Hematology Cases: Anemia & Leukemia

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Questions and Answers

What is the likelihood of iron deficiency anemia given the patient has a hemoglobin level of 5 g/dL and severe pallor?

It is likely but may indicate chronic disease.

It is not possible as the platelet count is normal.

It is highly likely based on the low hemoglobin and MCV. (correct)

It is unlikely due to the high reticulocyte count.

What does the presence of massive splenomegaly and a total leukocyte count of 240,000 cells/cmm suggest?

Polycythemia vera.

Chronic lymphocytic leukemia. (correct)

Myeloid leukemia.

Acute myeloid leukemia.

A 60-year-old man presents with normocytic and normochromic red blood cells and a leukocyte differential showing 90% lymphocytes. What is the most likely diagnosis?

Acute lymphoblastic leukemia.

Chronic lymphocytic leukemia. (correct)

Reactive lymphocytosis.

Myelodysplastic syndrome.

What is the significance of blast cells constituting 68% of the differential count in a patient with nosebleed and menorrhagia?

Indicative of acute myeloid leukemia. Signup and view all the answers

What does the reticulocyte count of 1% in a patient with anemia indicate?

Low bone marrow activity. Signup and view all the answers

Given the patient’s family history of similar bleeding symptoms, which condition should be considered?

Hereditary coagulopathy. Signup and view all the answers

In the context of a high leukocyte count and massive splenomegaly, which finding is most critical for diagnosis?

The presence of myeloblasts. Signup and view all the answers

What is the likely cause of a low MCV of 50 fl in a patient with severe anemia and pallor?

Iron deficiency anemia. Signup and view all the answers

What is the most likely diagnosis for the 8-year-old female child who developed nausea, vomiting, altered consciousness, and ultimately coma after a respiratory tract infection?

Diabetic ketoacidosis Signup and view all the answers

What condition is indicated by the deep yellow coloration of the eyes, colicky pain, clay-colored stools, and positive bile pigment in urine?

Obstructive jaundice Signup and view all the answers

What diagnosis is suggested by the 18-year-old male's symptoms of yellowish discoloration of skin, intermittent jaundice, and increased osmotic fragility?

Hereditary spherocytosis Signup and view all the answers

What is the most likely diagnosis for the 68-year-old male with lower back pain, weakness, lethargy, and marked rouleaux formation in blood tests?

Multiple myeloma Signup and view all the answers

What finding in the urine of the 68-year-old male suggests significant protein loss?

Protein +++ Signup and view all the answers

Which test result would support the diagnosis of diabetic ketoacidosis in the young child?

High blood glucose level Signup and view all the answers

Which symptom is least likely to be associated with obstructive jaundice as seen in the 40-year-old female?

Increased appetite Signup and view all the answers

What would be an expected finding in the peripheral blood smear of the 18-year-old male with hereditary spherocytosis?

Spherocytes Signup and view all the answers

What is the most likely diagnosis for the 53-year-old lady presenting with numerous RBCs and RBC casts?

Acute kidney injury due to diabetes Signup and view all the answers

For the 21-year-old medical student with abdominal pain and jaundice, what is the most likely diagnosis?

Acute viral hepatitis Signup and view all the answers

What condition is most likely indicated by the thyroid function tests of the 30-year-old lady with emotional instability?

Hyperthyroidism Signup and view all the answers

Which symptom best correlates with the diagnosis of the 9-year-old boy with spontaneous bleeding and high fever?

Bone marrow failure Signup and view all the answers

What is the primary concern for a patient with a blood sugar level of 292 mg% and significant renal impairment?

Diabetic ketoacidosis Signup and view all the answers

In the case of the 30-year-old lady with tachycardia and cardiomegaly, which underlying condition is most likely?

Hyperthyroid heart disease Signup and view all the answers

For the 21-year-old patient with icterus and elevated liver enzymes, which investigation would be essential next?

Hepatitis panel Signup and view all the answers

What is a common characteristic finding in the urine of a patient with significant renal dysfunction?

Hematuria with RBC casts Signup and view all the answers

What condition is most likely diagnosed in the 12-year-old male child with swelling and pallor?

Nephrotic syndrome Signup and view all the answers

What is the most likely diagnosis for the 6-year-old female with a turbid CSF and increased neutrophils?

Bacterial meningitis Signup and view all the answers

What is the most significant finding indicating diabetes mellitus in the 60-year-old female patient?

Ketones present in urine Signup and view all the answers

What does a decreased urine output combined with a history of sore throat in the 16-year-old male most likely indicate?

Acute kidney injury Signup and view all the answers

In the 12-year-old male child, what level of total plasma proteins would be expected in nephrotic syndrome?

3.7 gms/dl Signup and view all the answers

What laboratory finding is most indicative of bacterial infection in the 6-year-old with meningitis?

Low glucose levels Signup and view all the answers

What is the most likely primary cause of edema in the 12-year-old male child?

Increased albuminuria Signup and view all the answers

Which symptom in the 60-year-old female patient is most correlated with her high blood sugar level?

Increased urination Signup and view all the answers

Study Notes

Case 1 - Anemia

A female patient presents with irregular and heavy menstrual cycles for the past 6 months
She also has severe pallor
Blood test results show low hemoglobin (5 gm%), elevated ESR (70 mm after 1 hour), low reticulocyte count (1%), low platelet count (3.5 lakh/cumm), low MCV (50 fl), low MCH (18 pg), and low MCHC (25 gm%)
This suggests a diagnosis of anemia, potentially iron deficiency anemia due to heavy bleeding

Case 2 - Chronic Myeloid Leukemia

A 40-year-old male presents with fatigue and weakness
He has massive splenomegaly and pallor
Blood count results showed low hemoglobin (8 gm%), high total count (2,40,000 cells/cumm), and an abnormal differential count with a high percentage of myelocytes (35%)
Diagnosis: Chronic myeloid leukemia

Case 3 - Chronic Lymphocytic Leukemia

A 60-year-old male with no health complaints presents for a general checkup
Blood count shows a normal Hb level (12 gm%) with a low total count (80,000 cells/cmm) and a high percentage of lymphocytes (90%)
Peripheral smear shows normocytic and normochromic red blood cells (RBCs) and mature small lymphocytes
Platelets are within normal limits
These findings suggest a diagnosis of Chronic lymphocytic leukemia

Case 4 - Acute Lymphoblastic Leukemia

A 15-year-old female with a history of 15 days of nosebleeds, menorrhagia, and pallor
Examination reveals a palpable liver
Blood results show low hemoglobin (6.1 gm%), low total count (81,000 cells/cmm), high percentage of blast cells (68%), low platelet count (40,000 cells/cumm), and abnormal MCV (83 fl), MCH (25.8 pg), and MCHC (31%)
Cytochemistry shows myeloperoxidase-positive blasts
Diagnosis: Acute lymphoblastic leukemia

Case 5 - Diabetic Ketoacidosis

An 8-year-old female with insulin-dependent diabetes mellitus (IDDM) for 4 years
She develops respiratory tract infection followed by nausea, vomiting, altered consciousness and coma
Blood tests show high blood glucose (480 mg/dl), normal blood urea, a high total leukocyte count (15,000/cumm) with a high percentage of neutrophils (89%)
Urine analysis shows positive Benedict's and Rothera's tests
Cerebrospinal fluid (CSF) is within normal limits
Diagnosis: Diabetic ketoacidosis

Case 6 - Obstructive Jaundice

A 40-year-old female presents with deep yellow sclera, colicky right hypochondrium pain, vomiting, and pruritis for the past 4 months
She has clay-colored stools
Urine tests show deep yellow color, positive albumin, absent sugar, absent urobilinogen, and present bile salts and bile pigments
Diagnosis: Obstructive jaundice

Case 7 - Hereditary Spherocytosis

An 18-year-old male presents yellowish discoloration of skin and fatigue
He has a history of intermittent jaundice and his father had similar complaints
Examination reveals icterus and splenomegaly
Blood test results show low hemoglobin (8 gm%), high MCV (70 fl), high MCH (30 pg), high MCHC (40 gm/dl), increased reticulocyte count (8%), and increased osmotic fragility
Peripheral smear shows spherocytes
Diagnosis: Hereditary spherocytosis

Case 8 - Multiple Myeloma

A 68-year-old male presents with lower back pain, weakness, and lethargy
Examination shows multiple localized tender areas in the bones
Blood test results show low hemoglobin (6 gms%), high ESR (150 mm at the end of 1 hour), and marked rouleaux formation
Urine test shows positive protein and negative sugar
X-ray of the skull shows lytic lesions
Diagnosis: Multiple myeloma

Case 9 - Anemia

A 32-year-old female presents with dyspnea on exertion, palpitations, and generalized weakness for the last 3 months
This is a case of possible anemia, but further investigations are needed to understand the specific type and cause of the anemia.

Case 10 - Nephrotic Syndrome

A 12-year-old male child presents with generalized swelling for 8 months, paleness, and puffiness of the face for 1 month
Blood test results show low hemoglobin (8.2 gms%), low total count (9,200 cells/cumm), high ESR (35 mm after 1 hour), low total plasma protein (3.7 gms/dl), low plasma albumin (1.7 gms/dl), normal BUN (20 mg%), normal serum creatinine (0.6 mg%),
Urine test shows ++++ albumin and negative sugar
Diagnosis: Nephrotic syndrome

Case 11 - Bacterial Meningitis

A 6-year-old female child with severe headache and fever for 5 days
She has ear discharge on the left side
Lumbar puncture revealed a greatly increased CSF pressure, turbid appearance, high protein (500 mg/dl), low glucose (20 mg/dl), and high cell count (5,000 cells/cmm) with 95% neutrophils
Diagnosis: Bacterial meningitis

Case 12 - Diabetic Ketoacidosis

A 60-year-old obese female presents with increased urination frequency, increased appetite for 1 month, and breathlessness for 2 days
She is obese, afebrile, conscious and well-oriented with a rapid pulse (112/min), rapid respiratory rate (44/min), and normal blood pressure (130/80 mmHg)
Examination also reveals pallor and bilateral basal crepts
Blood results show normal hemoglobin (10 gm%), a high total leukocyte count (11,000/cumm), high percentage of polymorphonuclear leukocytes (80%), high ESR (25 mm at the end of 1 hour), and high random blood sugar (398 mg%)
Urine analysis shows negative albumin, positive sugar, present ketones, and negative microscopy
Diagnosis: Diabetic ketoacidosis

Case 13 - Acute Kidney Injury

A 16-year-old male presents with decreased urine output for 8 days, nausea, vomiting, and swelling of the feet for 15 days
He had sore throat 1 month ago
He is conscious, febrile, well-oriented with a rapid pulse (102/min), rapid respiratory rate (26/min), and high blood pressure (140/90 mmHg)
Examination reveals pallor and pitting edema of the feet
Blood results show low hemoglobin (7.6 gm%), low total leukocyte count (7800/cumm), high blood urea (245 mg%), high serum creatinine (10.6 mg%), and normal serum protein (7.1 gm%)
Urine results show positive albumin, negative sugar, pus cells, epithelial cells, numerous red blood cells with red blood cell casts
Diagnosis: Acute kidney injury

Case 14 - Diabetic Ketoacidosis

A 53-year-old lady presents in a semiconscious state with abnormal behavior since the last 15 days
She is a known case of non-insulin-dependent diabetes mellitus (NIDDM) for 12 years
She is unresponsive to oral commands, afebrile, with a rapid pulse (96/min), normal blood pressure (140/90 mmHg) and pallor
Blood results show low hemoglobin (8 gm%), high ESR (60 mm at the end of 1 hour), high blood sugar (292 mg%), high blood urea (133.8 mg%), and high serum creatinine (8.7 mg%)
Urine analysis shows positive albumin, positive sugar, and pus cells/epithelial cells
Diagnosis: Diabetic Ketoacidosis

Case 15 - Viral Hepatitis

A 21-year-old medical student presents with abdominal pain, vomiting, decreased appetite, and yellowish discoloration of urine for 15 days
He is conscious, afebrile, with a normal pulse (90/min), normal respiratory rate (22/min), and normal blood pressure (110/70 mmHg)
He has icterus and a palpable and tender liver
Blood results show normal hemoglobin (11 gm%), a high total leukocyte count (22,000/cumm), high serum bilirubin (12.8 mg%), high SGOT (88 IU/L), high SGPT (92 IU/L), normal blood sugar (107 mg%), normal serum protein (8.9 gm%), and normal serum albumin (4.2 gm%)
Diagnosis: Viral hepatitis (likely Hepatitis A due to age and absence of chronic liver disease)

Case 16 - Thyrotoxicosis

A 30-year-old lady presents with emotional instability, nervousness, palpitations, and menstrual disturbances for 3 months
She is poorly built and nourished with pallor and fine tremors in her hands
Examination also shows tachycardia and cardiomegaly, with a moderately enlarged thyroid gland
Thyroid function tests reveal high serum T4 (20 μg/dl), high serum T3 (260 ng/dl), and low serum TSH (0.2 μU/ml)
Diagnosis: Thyrotoxicosis (Graves' disease)

Case 17 - Acute Lymphoblastic Leukemia

A 9-year-old boy presents with spontaneous skin bleeding, weakness, and high fever
Examination shows palpable lymph nodes in the cervical and axillary regions, oral thrush, and moderate hepatomegaly
Blood test results show low hemoglobin (6 gms%), a high total count (1,10,000 cells/cmm)
Diagnosis: Acute lymphoblastic leukemia

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Description

This quiz covers three clinical cases related to hematology, focusing on anemia and types of leukemia. It explores the symptoms, lab findings, and diagnoses associated with these blood disorders. Test your knowledge and enhance your understanding of these critical conditions.