NURSING
ZAPORIZHYA STATE MEDICAL UNIVERSITY
THE DEPARTMENT OF INTERNAL DISEASES 3
Casebook
in HEMATOLOGY
(tutorial for practical exercises for 6-year students of
medical faculty)
2015
, «RATIFIED»
by Central methodical advice of
Zaporizhzhya state medical university
Protocol № 2 from 26.11.2015
Authors:
1. Dotsenko S.Y. - Head of department of internal diseases 3, Zaporizhzhya state
medical university, associate professor, doctor of medical sciences
2. Samura B. B. - associate professor of department of internal diseases 3, Zaporizhzhya
state medical university, candidate of medical sciences
3. Sychov R.A. - associate professor of department of internal diseases 3, Zaporizhzhya
state medical university, candidate of medical sciences
4. Chornaya I. V. - associate professor of department of internal diseases 3, Zaporizhzhya
state medical university, candidate of medical sciences
5. Medvedchuck G. Y. - associate professor of department of internal diseases 3,
Zaporizhzhya state medical university, candidate of medical sciences
Практикум “Сборник клинических задач по внутренней медицине (часть V:
гематология)” (на английском языке) предназначен для самостоятельной
подготовки к практическим занятиям по дисциплине внутренние болезни
англоговорящим студентам 6-го курса лечебного факультета. В практикум
включены клинические задачи, вопросы и ответы к ним, дискуссии по синдромной
диагностике в гематологической практике.
Reviewers:
- head of the department of Clinical Pharmacology, Pharmacy and Pharmacotherapy with
the Course of Cosmetology of Zaporizhzhya state medical university, doctor of medical
sciences, professor Kraydashenko O.V.
- professor of the Family Medicine and Therapy Department of FPE of Zaporizhzhya
state medical university, doctor of medical sciences Deynega V.G.
, Contents:
Path I: Anemia ………….………….………….………….………….……………….
Path II: Leukemia and leukemoid reaction ………….………….…………………..
Path III: Polycythemia ………….………….………….………….…………………..
Path IV: Purpura ………….………….………….………….…………………………
Path V: Lymphadenopathy ………….………….………….………….…………..…
Answers and discussion to cases………….………….………….………….………….
Path I: ANEMIA
CASE 1
A healthy 52-year-old man presents to the doctor's office complaining of increasing
fatigue for the past 4 to 5 months. He exercises every day, but lately he has noticed
becoming short of breath while jogging. He denies orthopnea, paroxysmal nocturnal
dyspnea (PND), or swelling in his ankles. The patient reports occasional joint pain, for
which he uses over-the-counter ibuprofen. He denies bowel changes, melena, or bright
red blood per rectum, but he reports vague left-side abdominal pain for a few months off
and on, not related to food intake. The patient denies fever, chills, nausea, or vomiting.
He has lost a few pounds intentionally with diet and exercise.
On examination, he weighs 205 lb, and he is afebrile. There is slight pallor of the
conjunctiva, skin, and palms. No lymphadenopathy is noted. Chest is clear to
auscultation bilaterally. Examination of the cardiovascular system reveals a regular rate
and rhythm, with no rub or gallop. There is a systolic ejection murmur. His abdomen is
soft, nontender, and without hepatosplenomegaly. Bowel sounds are present. He has no
extremity edema, cyanosis, or clubbing. His peripheral pulses are palpable and
symmetric. Hemoglobin level is 8.2 g/dL.
> What is the most likely diagnosis?
> What is the next diagnostic step?
CASE 2
A 43-year-old man presents with a 2-month history of fatigue, malaise, and dyspnea
on exertion. He does not take any medications. CBC from 2 years ago was normal. On
physical exam, there is conjunctival pallor. Hb is 5 g/dL, and HCT is 15%. Reticulocyte
, count is 20/mL, and RI is 0.1%. WBC and platelet counts are normal. There are very few
normocytic RBCs on peripheral smear. CXR is normal except for an anterior mediastinal
mass. EKG is normal.
> What type of anemia does this patient have?
CASE 3
A 27-year-old woman in her 18th week of gestation has Hb of 11.5 g/dL. She is
asymptomatic. There is no pallor or tachycardia. Reticulocyte count is 150,000, and RI is
1%. Iron studies are normal. Peripheral blood smear demonstrates normocytic RBCs.
> What is the next step in management?
CASE 4
A 65-year-old man presents with a 3-month history of back pain, fatigue, and an
unintentional 10-lb weight loss. The pain increases with movement. On physical exam,
there is pallor and vertebral tenderness. Abnormal findings on CBC are Hb 9.7 mg/dL,
HCT 29%, RI 0.5%, and MCV 90 dL. Figure 4–1 is the patient's peripheral smear.
Figure 4–1. Blood smear showing rouleaux.
> What is the most likely diagnosis?
CASE 5
A 76-year-old woman presents with fatigue and short-term memory loss. She does
not drink alcohol or smoke cigarettes. On physical exam, her tongue is shiny (atrophic
ZAPORIZHYA STATE MEDICAL UNIVERSITY
THE DEPARTMENT OF INTERNAL DISEASES 3
Casebook
in HEMATOLOGY
(tutorial for practical exercises for 6-year students of
medical faculty)
2015
, «RATIFIED»
by Central methodical advice of
Zaporizhzhya state medical university
Protocol № 2 from 26.11.2015
Authors:
1. Dotsenko S.Y. - Head of department of internal diseases 3, Zaporizhzhya state
medical university, associate professor, doctor of medical sciences
2. Samura B. B. - associate professor of department of internal diseases 3, Zaporizhzhya
state medical university, candidate of medical sciences
3. Sychov R.A. - associate professor of department of internal diseases 3, Zaporizhzhya
state medical university, candidate of medical sciences
4. Chornaya I. V. - associate professor of department of internal diseases 3, Zaporizhzhya
state medical university, candidate of medical sciences
5. Medvedchuck G. Y. - associate professor of department of internal diseases 3,
Zaporizhzhya state medical university, candidate of medical sciences
Практикум “Сборник клинических задач по внутренней медицине (часть V:
гематология)” (на английском языке) предназначен для самостоятельной
подготовки к практическим занятиям по дисциплине внутренние болезни
англоговорящим студентам 6-го курса лечебного факультета. В практикум
включены клинические задачи, вопросы и ответы к ним, дискуссии по синдромной
диагностике в гематологической практике.
Reviewers:
- head of the department of Clinical Pharmacology, Pharmacy and Pharmacotherapy with
the Course of Cosmetology of Zaporizhzhya state medical university, doctor of medical
sciences, professor Kraydashenko O.V.
- professor of the Family Medicine and Therapy Department of FPE of Zaporizhzhya
state medical university, doctor of medical sciences Deynega V.G.
, Contents:
Path I: Anemia ………….………….………….………….………….……………….
Path II: Leukemia and leukemoid reaction ………….………….…………………..
Path III: Polycythemia ………….………….………….………….…………………..
Path IV: Purpura ………….………….………….………….…………………………
Path V: Lymphadenopathy ………….………….………….………….…………..…
Answers and discussion to cases………….………….………….………….………….
Path I: ANEMIA
CASE 1
A healthy 52-year-old man presents to the doctor's office complaining of increasing
fatigue for the past 4 to 5 months. He exercises every day, but lately he has noticed
becoming short of breath while jogging. He denies orthopnea, paroxysmal nocturnal
dyspnea (PND), or swelling in his ankles. The patient reports occasional joint pain, for
which he uses over-the-counter ibuprofen. He denies bowel changes, melena, or bright
red blood per rectum, but he reports vague left-side abdominal pain for a few months off
and on, not related to food intake. The patient denies fever, chills, nausea, or vomiting.
He has lost a few pounds intentionally with diet and exercise.
On examination, he weighs 205 lb, and he is afebrile. There is slight pallor of the
conjunctiva, skin, and palms. No lymphadenopathy is noted. Chest is clear to
auscultation bilaterally. Examination of the cardiovascular system reveals a regular rate
and rhythm, with no rub or gallop. There is a systolic ejection murmur. His abdomen is
soft, nontender, and without hepatosplenomegaly. Bowel sounds are present. He has no
extremity edema, cyanosis, or clubbing. His peripheral pulses are palpable and
symmetric. Hemoglobin level is 8.2 g/dL.
> What is the most likely diagnosis?
> What is the next diagnostic step?
CASE 2
A 43-year-old man presents with a 2-month history of fatigue, malaise, and dyspnea
on exertion. He does not take any medications. CBC from 2 years ago was normal. On
physical exam, there is conjunctival pallor. Hb is 5 g/dL, and HCT is 15%. Reticulocyte
, count is 20/mL, and RI is 0.1%. WBC and platelet counts are normal. There are very few
normocytic RBCs on peripheral smear. CXR is normal except for an anterior mediastinal
mass. EKG is normal.
> What type of anemia does this patient have?
CASE 3
A 27-year-old woman in her 18th week of gestation has Hb of 11.5 g/dL. She is
asymptomatic. There is no pallor or tachycardia. Reticulocyte count is 150,000, and RI is
1%. Iron studies are normal. Peripheral blood smear demonstrates normocytic RBCs.
> What is the next step in management?
CASE 4
A 65-year-old man presents with a 3-month history of back pain, fatigue, and an
unintentional 10-lb weight loss. The pain increases with movement. On physical exam,
there is pallor and vertebral tenderness. Abnormal findings on CBC are Hb 9.7 mg/dL,
HCT 29%, RI 0.5%, and MCV 90 dL. Figure 4–1 is the patient's peripheral smear.
Figure 4–1. Blood smear showing rouleaux.
> What is the most likely diagnosis?
CASE 5
A 76-year-old woman presents with fatigue and short-term memory loss. She does
not drink alcohol or smoke cigarettes. On physical exam, her tongue is shiny (atrophic
