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Hematopathology
LAB 1: Anemias and Leukocytoses

Last year, a new approach was piloted in the labs. It worked well and will be used again this year. It uses a PowerPoint Show (PPS) that brings together Case histories, questions (and answers), photomicrographs (taken from virtual slides) and the virtual slide viewing all accessed from one a PowerPoint show.

The PowerPoint documents used in the labs and the hyperlinks to virtual slides should work from any desktop/laptop attached to the Medical School’s intranet (ethernet best, WiFi will be slower). The PowerPoint document can be viewed on most tablets (equipped with a reader, I use SlideShark on Apple tablets). Virtual slide viewing on tablets is problematic and, on Apple tablets, requires purchase of an Aperio ePathViewer (from App store).

INSTRUCTIONS AND LINKS FOR LAB 1:

Download (save to desktop) the PowerPoint presentation entitled "Hematopathology Lab 1" from either Path Lab Resources or the adjacent hyperlink (CLICK HERE). Initiate the “Slideshow” mode using the “screen” icon or the appropriate dropdown menu. Resize the slideshow window for comfortable viewing and proceed.

The PPS uses simple space-bar/arrow/mouse-click triggered animations to present the case history, illustrative micrographs (from virtual slides), relevant questions and a uniform set of "answers". It also contains links to the M2 Hematopathology Website, the complete virtual slide for each case and the self-test tool for virtual slides. Your instructor will introduce each case then ask students to work through the questions, answers and virtual slides using the PPS on their laptops. He/she will answer individual questions as they arise and address areas of common difficulty.

Remember, the Final has at least five questions based on virtual slides and the content in Lab 1 and 2 (the other five questions cover the material in the Atlas from week 1). Please make sure that you can identify the relevant findings on the virtual slides, not just the micrographs.

Refer to the following NORMAL BLOOD SMEAR for comparison:
[WebScope] [ImageScope]


Case 1:  RBC abnormalities

Blood smear: [WebScope] [ImageScope]

History:  History: A 19-year-old woman with anemia presents with a two day history of fever and joint pain.  She reports experiencing similar episodes 2-3 times/year that respond to hydration and pain medication. Her history is notable for avascular necrosis of the left femoral head at age 14. Examine the virtual slide and answer the following questions.

  1. What are the major RBC abnormalities on the smear?

  2. A diagnosis of the "process" is readily made by inspection of the smear, but what additional test(s) are needed to establish the specific cause (etiology)?

  3. What additional morphologic abnormalities might you expect in some cases?

  4. What would you expect the red cell indices to show in this case?

  5. If you just had the CBC and red blood cell indices, what other types of anemia would you consider?

  6. How do the morphologic and biochemical abnormalities in this case produce symptoms, signs, and complications in this disease?



Case 2:  RBC abnormalities

Blood smear: [WebScope] [ImageScope]

History:  The patient is a 28-year-old woman in the second trimester of pregnancy with her first child. Her pregnancy has been uncomplicated but recently she has noticed that she tires easily and is short of breath from even the slightest exertion. She also has periods of light-headedness, though not to the point of fainting.  On examination, the patient has tachycardia at rest, pale gums and nail beds. Examine the virtual slide and answer the following questions.

  1. What are the major RBC abnormalities on the smear?

  2. A diagnosis of the "process" is readily made by inspection of the smear, but what additional test(s) are needed to establish the specific cause (etiology)?

  3. What would you expect the red cell indices to show in this case?

  4. If you just had the CBC and red blood cell indices, what other types of anemia would you consider?

  5. How do the morphologic and biochemical abnormalities in this case produce symptoms, signs, and complications in this disease?



Case 3:  WBC abnormalities

Blood smear: [WebScope] [ImageScope]

History:  A previously fit 20 year old man was admitted with a three day history of fever, sore throat, dyspnea, and malaise. On admission he was febrile, temperature of 39.7°C, with generalized lymphadenopathy, non-exudative pharyngitis, mild hepatomegaly and splenomegaly of 2 cm below the costal margin. He looked pale but well, blood pressure 115/95 mm Hg, pulse 96 beats/min. He had mild left and right abdominal tenderness without guarding. Normal CBC except for an elevated percentage of lymphocytes (see virtual slide).

  1. What are the major WBC abnormalities on the smear?

  2. What additional test(s) are needed to establish a diagnosis?

  3. What other conditions should you consider?

  4. How are the morphologic abnormalities in the blood smear related to the symptoms, signs, and complications in this disease?



Case 4:  WBC abnormalities

Blood smear: [WebScope] [ImageScope]

History:  After a several day prodrome of fever, chills, cough, and shortness of breath, an elderly patient presented to the emergency department (ED). In the ED, the subject was febrile, hypotensive and hypoxemic. The white count was elevated.

  1. What are the major WBC abnormalities on the smear?

  2. What additional test(s) are needed to establish a diagnosis?

  3. What other conditions should you consider?

  4. How are the morphologic abnormalities in the blood smear related to the symptoms, signs, and complications in this disease?

 


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