Question 1
A 49-year-old male is referred for an incidental finding of leukocytosis on a pre-operative FBC. Hb 7.4 TW 42.56 Plt 134.
Report the peripheral blood film. You can adjust the brightness using the settings button in the top right hand corner.
Leukocytosis with numerous circulating neutrophils and myelocytes. Blasts are increased but do not exceed 20%. There is prominent basophilia. There are no overt dysplastic features. The patient has a normocytic, normochromic anaemia and a mild thrombocytopaenia.
What is the most likely diagnosis?
CML in accelerated phase.
Give three specific morphological features you will be looking for when reporting this patient’s bone marrow aspirate.
Blast count, basophil count and myelocyte count.
Give one test which you would do to confirm the diagnosis.
RT-PCR for BCR/ABL fusion oncogene.
Cytogenetics for t(9;22) is also acceptable.
Question 2
A 6-month-old child is brought to the Emergency Department after her father felt a mass in her abdomen. Her PBF and bone marrow aspirate are shown. Hb 11 TW 14 Plt 222.
Report the peripheral blood film.
Mild leukocytosis with occasional myelocytes and metamyelocytes. Teardrop cells seen.
Report the bone marrow aspirate.
Clumps of non-haematopoietic cells which are small and round and which form rosettes with a neurofibrillary centre.
Give three possible explanations for the appearance of the PBF and BMA.
Bone marrow involvement by a non-haematopoeitic malignancy such as neuroblastoma. Other possibilities include sarcoma and retinoblastoma.
Question 3
A 59-year-old female patient is referred for thrombocytopaenia.
Report the peripheral blood film.
- Thrombocytopaenia
- No platelet clumps
- Reactive lymphocytes
How would you further investigate?
Viral tests such as tests for dengue virus infection. EBV is an acceptable alternative, but the atypical lymphoid cells do not resemble those seen in EBV.
What is the most likely cause of the patient’s thrombocytopaenia?
Viral infection (lymphoma or lymphoproliferative disease is incorrect given the reactive nature of the lymphoid cells).
Question 4
This patient is a 48-year-old male referred for fever.
Describe the trephine.
Monotonous lymphoid infiltrate with a well-spaced appearance due to centrally-placed nuclei and abundant cytoplasm.
What is the most likely diagnosis?
Hairy cell leukaemia
What is the expected immunophenotype on flow cytometry?
CD20++/11c+/123+/25+/103+
Question 5
This patient is referred for fever.
List 5 important features on the blood film.
- Malaria parasites seen
- Red cells enlarged with Schüffner’s dots
- Schizonts
- Mature trophozoites
- Gametocytes present
What is the most likely diagnosis?
Plasmodium vivax
P. ovale can be accepted as a differential as it also gives rise to macrocytic RBCs.
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