45.0T ?
%] 37.5
HFR 26.4 1%] RET PLT-O 30.0
Patient Case History:
25
15.0
CBC
2
Time (min)
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Department of Pathology, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha
 Clinical Case 13:
A 70 year-old-male patient presented with weakness, fatigue and repeated infections for last
6 months.On physical examination: generalized lymphadenopathy and mild hepato-splenomegaly
was noted.
O
CBC:
Hb: 10.2 gms / dL.
PS
PCV: 31%.
MCV: 92 fL.
TPC: 1.64 lakh/ mm3
TLC: 1.42 lakh/ mm3
DLC: 90% are Lymphocytes
Interphase FISH,
Centromere of 12
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Department of Pathology, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha
 Clinical Case 14:
A 53 year-old-male patient presented with weakness, fatigue, anorexia, abdominal fullness
and pain and repeated infections for last 3 months. On physical examination:
marked
splenomegaly was noted.
CBC:
Hb: 10.0 gms/dL.
PCV: 28.6%.
MCV: 97.2 fL.
LAP ?
TPC: 3.74 lakh/ mm3
TLC: 2.2 lakh / mm3
DLC: PS BM
Basophil- 6%
Myelo-metamyelocytic bulge.
FISH for t (9, 22)
?
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Department of Pathology, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha
 C.S.F. Study Chart: Case1
A 17-year-old adolescent boy presented with high grade fever with chill and convulsions. On
examination: he had neck rigidity & Kernig's sign is positive.
CSF Examination findings:
Physical & Biochemical Examination:
Pressure: 260 mm of H20
Physical Examination: Turbid
Protein: 195 mg/dL
Chloride: 118 mEq/L
Glucose 13 mg/dL
Cytological Examination:
Total Leucocyte Count: 1580/mm
Differential Count:
Polymorphs: 90%
Lymphocytes: 10%
Bacteria present.
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Department of Pathology, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha
 C.S.F. Study Chart:Case 2
A 3 years male child with irregular, low grade pyrexia, neck rigidity and vomiting. On
examination Kernig's sign was positive with brisk jerks and extensors planter response.
CSF Examination findings:
Physical & Biochemical Examination:
Pressure: 220 mm of H20
Physical Examination: Clear with Cob-web coagulum
Protein: 250 mg/dL
Chloride: 88 mEq/L
Glucose 28 mg/dL
Cytological Examination:
Total Leucocyte Count: 324/mm3
Differential Count: All are lymphocytes
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Department of Pathology, Hi-Tech Medical College& Hospital, Bhubaneswar, Odisha
 C.S.F. Study Chart: Case 3
A 13-year-old girl came to outdoor with fever, intense headache, photophobia and neck
rigidity. Younger brother of the girl had suffered from fever with rash 7 days ago.
CSFExamination findings:
Physical &Biochemical Examination:
Pressure: 180 mm of H20
Physical Examination: Clear
Protein: 79 mg/dL
Chloride: 122 mEq/L
Glucose 58 mg/dL
Cytological Examination:
Total Leucocyte Count: 148/mm3
Differential Count: All are lymphocytes
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Department of Pathology, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha
 Karyotype Chart 1
10 11
18
13 14 15
21 22
R
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Department of Pathology, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha
 Karyotype Chart 2:
2 3
i 6 7 8 9 10 11 12
13 14 15 16 17 18
19 20 21 22 X
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Department of Pathology, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha
 N

xtc
 KaryotypeChart 4:
2 3
6 8 9 10 11 12
13 14 15 16 17 18
19
20 21 22
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Department of Pathology, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha
 Plasma Glucose in mg/dL

N
 Plasma Glucose in mg/ dL>

bre

N
 Plasma Glucose in mg / dL»

sting

N
 Plasma Glucose in mg/ dL»

N
 Plasma Glucose in mg/dl

Dra

D
 Plasma Glucose in mg/ dL

N
 Hb Electrophoresis: Agarose Gel (pH: 8.6)
A new born child with severe anemia, organomegaly and cutaneous edema.
Origin HbA, HbS HbF HbA
Control
Origin Hb Barts
Test
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Department of Pathology, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha
 HbElectrophoresis: Agarose Gel (pH: 8.6)
A3 year-old-boy presented with failure to thrive. On examination, he had P*, I,cy', CP&0'
Pulse -92/min and regular, marked hepato-splenomegaly.
Origin HbA2 HbS HbE HbA
Control
HbA2 HbE
Origin (4.2%) (80%)
Test
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Department of Pathology, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha
 Hb Electrophoresis: Agarose Gel (pH: 8.6)
with excruciating abdominal pain and pain in the hands and feet.
A6 year-old-boy presented
On examination, he had P , I", cy, cP & 0°, Pulse - 90/ min and regular, splenomegaly.
Origin HbA HbS HbF HbA
Control
HbA2 HbS HbE
Origin (2.5%. (76%) (20.5%)
Test
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Department of Pathology, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha
 HbElectrophoresis:AgaroseGel (pH:8.6)
A 25 year-old-female patient reported for routine prenatal checkup. On examination, no
anemia or organomegaly.
Origin HbA, HbS HbF HbA
Control
HbA2 HbF HbA
origin (5.1%)_ (1%) (90%)
Test
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Department of Pathology, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha
 Hb Electrophoresis: Agarose Gel (pH: 8.6)
A 15 year-old-boy presented with abdominal discomfort and pain on exertion. On examination,
he had P, 1, Cy°, CI& 0°, Pulse 80/min and regular, mild splenomegaly.
Origin HbA HbS HbF HbA
Control
HbA2 HbS HbA
Origin (2.5%) (45%) (50%)
Test
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Department of Pathology, Hi-Tech Medical College& Hospital, Bhubaneswar, Odisha