4) A 59-year-old female has the presented clinically with the following: - Weight-loss and night sweats - Splenomegaly - Pallor and dyspnoea - Bruising - Complaints of occasional blurry vision Her clinician ordered a full blood count and a general chemistry profile. The following flagged results were returned: Parameter | Result | Reference Range Haemoglobin (Hb) | 94 g/L | 115-160 g/L Red cell count (RCC) | 3.54 x 10^12/L | 3.8-5.2 x 10^12/L Platelets (PLT) | 525 x 10^9/L | 140-400 x 10^9/L White cell count (WCC) | 151.4 x 10^9/L | 4.0-11.0 x 10^9/L Neutrophil count (Neut) | 53 % 80.2 x 10^9/L | 2.0-8.0 x 10^9/L Lymphocyte count (Lymph) | 2 % 3.0 x 10^9/L | 1.0-4.0 x 10^9/L Monocyte count (Mono) | 2 % 3.0 x 10^9/L | 0.1-1.0 x 10^9/L Eosinophil count (Eos) | 6 % 9.0 x 10^9/L | <0.6 x 10^9/L Basophil Count (Baso) | 3 % 4.5 x 10^9/L | <0.2 x 10^9/L Metamyelocytes | 15 % 22.7 x 10^9/L | Myelocytes | 14 % 21.2 x 10^9/L | Promyelocytes | 3 % 4.5 x 10^9/L | Blasts | 2 % 3.0 x 10^9/L | Nucleated RBC (NRBC) | 2 Per 100/WCC | Morphology | Leucocytosis with a full spectrum of immature and mature myeloid cells. Myeloid cells have normal morphology. Red blood cells are normochromic and normocytic. | Neutrophil alkaline phosphatase score | Markedly decreased | Uric acid (Urate) | 0.59 mmol/L | 0.15 - 0.40 mmol/L Lactate dehydrogenase (LDH) | 646 U/L | 120 - 250 U/L From these results, her clinician requested a bone marrow biopsy for chromosomal analysis. a) Given the results indicate above, what type of leukaemia would you expect this patient to have? b) What abnormality/result would you expect cytogenetic analysis to show and what specific type of chromosomal alteration is this?
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4. a) How would you confirm a variant of CML? Take an accurate drug history. Perform cytochemical staining for MPO and PAS. * Verify BCR/ABL fusion using FISH analysis. Perform a bone marrow aspirate. b) The Philadelphia chromosome results from the fusion of which of the following? Chromosomes 8 and 21 Chromosomes 9 and 22 * Chromosomes 8 and 14 Chromosomes 15 and 17 c) The myeloproliferative disorder best described by increased leukocytes, immature granulocytes, and decreased LAP with the Philadelphia chromosome present is which of the following? ET CIMF PV CML * d) A patient's CBC revealed marked leukocytosis with an increased number of immature granulocytes. A few promyelocytes and blasts were seen. There were also an increased number of eosinophils and basophils with rare immature forms. The hemoglobin and hematocrit were normal, but platelets were slightly decreased. Which disorder is associated with these findings? PMF Leukemoid reaction CML * Severe infection
Adi S.
The images below is of Flow Cytometry results taken from a sample of a 36 year old women diagnosed with leukemia. (20 points) a. Please describe the distribution of cells found in the sample portrayed in Figure A of Human Blood Leukocytes. b. A sample of human lymphocytes from the original leukemia sample was taken for further analysis. i. What cell markers were found in abundance on these cells? ii. Where both cell markers found on the majority of the cells?
Hematology Case 3-3 Jean L, a 30-year-old white woman, was seen in the office of a rheumatologist. She was diagnosed in childhood with rheumatoid arthritis. Even at the relatively young age of 30 years, the joints of her hands were noticeably enlarged and deformed, and her gait was affected by knee and hip pain. See Table 3-4. Table 3-4 COMPLETE BLOOD COUNT Jean L Adult Female Reference Range WBC count 12.1 x 10^9/L 4.0-15.0 x 10^9/L RBC count 4.23 x 10^12/L 4.0-5.0 x 10^12/L Hb 105 g/L 120-160 g/L Hct 33% 36-46% MCV 78 fL 80-100 fL MCH 25 pg 26-34 pg MCHC 32 g/dL 31-37 g/dL RDW-CV 15% 11.5-14.5% Platelets 230 x 10^9/L 150-400 x 10^9/L Differential Neutrophils 46% 25-60% Bands 0% 0-10% Lymphocytes 20% 20-50% Monocytes 2% 2-11% Eosinophils 0% 0-8% Basophils 0% 0-2% Morphology Unremarkable (Source: Handin, Lux, & Stossel, 1995)
Sri K.
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