baryar
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A man of 50 yrs,
complete blood count values are
Hb =2.8 gm/dL
Hematocrit =10.8 %
RBC =90,000/uL
WBC =3700/uL
Neutrophils =13%
Lymphocytes =84%
Monocytes =01 %
Eosinophils =02%
Platelets =19,000/uL
ESR =48 mm after first hour
peripheral blood film showed moderate degree of anisocytosis of RBC and microcytosis.lymphocytes were small and mature.
bone marrow aspiration..............hypoplastic ( aplastic?? ) marrow
on the basis of complete blood count,peripheral blood film and bone marrow analysis......whats the diagnosis?
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| new_n_lost
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Aplastic Anemia
If the Bone Marrow was anything other than hypoplastic then it would be something else which would be indicated by the bone marrow composition but this should be Aplastic Anemia.
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| baryar
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HYPOPLASTIC MARROW ..........alright. sir i dont know about the diagnosis.this case i came across recently in hospital.i put it here in forum for discussion, so that may b some senior will give some knowledge and facts regarding this case
my first thought was that its a case of APLASTIC ANEMIA
but if u c,it is only effecting the erythroid series.on the other hand lymphoid series is not disturbed..
in complete blood picture....lymphocytes are 84% of total of 3700/uL WBCs.....so it means that lymphocytes are around about 3100/uL
( lymphocytes=3100/uL... thats in normal range in a normal blood picture).......... ( % of lymphos is high bcaz neutrophils are less.)
what i thought was that only the cells of eryrthroid series are effected,and lymphoid series cells seems not been disturbed
also on peripheral film.......lymphocytes are reported to b mature-lymphocytes
if it is aplastic anemia,....
1=y not aal the series effected (eryhtroid + lymphoid )
2= is there any evidence that earlier in the course of aplastic anemia, lymphoid series is not effected,and it is disturbed relatively later than erythroid series???....( as in this pt's case....he has 3-months history of fatigue,weakness,pallor etc.........and these lab reports are of 5 days back from date of posting this topic )
can it b that there is some abnormality in erythroid series pre-cursors, ( for example lack of eryhtropoetin or etc ) so only eryhtroid precursors are effected and lymphoid series is not disturbed.
these were few points that i wanted to discuss with u fellows.i hope someone will brief us on it.
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| new_n_lost
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Explain the low platelet count
And if you care to noitce the ALL THE COUNTS ARE BELOW NORMAL. Last time i checked a count of 3700/uL was below normal whereas 4500-11000/uL was considered the normal range.
Besides if you saw this case then there are 3 possibilities.
1. You are medical student therefore i am not going to do your homework for you.
2. If you are Resident (a bit hard to believe) then go and get the labs redone, and ask them to have a special look at the Bone Marrow and ask them if the picture fits Either Aplastic Anemia or SLL because based on the fact that the relatively few numbers of WBCs are neutrophils and the bone marrow is hypoplastic and could they also tell if there were any smudge cells or any teardrop cells.
3. Even if you are an Observer or doing an Externship honestly you have a golden opportunity to go to the lab and see the blood films. And an excellent discussion could get you noticed and maybe and hopefully a good LOR.
Best of Luck & Cheers.
Edited by new_n_lost on 04/05/08 - 10:41 PM
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| hottie99
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honestly dude, the guy was just asking for opinions, and u gave urs, and if u felt the need to belitte him, why bother?? he said he was asking for opinions of others, and if u were just going to be nasty with him and berrate him, i see no point to say anything at all.. ur not doing his homework by replying to his q, and if his patient is coding, im sure he pushed the blue button on the wall..
relax, this is a forum to discuss, and that's what is going on.. i see no point why ur miserable and putting him down, fine u think what it is, and u said it, point taken, he's just referring to what he saw, ok, good point taken. now discuss..
i think it's aplastic anemia, but then again, im not in a hosptal rite now and nor do i have live patients yet, but looking at the bigger picture, i too would use the marrow biopsy as the factor so hypoplastic would be aplastic anemia, and the lymphocytosis i would explain by the viral cause of aplastic anemia (parvo), as for the platelets, well i thought they go down too if the marrow is empty, just thinking out loud here.. goodnites 
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| new_n_lost
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You also believe that 3700/uL is normal
Hmm interesting.
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| hottie99
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uh no smarty pants, i said i too would think it would go down, as it showed, since yes it is below nl value of 4500 being the lower end of nl range. jeez lighten up dude, this isn't the whole world, get off the high horse man and take a peek at the world.. it's not that awful.. 
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| new_n_lost
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Roflmao
No that is not what i m talking about.
the lymphocytosis i would explain by the viral cause of aplastic anemia (parvo), as for the platelets, well i thought they go down too if the marrow is empty, just thinking out loud here..
Sorry to have offended you but thats what i understood from your last 2 lines. And FYI Parvovirus infection only targets the RBCs can goes after them causing an Aplastic crisis which would also lead to a lot of complications. If you had said Epstein Barr virus that was also a good probability but not parvo virus in case of LYMPHOCYTOSIS.
Secondly i wasnt being rude to him or going on my high horse or whatever idea you seem to entertain. Yes there was a sarcastic remark there which do i realise was a bit rubbing it in.
But again it wasnt meant to berate anyone for that matter but perceptions are everything.
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| baryar
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in a case of deficiency of erythropoetin what will be....
1 = complete blood picture ??
2 = peripheral blood film ??
3 = bone marrow analysis ??
particularly as compared to the reports of this patient.
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| sigh
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I think that Erythropoetin deficiency will affect only RBC...
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| hottie99
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ok genius, i bow down, but i also dont claim to be any sort of expert, thus me 'thinking outloud'.. regardless, i was under the impression any viral cause can give a lymphocytosis, yes we know ebv gives an atypical lymphocytosis, but im pretty sure just a viral cause will cause lymphocytosis, which was what i was referring to.. and i said the platelets were low, i dont know wat or how ur interpreting stuff, nor do i care really.. u just seem to reply in condecending ways, that's all i meant by 'get off ur high horse'.. anyhoo im over it, have a good one 
as for deficiency of epo, well for sure u'd have a low retic count (bc the problem is in bone marrow) so that would be shown on lab.. not so sure about others, sorry!
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| bioguy
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thats the problem with internet. things don't get settled quick.
if it were face-to-face then a couple of punches on the face and a kick in the nads will decide who is right.
as with the case above, i have no thoughts to think aloud
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| bioguy
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Ethnic Differences in Normal White cell count (X1000 per ul)
(mean followed by range in brackets)
Men
European Descent 5.7 (3.6–9.2)
Afro-Carribean 5.2 (2.8–9.5)
African 4.5 (2.8–7.2)
Women
European Descent 6.2 (3.5–10.8)
Afro-Carribean 5.7 (3.3–9.9)
African 5.0 (3.2–7.8)
Ref: William's hematology
Lets be willing to stretch the rules a bit... makes life easy.
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| bioguy
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baryar wrote:
in complete blood picture....lymphocytes are 84% of total of 3700/uL WBCs.....so it means that lymphocytes are around about 3100/uL
( lymphocytes=3100/uL... thats in normal range in a normal blood picture).......... ( % of lymphos is high bcaz neutrophils are less.)
what i thought was that only the cells of eryrthroid series are effected,and lymphoid series cells seems not been disturbed
I do not agree with this. its possible that all leukocytes were affected by the aplastic process and so the reduced number, and some stimulating process ( viral infection) is responsible for the increase in lymphocytes, and the tug-of-war between the aplastic process and the lymphocytosis process might have resulted in an equilibrium that happened to fall in the normal zone. i am saying THIS IS POSSIBLE, not that I am absolutely right. apart from neutrophils even monocytes and eosinophils are reduced. so i do not agree with the statement that leukocytes were unaffected.
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| bioguy
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so, even if you consider 3700 as normal, this patient has that number because all his leukocytes are reduced by aplastic process and the modest increase in lymphocytes (which lets say is abnormal) resulted in the increase in total WBC count.
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| hottie99
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hahaa i have no 'nads' persay, since im a gal, but it's fine.. i dont plan to see in him person, i probably wouldn't also answer to ppl's posts in negative manner (as it seems he consistently does) but whatever... are u mocking my thinking aloud?? hahaha
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| bioguy
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hottie99 wrote:... are u mocking my thinking aloud?? hahaha
no ma'am, absolutely not !
...add this to the internet age of communication. Inspite of having millions of these smilies, its tough to express emotions associated with whatever is being written on the net. So people tend to imagine the other person's intent and one doesn't realize that that imagination is a figment of one's character. One cannot imagine what one's mind cannot think. In other words - one's imagination is dictated or limited by one's thought. So its all in the mind. If you think I am rude, or I think you are rude, maybe we both are rude, maybe we both are not. Who will decide?
(I can imagine myself sitting under the Bodhi tree, giving this discourse)
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| new_n_lost
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bioguy wrote: no ma'am, absolutely not ! ...add this to the internet age of communication. Inspite of having millions of these smilies, its tough to express emotions associated with whatever is being written on the net. So people tend to imagine the other person's intent and one doesn't realize that that imagination is a figment of one's character. One cannot imagine what one's mind cannot think. In other words - one's imagination is dictated or limited by one's thought. So its all in the mind. If you think I am rude, or I think you are rude, maybe we both are rude, maybe we both are not. Who will decide? (I can imagine myself sitting under the Bodhi tree, giving this discourse )
Dude you always crack me up and as always you are spot on !!!
Like the Zen master said " we will see"
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| bioguy
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Rare cases of parvovirus B19 may lead to neutropenia and apparent lymphocytosis.
Koch WC, Massey G, Russell CE, Adler SP. Manifestations and treatment of human parvovirus B19 infection in immunocompromised patients. J Pediatr. 1990;116:355-359.
Sorry, couldn't get hold of the actual article.
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| bioguy
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new_n_lost wrote:
Dude you always crack me up and as always you are spot on !!!
Like the Zen master said " we will see"
man! it applies to you too. you thought the first person was rude, in the first place.
forget it, lets talk about the case.
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| new_n_lost
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bioguy wrote:new_n_lost wrote:
Dude you always crack me up and as always you are spot on !!!
Like the Zen master said " we will see"
man! it applies to you too. you thought the first person was rude, in the first place. forget it, lets talk about the case.
Ji ji zen master
(app bhojan jari rakhiye)
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| bioguy
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Hey, Baryar!!!! What about the reticulocyte count????
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| baryar
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U all have posted very good replies and i respect knowledge of all u fellows.
There are two series in bone marrow....
1= erythroid or myeloid ( it includes aal the cells other than lymphos )
2=lymphoid
It is known that erythropoetin effects (stimulates ) aal the cells of erythroid series,and it doesnt effect cells of lymphoid series.
The original brain-wave behind asking this question was that how can u say that its not a case of deficiency of eryhtropoetin.
.... whats the effect of eryhtropoetin deficeincy....just that it will effect all the cell lines of erythroid series (and thus cause hypoplastic marrow ) and it will not disturb lymphoid series...thats what the labs show us in this case....SO HOW CAN U SAY THAT ITS NOT A CASE DEFICIENCY OF ERYTHROPOETIN ???. thats what in particular i wanted to discuss.
KEEP SMILING
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| bioguy
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The hallmark of aplastic anemia is pancytopenia. However, early in the evolution of aplastic anemia, only one or two cell lines may be reduced.
Anemia may be severe and is always associated with decreased reticulocytes. Red blood cell morphology is unremarkable. Neutrophils and platelets are reduced in number, and no immature or abnormal forms are seen. The bone marrow aspirate and the bone marrow biopsy appear hypocellular, with only scant amounts of normal hematopoietic progenitors. No abnormal cells are seen.
CMDT08
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| baryar
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@BIOGUY
reticulocyte count was within normal.it was not above normal.
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