Question

CLINICAL CASE 3/2 Lymphatic System and Immunity A 61-year old male with a past medical history of chronic obstructive pulmonary disorder (COPD) was recently admitted for left-sided pneumothorax. He underwent chest tube placement and pleurodesis and was discharged home. Three days later, he returned to the Emergency Room with shortness of breath, cough, and left-sided pleuritic chest pain. A CT scan of the chest showed left upper lobe lung consolidation consistent with pneumonia, a moderate left pleural effusion, and giant bullous emphysema. Figure 1: Complete Blood Count (CBC) and Differential Patient value UPMC PUN/SHY Norwmal Range Male wBC 12.5 xOE+9/L 2.20 M1OE+ 12/L 9/a1 10.6) 3.8- RBC C4.33 S.s7) 12.9 - 16.9) 30.0- 40.0) 82.6 - 97.4) Hgb Het MCV 23. 104.0 tL tн) мсн MCHC 34.3 Pg 33.0 gm/dt. ( 12.7 35.5) 15.2) 369) RDW PLT 10.4 сн) (11.0- 156- 284 x1oE+9/1 Peripheral Blood Difterential ABS. No. UPHC PUH/sHY Normal Range (ABs) POLYS BANDS 2-30) 39.0 16.5 9 C2.24 7.68) .B0) сH] 2.06) LYMPHS монов 9.0 26.0 1.12) 3.25) 0.30- 0.0 o.90) EOS 1.0 o.12) 3.S0) o.40) DOASTS HETA NRBC/10o WDC .5 Figure 4: Bone Marrow Aspirate, Manual Differential Count Bone Marrow Adult Normal Range Differential Patient Mean 1.0 3.0 2.0) 4.0) 16.0) 25.0) 18.0) 14.0) 4.0) 3.0) 2.0) 0.2) 2.0) 1.0) 32.0) (11.0 23.0) 3.0) 0.0- Blaat Promyelocyte Myelocyte Metamyeloayte Band PMN Bos Myelo/Meta Bos Band Bos Seg 46.3 0.0 2.0 8.0 (10.0- 12.0 17.0 12.0 9.0 2.0 1.0 1.0 2.0 2.0 2.3 2.3 # 0.3 0.7 $ (9.0- (7.0- 1.0- 0.0 1.0- 2.0 Basophil Monocytes Pronormoblaste Normoblasts Lymphocytes Plasma Cella other Myeloid/Brythroid (ratio) 0.0- 0.0 0.0 1.0 0.3 1.7 0.7 35.0 0.0- 1.0 (16.0 24.0 16.0 3.7 0.7 0.0 N/A 0.0- 2.0 3.3) 1.5- 2.4 300 Tot. # of Celle counted Questions: 1. Try to describe and analyze the first chart CBC and differential. a. RBC b. WBC c. Hgb d. Hct e. Blasts? 2. Try to analyze Bone Marrow Biopsy a. Blasts, etc 3. What do you think about the diagnosis? Do you need more data? Which ones do you like to ask? 4. Cytogenic studies: The patient's karyotype demonstrates a paracentric inversion of the long arm of one chromosome 3 in all 20 cells examined. How does it help toward the diagnosis? 5. If your diagnosis is Leukemia you are on the right track, but you should be able to tell which type of leukemia is this: acute or chronic and myelogenous or lymphocytic. 6. After the diagnosis, tell us something about the prognosis and the treatment.

Answer 1

1Q).

Parameter	Normal range	Patient’s value
a). RBC (red blood cell)	4.13 -5.57 million/mm3	2.20 million/mm3
b). WBC (white blood cell)	3.8 – 10.6 /mm3	12.5 / mm3
c). Hgb (hemoglobin)	12.9 – 16.9 g/dL	7.8 g/dL
d). Hct (hematocrit)	30 – 48 %	23.7 %
e). Blasts	-	28%

From the above results, it can be observed that the patient’s RBC, hemoglobin, and hematocrit values are less than the normal. The low RBC, Hgb, and Hct count indicate low erythropoiesis. The high WBC count and the presence of blast cells (immature WBC) in the circulation suggest that the patient had increased WBC production or elevated immune response.