RBC TUTORIAL AND ASSIGNMENT

CASE 1

History:

A 72-year-old man has had increasing fatigue for the past 5 months. On physical examination there no
abnormal findings. Laboratory studies include a CBC with peripheral blood smear
 a. Demonstrate how to estimate the red blood cell size.
b. What is the diagnosis from these findings?
c. Which of the following tests would be most useful to determine the etiology?

A. Hemoglobin electrophoresis
B. Reticulocyte count
C. Stool for occult blood
D. Vitamin B12 assay
E. Bone marrow biopsy
d. How is this treated?

CASE 2

History:

A 48-year-old man has become progressively more fatigued at the end of the day. This has been
going on for the past 6 months. In the past month he has noted paresthesias with numbness in
his hands and feet. On physical examination he has decreased vibration and position sensation in
both hands and feet. Laboratory studies include a CBC with peripheral blood smear.
 1. What is the diagnosis from these findings?
2. Which of the following tests would be most useful to determine the etiology

A. Hemoglobin electrophoresis
B. Reticulocyte count
C. Stool for occult blood
D. Vitamin B12 assay
E. Bone marrow biopsy

3. How do you explain the neurologic findings?

4. How do treat this condition?

CASE 3

History:

A 30-year-old woman has the onset of fever, abdominal pain, nausea over the past day. On
physical examination her vital signs include temperature 38 C, pulse 102/minute, respirations
20/minute, and blood pressure 95/50 mm Hg. She has scleral icterus. Her spleen tip is palpable,
but there is no lymphadenopathy or hepatomegaly. She has Hgb 11.1 g/dL, Hct 28.8%, MCV 77
fL, platelet count 273,400/microliter, and WBC count 8900/microliter. The direct and indirect
Coombs tests are negative. A month ago, a CBC showed the following findings:
 Discuss the terms reticulocytosis and polychromasia.

1. What is the diagnosis from these findings?

2. The probable association(s) with this disease is(are):

A. Autosomal dominant, European ancestry

B. X-linked, Asian ancestry
C. Autosomal recessive, Middle Eastern ancestry
D. Autosomal recessive, West African ancestry
 E. Sporadic occurrence

3. 3. An aplastic crisis in this patient could be initiated by:

A. Quinacrine
B. Parvovirus infection
C. Decreased oxygen tension
D. Exposure to cold
E. Transfusion

CASE 4

History:

A 29-year-old woman with a diagnosis of acute promyelocytic leukemia has developed petechiae
and ecchymoses over the skin of her trunk and extremities in the past 3 days. On physical
examination her vital signs include temperature 37.2 C, pulse 101/minute, respirations 19/minute,
and blood pressure 85/45 mm Hg. Laboratory studies include a CBC showing Hgb 8.7 g/dL, Hct
24.5%, MCV 85 fL, platelet count 17,000/microliter, and WBC count 8700/microliter.

1. What is the diagnosis from these findings?

2. Discuss the conditions in which this can occur.
3. Which of the following tests would be most useful to diagnose this condition in this patient with
acute promyelocytic leukemia:

A. Hemoglobin electrophoresis
B. Reticulocyte count
C. Coagulation tests
D. Vitamin B12 assay
E. Bone marrow biopsy
 CASE 5

History:

A 20-year-old African man comes to the emergency room because of the sudden onset of severe
abdominal pain. On physical examination he has diffuse, severe abdominal tenderness. Bowel
sounds are absent. His sclerae appear icteric. A plain film radiograph of the abdomen shows no
free air, only dilated loops of bowel. Laboratory studies include a CBC that shows Hgb 4.8 g/dL,
Hct 12.8%, MCV 80 fL, platelet count 205,000/microliter, and WBC count 9800/microliter with
differential count showing 70 segs, 7 bands, 22 lymphs, and 3 monos, with 12 NRBC's per 100
WBC's.
 Discuss the demographics of this disease

1. What is the diagnosis from these findings?

2. Which of the following tests would be most useful to determine the etiology:

A. Hemoglobin electrophoresis
B. Reticulocyte count
C. Stool for occult blood
D. Vitamin B12 assay
E. Bone marrow biopsy

3. 3. The "crisis" in this patient was initiated by:

A. Quinacrine ingestion
B. Parvovirus infection
C. Decreased oxygen tension
D. Exposure to cold
E. Transfusion therapy