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CASE STUDIES in
 RBC Disorders
  Dr.CSBR.Prasad, M.D.,




        v1-CSBRP-Nov-2012
Case-1
• 8month old infant with 2week history of
  swollen hands and feet




                    v1-CSBRP-Nov-2012
Case-1




v1-CSBRP-Nov-2012
Case-1 Peripheral blood smear




           v1-CSBRP-Nov-2012
Case-1
1. What are the x-ray findings?
2. How do you describe the hand?
3. What is the abnormality in the peripheral
   smear?
4. How do you confirm your diagnosis?
5. How do you prevent future recurrent
   complications of this disease?


                    v1-CSBRP-Nov-2012
Case-2
• 29yo male. Incidental finding in routine
  hemogram. What is your interpretation?




                    v1-CSBRP-Nov-2012
Case-2




v1-CSBRP-Nov-2012
Case-2
• How do you confirm your suspicion?




                   v1-CSBRP-Nov-2012
Case-3
• 60yo male with weakness and pallor.
• Hemogram and PBS are given for your
  interpretation.




                   v1-CSBRP-Nov-2012
Case-3




v1-CSBRP-Nov-2012
Case-3 PBS




  v1-CSBRP-Nov-2012
Case-3
1. What are the significant abnormal values in
   hemogram report?
2. What are your PBS findings?
3. What is your diagnosis?
4. What do you do next?




                    v1-CSBRP-Nov-2012
Case-4
• 60yo female with chronic severe joint pains
  and deformity was found to have
  HGB=8gm/dl, MCV=68fl, serum iron=100µg/dl
• Peripheral smear and BM are given for your
  interpretation




                   v1-CSBRP-Nov-2012
Case-4




v1-CSBRP-Nov-2012
Case-4 PBS




  v1-CSBRP-Nov-2012
Case-4 BM, Perl’s stain




        v1-CSBRP-Nov-2012
Case-4
1. How do you describe the appearance of the
   hand ?
2. Describe the peripheral blood smear
3. What is being demonstrated in the Bone
   marrow smear? Is it normal or altered?
4. What is your diagnosis?
5. What is the basic pathology in this disease?
6. What should be the main stay of treatment?
                    v1-CSBRP-Nov-2012
Case-5
• 40yo female with weakness and very mild
  jaundice and recent onset foot drop
• Hemogram and PBS and BM images are given
  for your interpretation




                  v1-CSBRP-Nov-2012
Case-5 Hemogram




     v1-CSBRP-Nov-2012
Case-5 PBS




  v1-CSBRP-Nov-2012
Case-5 BM




  v1-CSBRP-Nov-2012
Case-5 BM




  v1-CSBRP-Nov-2012
Case-5 BM




  v1-CSBRP-Nov-2012
Case-5 BM




  v1-CSBRP-Nov-2012
Case-5
1. What are the striking abnormalities in
   hemogram values?
2. What are your findings in PBS, BM smears?
3. Why this patient has foot drop?
4. How do you assess the response to
   treatment in these cases?
5. How do you explain jaundice in this patient?


                    v1-CSBRP-Nov-2012
Case-6
• 35yo female with chronic anemia and whitish
  skin lesions and indigestion
• Gastric biopsy was done




                   v1-CSBRP-Nov-2012
Case-6 Skin lesions




      v1-CSBRP-Nov-2012
Case-6 Section from stomach




          v1-CSBRP-Nov-2012
Case-6 PBS
v1-CSBRP-Nov-2012
Case-6
1. Enumerate the histological findings in
   stomach biopsy
2. What are the PBS findings?
3. What is your diagnosis?
4. What is the importance of finding shown in
   the clinical photograph of the patient?



                    v1-CSBRP-Nov-2012
Case-7
• 40yo male patient complains of passing red
  colored urine after consuming beans shown in
  the image.




                   v1-CSBRP-Nov-2012
Case-7




v1-CSBRP-Nov-2012
Case-7

B - Patient’s urine sample
A - Normal urine for
comparison


 v1-CSBRP-Nov-2012
Case-7 PBS




  v1-CSBRP-Nov-2012
Case-7 Reticulocyte preparation




            v1-CSBRP-Nov-2012
Case-7
1. Describe the abnormality in urine sample
2. What are your findings in retic prep?
3. Describe the typical cells shown in the
   peripheral blood
4. How do you confirm the diagnosis?
5. Which famous mathematician suffered from
   this disease?


                  v1-CSBRP-Nov-2012
Case-8 Urine samples from a patient
      What is your diagnosis?




              v1-CSBRP-Nov-2012
Case-9
• 18yo boy with h/o jaundice since birth
• Operated for Gall stones recently
• Sectioned gall bladder and PBS images are
  given for your interpretation




                    v1-CSBRP-Nov-2012
Case-9




v1-CSBRP-Nov-2012
Case-9 PBS




  v1-CSBRP-Nov-2012
Case-9
1.   What are your findings in the gall bladder?
2.   What are your findings in the peripheral smear?
3.   What is your diagnosis?
4.   What test will help in establishing the diagnosis?
5.   What one may find in the abdominal examination?
6.   Name some other causes for PBS findings
7.   What are the other causes for gall bladder findings
8.   Can you name some causes for “jaundice since birth”
9.   After what period “neonatal jaundice” becomes
     worrysome?
                        v1-CSBRP-Nov-2012
Case-10
             Patient’s spun
           blood sample and
           micro-HCT tubes
               (Arrows).
             What are the
           causes for such a
                finding?

v1-CSBRP-Nov-2012
Case-11
• Child with chronic microcytic hypochromic
  anemia
• Blood and BM images are given




                   v1-CSBRP-Nov-2012
Case-11 PBS & BM




     v1-CSBRP-Nov-2012
Case-11




 v1-CSBRP-Nov-2012
Case-11
1. What is your diagnosis?
2. What are the differentials for microcytic
   hypochromic anemia?




                     v1-CSBRP-Nov-2012
Case-12
• A child with hemolytic anemia
• After a brief illness his anemia worsened
• Clinical image, BM pictures are given for your
  interpretation




                    v1-CSBRP-Nov-2012
v1-CSBRP-Nov-2012
Case-12 BM




  v1-CSBRP-Nov-2012
Case-12 BM aspirate




      v1-CSBRP-Nov-2012
Case-12 BM biopsy




      v1-CSBRP-Nov-2012
Case-12
• What are the BM findings?
• How do you treat these cases?




                   v1-CSBRP-Nov-2012
Case-13
• 40 yo female with muscle weakness and
  anterior mediastinal tumor
• Chest CT and BM images are given for
  interpretation




                   v1-CSBRP-Nov-2012
Case-13 Chest CT




     v1-CSBRP-Nov-2012
Case-13 BM




   v1-CSBRP-Nov-2012
Case-13 BM




  v1-CSBRP-Nov-2012
Case-13
1. What are the CT findings?
2. Name some DDs for anterior mediastinal mass
3. What are the BM findings?
4. What is your diagnosis?
5. How do explain muscle weakness in this
   patient?
6. What are the other causes for this type of BM
   changes?

                     v1-CSBRP-Nov-2012
Case-14 15yo female with chronic anemia




                v1-CSBRP-Nov-2012
Case-14 PBS




   v1-CSBRP-Nov-2012
Case-14
1. What is the descriptive term used for the
   facial appearances in this case?
2. Describe the changes in skull X-ray?
3. What are the findings in peripheral blood
   smear?
4. What is your diagnosis?
5. How do you confirm the diagnosis?


                    v1-CSBRP-Nov-2012
Case-15 50yo male with a HGB=11gm/dl.
   PBS given for your interpretation.




               v1-CSBRP-Nov-2012
Case-16 How do you prove it’s hereditary?




                 v1-CSBRP-Nov-2012
Case-17 Paleopathology case


  Skull from Italian excavation site




              v1-CSBRP-Nov-2012
Case-17 Clue: Bottom image




          v1-CSBRP-Nov-2012
Case-17 Paleopathology case
1. Describe the abnormality seen in the skull
2. What are the causes for such changes
3. How do you interpret the findings in the
   bottom image
4. What is your probable diagnosis?




                    v1-CSBRP-Nov-2012
END




v1-CSBRP-Nov-2012
Please make an attempt to get the
           right answers

For answers contact:
Dr.CSBR.Prasad, M.D.,
Associate Professor,
Deptt. of Pathology,
Sri Devaraj Urs Medical College,
Kolar-563101,
Karnataka
<CSBRPRASAD@rediffmail.com>
                    v1-CSBRP-Nov-2012

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RBC Disorders - case studies

  • 1. CASE STUDIES in RBC Disorders Dr.CSBR.Prasad, M.D., v1-CSBRP-Nov-2012
  • 2. Case-1 • 8month old infant with 2week history of swollen hands and feet v1-CSBRP-Nov-2012
  • 4. Case-1 Peripheral blood smear v1-CSBRP-Nov-2012
  • 5. Case-1 1. What are the x-ray findings? 2. How do you describe the hand? 3. What is the abnormality in the peripheral smear? 4. How do you confirm your diagnosis? 5. How do you prevent future recurrent complications of this disease? v1-CSBRP-Nov-2012
  • 6. Case-2 • 29yo male. Incidental finding in routine hemogram. What is your interpretation? v1-CSBRP-Nov-2012
  • 8. Case-2 • How do you confirm your suspicion? v1-CSBRP-Nov-2012
  • 9. Case-3 • 60yo male with weakness and pallor. • Hemogram and PBS are given for your interpretation. v1-CSBRP-Nov-2012
  • 11. Case-3 PBS v1-CSBRP-Nov-2012
  • 12. Case-3 1. What are the significant abnormal values in hemogram report? 2. What are your PBS findings? 3. What is your diagnosis? 4. What do you do next? v1-CSBRP-Nov-2012
  • 13. Case-4 • 60yo female with chronic severe joint pains and deformity was found to have HGB=8gm/dl, MCV=68fl, serum iron=100µg/dl • Peripheral smear and BM are given for your interpretation v1-CSBRP-Nov-2012
  • 15. Case-4 PBS v1-CSBRP-Nov-2012
  • 16. Case-4 BM, Perl’s stain v1-CSBRP-Nov-2012
  • 17. Case-4 1. How do you describe the appearance of the hand ? 2. Describe the peripheral blood smear 3. What is being demonstrated in the Bone marrow smear? Is it normal or altered? 4. What is your diagnosis? 5. What is the basic pathology in this disease? 6. What should be the main stay of treatment? v1-CSBRP-Nov-2012
  • 18. Case-5 • 40yo female with weakness and very mild jaundice and recent onset foot drop • Hemogram and PBS and BM images are given for your interpretation v1-CSBRP-Nov-2012
  • 19. Case-5 Hemogram v1-CSBRP-Nov-2012
  • 20. Case-5 PBS v1-CSBRP-Nov-2012
  • 21. Case-5 BM v1-CSBRP-Nov-2012
  • 22. Case-5 BM v1-CSBRP-Nov-2012
  • 23. Case-5 BM v1-CSBRP-Nov-2012
  • 24. Case-5 BM v1-CSBRP-Nov-2012
  • 25. Case-5 1. What are the striking abnormalities in hemogram values? 2. What are your findings in PBS, BM smears? 3. Why this patient has foot drop? 4. How do you assess the response to treatment in these cases? 5. How do you explain jaundice in this patient? v1-CSBRP-Nov-2012
  • 26. Case-6 • 35yo female with chronic anemia and whitish skin lesions and indigestion • Gastric biopsy was done v1-CSBRP-Nov-2012
  • 27. Case-6 Skin lesions v1-CSBRP-Nov-2012
  • 28. Case-6 Section from stomach v1-CSBRP-Nov-2012
  • 30. Case-6 1. Enumerate the histological findings in stomach biopsy 2. What are the PBS findings? 3. What is your diagnosis? 4. What is the importance of finding shown in the clinical photograph of the patient? v1-CSBRP-Nov-2012
  • 31. Case-7 • 40yo male patient complains of passing red colored urine after consuming beans shown in the image. v1-CSBRP-Nov-2012
  • 33. Case-7 B - Patient’s urine sample A - Normal urine for comparison v1-CSBRP-Nov-2012
  • 34. Case-7 PBS v1-CSBRP-Nov-2012
  • 35. Case-7 Reticulocyte preparation v1-CSBRP-Nov-2012
  • 36. Case-7 1. Describe the abnormality in urine sample 2. What are your findings in retic prep? 3. Describe the typical cells shown in the peripheral blood 4. How do you confirm the diagnosis? 5. Which famous mathematician suffered from this disease? v1-CSBRP-Nov-2012
  • 37. Case-8 Urine samples from a patient What is your diagnosis? v1-CSBRP-Nov-2012
  • 38. Case-9 • 18yo boy with h/o jaundice since birth • Operated for Gall stones recently • Sectioned gall bladder and PBS images are given for your interpretation v1-CSBRP-Nov-2012
  • 40. Case-9 PBS v1-CSBRP-Nov-2012
  • 41. Case-9 1. What are your findings in the gall bladder? 2. What are your findings in the peripheral smear? 3. What is your diagnosis? 4. What test will help in establishing the diagnosis? 5. What one may find in the abdominal examination? 6. Name some other causes for PBS findings 7. What are the other causes for gall bladder findings 8. Can you name some causes for “jaundice since birth” 9. After what period “neonatal jaundice” becomes worrysome? v1-CSBRP-Nov-2012
  • 42. Case-10 Patient’s spun blood sample and micro-HCT tubes (Arrows). What are the causes for such a finding? v1-CSBRP-Nov-2012
  • 43. Case-11 • Child with chronic microcytic hypochromic anemia • Blood and BM images are given v1-CSBRP-Nov-2012
  • 44. Case-11 PBS & BM v1-CSBRP-Nov-2012
  • 46. Case-11 1. What is your diagnosis? 2. What are the differentials for microcytic hypochromic anemia? v1-CSBRP-Nov-2012
  • 47. Case-12 • A child with hemolytic anemia • After a brief illness his anemia worsened • Clinical image, BM pictures are given for your interpretation v1-CSBRP-Nov-2012
  • 49. Case-12 BM v1-CSBRP-Nov-2012
  • 50. Case-12 BM aspirate v1-CSBRP-Nov-2012
  • 51. Case-12 BM biopsy v1-CSBRP-Nov-2012
  • 52. Case-12 • What are the BM findings? • How do you treat these cases? v1-CSBRP-Nov-2012
  • 53. Case-13 • 40 yo female with muscle weakness and anterior mediastinal tumor • Chest CT and BM images are given for interpretation v1-CSBRP-Nov-2012
  • 54. Case-13 Chest CT v1-CSBRP-Nov-2012
  • 55. Case-13 BM v1-CSBRP-Nov-2012
  • 56. Case-13 BM v1-CSBRP-Nov-2012
  • 57. Case-13 1. What are the CT findings? 2. Name some DDs for anterior mediastinal mass 3. What are the BM findings? 4. What is your diagnosis? 5. How do explain muscle weakness in this patient? 6. What are the other causes for this type of BM changes? v1-CSBRP-Nov-2012
  • 58. Case-14 15yo female with chronic anemia v1-CSBRP-Nov-2012
  • 59. Case-14 PBS v1-CSBRP-Nov-2012
  • 60. Case-14 1. What is the descriptive term used for the facial appearances in this case? 2. Describe the changes in skull X-ray? 3. What are the findings in peripheral blood smear? 4. What is your diagnosis? 5. How do you confirm the diagnosis? v1-CSBRP-Nov-2012
  • 61. Case-15 50yo male with a HGB=11gm/dl. PBS given for your interpretation. v1-CSBRP-Nov-2012
  • 62. Case-16 How do you prove it’s hereditary? v1-CSBRP-Nov-2012
  • 63. Case-17 Paleopathology case Skull from Italian excavation site v1-CSBRP-Nov-2012
  • 64. Case-17 Clue: Bottom image v1-CSBRP-Nov-2012
  • 65. Case-17 Paleopathology case 1. Describe the abnormality seen in the skull 2. What are the causes for such changes 3. How do you interpret the findings in the bottom image 4. What is your probable diagnosis? v1-CSBRP-Nov-2012
  • 67. Please make an attempt to get the right answers For answers contact: Dr.CSBR.Prasad, M.D., Associate Professor, Deptt. of Pathology, Sri Devaraj Urs Medical College, Kolar-563101, Karnataka <CSBRPRASAD@rediffmail.com> v1-CSBRP-Nov-2012