Haem case study
Female, 57 years old
Given diagnosis: Acute lymphocytic leukaemia (ALL)
Routine FBC / Reference range
WBC --> 2.16 X 103 cells/mL /4.5 – 11.0 X 10(power 9)
RBC --> 3.04 X 106 cells/mL /4.2 – 5.4 X 10(power 12)
Hb --> 9.5 g/dL /11.5 – 16.0
HCT --> 27.2% /37% – 47%
MCV --> 89.7 fL /80 -96
MCH --> 31.3 pg /27-29
MCHC -->34.9 g/dL /31.5 – 34.5
RDW --> 15.6% /11.5% - 14.5%
PLT --> 21 X 103 cells/mL /150 – 450 X 10(power 9)
Routine WBC differential (100%) /Reference range
Neutrophil : 38 /40-75
Lymphocyte: 47 /15-41
Monocyte: 15 /2-10
Eosinophil : 0 /0-6
Morphology flags
Blasts : +
ATYP(atypical lymphocyte): +
Discussion:
Clinical presentation/ symptoms : Fatigue, weight loss, anemia, bleeding gums, breathlessness, enlarged lymph nodes, liver and/or spleen, fever and paleness.
Sample Collection: Whole blood via venipuncture
Samples Processing:
1)Blood sample is collected in an EDTA tube
2)A blood smear is made followed by staining. This is for microscopic viewing.
3)The blood sample is then placed on a special rack on the automated analyser to carry out full blood count (FBC)
Preliminary laboratory tests: FBC
Preliminary investigation: RBC, WBC, Hb, HCT, MCV, MCH, MCHC, RDW, PLT, differential count and morphology flags.
Expected results for laboratory tests:
1)Values of WBC, RBC, Hb, HCT and PLT are lower than reference range
2)Values of MCH and RDW are higher than reference range
3)Values of MCV and MCHC are normal.
4)There are also abnormal amounts of neutrophils, lymphocyte and monocyte.
5)There are presence of blasts (lymphoblasts) and atypical lymphocyte (ATYP)
Interpretation:
1) Values of WBC and PLT are low, indicating that there is failure of the bone marrow. In ALL, the WBC is usually high. In this case, the patient may have gotten leukaemia for quite some time hence the WBC may decrease due to earlier treatment.
2) The low amounts of RBC, Hb, HCT indicates anemia, which is one of the symptoms of leukaemia.
3) The presence of blasts highly indicates possibility of ALL.
4) An increased level of RDW reveals presence of anisocytosis due to bone marrow failure.
5) The abnormal amounts of WBC differential count confirm that there is abnormality of the WBC.
Confirmatory tests:
1) Cell markers test (flowcytometer) to confirm presence of lymphoid or myeloid.
2) Cytochemical stain: Used in the identification of the different subtypes of acute leukaemia.
3) Immunological markers (Antigens/ antibodies specific to ALL): A positive test indicates presence of ALL
4) Bone marrow aspiration / biopsy: An increased number of cells and lymphoblasts confirms presence of ALL.
Prognosis: There are treatments for leukaemia. This includes chemotherapy, steroids, radiation therapy and growth factors. The main goal of treatment is remission of the cancer. Administration of blood products (packed RBCs, platelets) may also be needed to treat the anemia and low platelet count.
posted by SyafiqaH @ 10:19 PM
6 comments
6 Comments:
1. Your case study format is OK but it is more descriptive.
2. You will need to highlight the FBC features that point to medical tech to possible diagnosis of ALL.
3. You need to highlight the specific confirmatory tests for ALL.
4. The rest are OK. Hope to see more specific details of your case based study in Haematology.
A Public Forum on The Use of Personal Information in Biomedical Research on 15 July 2005 has been published in the SIP Blackboard.
You are strongly encouraged to attend. Please let me know by Mon 10 July 2006.
Mr Alvin Poh
hey syafiqah! can you give me a rough idea of how cell markers test , cytochemical stain and Immunological markers test are carried out?
you said that for cell markers test, a flow cytometer is used. we also use that in the research lab, but so far what i've learnt is that the flow cytometer is used to detect for cell viability or to see if there are any apoptotic cells.
Mr Loh,
Farhana will be posting a case study relating to MMIC soon. We apologise for not posting sooner.
Refering to Yasmin's and Junting's qn, blood samples in the EDTA tubes are firstly placed in a rack and barcode labels are pasted for identification. the machine will "suck out" fixed volume of blood for the test.
Different analysers may have different principles on how it works. For the Coulter LH750 analyser,electrical means are used.
For FBC analysis, the analyser will count and size the cells by detecting and measuring changes in electrical resistance when a particle ,such as cells, goes through a small aperture (i.e an opening such as a hole) in a conductive liquid. Each cell suspended in a conductive liquid acts as an insulator. As each cells moves through the aperture, the resistance of the aperture will increase.This cause an electrical pulse that can be quantitated/counted and sized. the no. of pulses indicates particle count while the size of electrical pulse is proportional to the cell volume.MCV and RDW is derived from RBC histogram while platelet count is derived from platelet histogram. HCT, MCH and MCHC are computed values.
The differential analysis occurs in a flow cell. Decreased frequency current measures volume while increased frequency current senses cellular changes in conductivity. Light from laser bouncing off the individual WBC cells will distinguish cellular surface, shape and reflectivity. Lytic reagents destroy erythrocytes without significantly affecting leukocytes. this is done so that RBCs will be excluded from the WBC analysis.
(reference: Technical Procedure Manual for the analyser)
P.s: Samantha and Yasmin, I will reply your qn regarding the cell markers test and cell morphology ASAP. Sorry for the delay
=)
hey sam!
the cytochemical stain includes sudan black stain, periodic acid schiff (PAS) reaction and peroxidase stain. These are used to confirm the diagnosis. PAS stains a variety of carbohydrate and is used in the differential diagnosis of acute leukaemia. Peroxidase stain is used to establish and confirm diagnosis of acute myeloid leukaemia while sudan black stain is used as a marker in the differentiation of acute myeloid leukaemia.
Yes, flow cytometers are used for viability test. However, it can also be use in the diagnosis and prognosis of diseases. The process in this case is known as immunophenotyping. It is also useful in monitoring patient's response during theraphy. For example,there was a case where a patient who had bone marrow transplant, have to go for bone marrow aspiration to get samples for immunophenotyping.This is done a few times after the transplant to monitor the patient.
Immunophenotyping of cells in leukaemia and lymphoma are carried ou with a panel of Ab, which detects the Ag on the surface membrane. The flow cytometer is used to carry out this process.
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