Page 460 - Clinical Hematology_ Theory _ Procedures ( PDFDrive )

444 PART 6 ■ Neoplastic Disorders

CASE STUDIES (continued)

Case Study 22.2 ■ Laboratory Data
He oglobin 6.0 g/ L
A 58-ye r-ol le college pro essor s w his ily physi- He tocrit 20%

ci n bec use o incre sing tigue n we kness. He lso ot l leukocyte count 4.1 × 10 /L
9
reporte p in in his lower b ck n r s when he w lke .

Physic l ex in tion reve le th t the n h p le ■ Leukocyte Differential

ucous e br nes n hep tospleno eg ly. T e physi- Pl s cells 25%

ci n or ere CBC n urin lysis. A ollow-up ppoint- Seg ente neutrophils 26%

ent w s sche ule or the ollowing week. I ture gr nulocytes 13%
Ly phocytes (v ri nt or s note ) 36%

■ Laboratory Data ■ Other Test Results
Te CBC reve le th t the p tient h ne i . His leu- Urin lysis positive or bloo n positive or protein

kocyte count n i erenti l count were nor l, except Bloo culture neg tive

or roule ux (rolle coin) ppe r nce o the RBCs. T e I unoelectrophoresis ecre se IgG

result o urin lysis w s nor l. T e p tient w s c lle , Co ple ent ss y ecre se

n it w s requeste th t he returns to the l bor tory or

ition l tests. T e physici n or ere the ollowing tests: ■ Critical Thinking Group Discussion Questions

ESR, ki ney screening prof le, liver bloo prof le, n 1. Why oes this p tient h ve i unoco petency?

r iogr phic skelet l survey, with the ollowing results:

ESR, 50 /h; nor l ki ney prof le; n nor l liver 2. Why oes the p tient h ve gr nulocytopeni ?

prof le except or incre se globul r protein. T e skelet l

survey in ic te bone lesions in v rious sites. 3. Coul this p tient h ve n in ection?

Case Study 22.4

A 75-ye r-ol n w s re erre to ultispeci lty group

pr ctice or ev lu tion o chronic ly phoproli er tive

isor er.

■ Laboratory Data

He oglobin 9.0 g/ L
He tocrit 32%

RBC count 2.9 × 10 /L
12
ot l leukocyte count 7.5 × 10 /L
9

ot l pl telet count 150 × 10 /L
12

T e peripher l bloo s e r reve le ly phocytic-looking

(Reprinte ro An erson S, Poulsen K. Anderson's leukocytes with cytopl s ic projections, pro inent nucle-

Atlas o Hematology, Phil elphi , PA: Lippincott oli, n over ll s ller cell size.

Willi s & Wilkins, 2003, with per ission.)

■ Critical Thinking Group Discussion Questions
1. Wh t ollow-up l bor tory tests ight be or ere to s-

sist in est blishing ef nitive i gnosis?

2. Wh t type o leukocyte isor er coul be present?

3. Wh t is the n ture o the protein oun in the urine?

4. Wh t is the ost signif c nt l bor tory f n ing in this

isor er?

Case Study 22.3
(Reprinte ro Rubin R, Str yer DS. Rubin’s

A 70-ye r-ol wo n with i gnosis o re r ctory ul- Pathology: Clinicopathologic Foundations o

tiple yelo n i betes w s itte to the hospit l Medicine, 5th e , Phil elphi , PA: Lippincott

bec use o blee ing c use by p ncytopeni . Willi s & Wilkins, 2008, with per ission.)