Unit 3 case studies Questions and Answers

Unit 3 case studies Questions and Answers A 5-year-old boy has been too tired to play with his friends for two months. His mother is also worried that whenever he falls or bumps into anything, a big bruise forms, and for the past two days he's had a high fever. Physical exam shows bruising, a slightly enlarged spleen, and pain when the physician presses on the child's sternum. The peripheral blood smear showed many lymphoblasts. ALL A 48-year-old man has become progressively more fatigued at the end of the day. This has been going on for months, and in the past month he has noted tingling and numbness in his hands and feet. He has also been experiencing increasing gastrointestinal pain. macrocytic, normochromic pernicious anemia Lack of Vit B12 in his diet A 72-year-old man has been feeling extremely tired lately; he has very pale skin, and a rapid pulse. He has been complaining that his hands and feet are always cold and he is very weak. When you ask about his eating habits, he tells you he hasn't been hungry lately and likes to eat ice. Iron deficiency anemia A 27-year-old woman presented to you with a month-long history of chest pain. She complained of waking in night sweats, itching, and recent weight loss. On physical examination, you noted lymphadenopathy in the neck. You order a routine chest radiograph and a CBC. Click on case 4, image 4a and 4b: A biopsy of a lymph node shows small lymphocytes mixed with some large cells with lobulated nuclei, or with multinucleated cells that have prominent nucleoli. Some of these large cells appear to be lying in a space (lacunar Reed-Sternberg cells). Hodgkin Lymphoma A 20-year-old African-American man comes to the emergency room because of the onset of severe abdominal pain. He indicates to the admitting clerk that he has recently moved to Utah from the east coast. Click on case 5, image 5a and 5b: The differential count shows 12 nucleated red blood cells per 100 WBC's. Examination of the peripheral smear shows numerous sickled erythrocytes. Sickle Cell anemia issue: these sickled RBCs get caught and clump together at the capillaries. As it clogs the capillaries, it blocks off blood supply to the tissues A 52-year-old man had gradually increasing fatigue, accompanied with discomfort in the left upper quadrant. Physical examination revealed an easily palpable spleen and liver edge. A few slightly enlarged lymph nodes were palpable in the neck. Click on case 6, image 6a and 6b: Peripheral blood smears demonstrated increased numbers of granulocytes, mostly mature forms, as well as increased platelets. Cytogenetic studies on a bone marrow aspirate identified cells containing of the Philadelphia chromosome. CML translocation 9:22 A 15-year-old girl was sent home from summer camp because of weakness, lassitude, and sore throat. As her family physician, you found upon physical examination that she had an inflamed pharynx, enlarged tonsils, several enlarged and slightly tender lymph nodes in the neck, a palpable spleen, and a tender palpable liver edge. Her heterophile antibody test (monospot) was positive. Infection Mononucleosis predominant WBC: lymphocytes A 6-month-old infant is brought to the family physician. The child is very lethargic, and the physician noted an elevated heart rate and blood pressure. Hemoglobin electrophoresis showed diminished amounts of the hemoglobin beta chains. Beta Thalassemia irregular shaped A 30-year-old man had noticed progressive weakness for one month. On physical examination, a few small lymph nodes were palpable in both axillae, and the tip of the spleen was palpable. There was also sternal tenderness present. AML A 66-year-old man had been complaining of back pain for several months, for which he had taken non-steroidal anti-inflammatory medications. He had been treated for approximately six months for low back pain. Radiographs revealed a lytic bone lesion in the right posterior iliac crest as well as multiple lytic lesions on the skull and vertebral column. Serum chemistry results showed elevated total serum protein with a decreased albumin level. Protein was also present in the urine. multiple myeloma Malignant plasma cells are invading the bone marrow of these bones and stealing nutrients and absorbing Ca++ molecules. making the bones more fragile A 65-year-old man was in good health except for mild hypertension. At his last check-up, a CBC showed a markedly elevated white blood cell count and physical examination revealed several slightly enlarged lymph nodes in the neck and the axillae, and the spleen was palpable. CLL A 20-year-old college student presented to the emergency room with general malaise, low-grade fever, and purplish discoloration on his face. The facial discoloration developed rapidly during the time from when he left his house to the time he arrived at the emergency room. A CBC and blood cultures were drawn, and a spinal tap was performed to obtain cerebrospinal fluid. The patient was admitted to the intensive care unit, where he received antibiotics and was given fresh frozen plasma, cryoprecipitate, and intravenous fluids. DIC what triggers DIC? The bacteria from his infection release an endotoxin that triggered systematic coagulation. Meaning the clotting factors roaming in the blood starts forming those fibrin clots. These micro coagulation deposits block the capillaries causing his purple discoloration