CASE STUDY 1

A 19-years old female is brought to the emergency room by her mother with a history of increased
heavy and prolonged menstrual period. The young women also complain intense pain during her period
and tiredness throughout the whole month. A complete blood count brings the following result:

Result (unit) Reference range

Hemoglobin 109g/L • Male 135-180g/L
• Female 120-150g/L
• Newborn 165-215g/L

Hematocrit 0.31L/L • Male 0.40-0.54L/L

• Female 0.35-0.49L/L
Red Blood Cells 3.6x 1012/L • 3.9-5.0x1012/L
MCV 72fL • 80-100fL
RDW 15% • 11.5-14.5%
MCH 22pg • 26-34pg
ESR 9mm/hour • <10
Ferritin 10ng/ml • 12-150ng/ml
Total Iron Binding Capacity Increased
Transferrin Increased
C-reactive protein Normal

*WBC shows no leukocytosis and differential does not show any left shift. Platelets are within normal
range and shape.

QUESTIONS:

1. What is the most likely diagnosis of the patient? Explain.

2. Discuss the correlation of the result of transferrin and ferritin.
3. Discuss the treatments available and its limitations.
4. With the given laboratory results above, identify the diagnosis counterpart disease if the serum
ferritin and TIBC is inverse. Explain.
CASE STUDY 2
Carla, a 20-years old female was administered to hospital with complaints of progressive weaknesses,
shortness of breath, dizziness, headache, unexplained fatigue of recent onset and she has experienced
recurrent fever reaching 38.4°C with stable vital signs. No lymphadenopathy and splenomegaly. Upon
physical examination she showed pale skin with rashes and several bruises are found on her legs and
thighs.

Laboratory findings:

TESTS RESULTS
Peripheral blood smear shows no abnormal cells/blasts.
MCV, MCH Normal

HGB, HCT decreased

Red blood cells decreased

White blood cells decreased

Platelets decreased

Reticulocyte count decreased

Bleeding time Prolonged

Hypocellular bone marrow >70% yellow marrow

Initial stage of lymphocyte count normal

Questions:

1. What is the most likely diagnosis? Explain.

2. What are possible etiologies of this disorder?
3. What therapeutic modalities are most appropriate for this patient and why?
4. What are the complications that can progress with the diagnosis?
CASE STUDY 3
A 62-years old male non-diabetic and normotensive presented to his physician with symptoms of
fatigue, dizziness, night sweats, shortness of breath, abdominal pain/discomforts and with pruritis. He
also reported increased bruising. His spleen was palpable 8cm below the left costal margin. His history
was notable for smoking.

Laboratory findings:

Tests Results
HGB, HCT Increased
RBC count, Total red cell volume Increased
Platelet count Increased
Peripheral blood granulocyte Present
Serum erythropoietin Low
Bone marrow Hypercellular with trilineage growth (assessed by
trephine biopsy)
JAK2 mutation present
Leukocyte alkaline phosphatase High

Questions:

1. From Patient’s age, history, sex and laboratory results what diagnosis might be expected?
2. What is the most likely cause(s) of the principal complications found in this patient’s condition?
3. This patient had markedly increased red blood cell count. What is the significance of this
increase?
4. What is the most appropriate treatment for this patient?
CASE STUDY 4
A 25-years old male patient went to his physician complaining of fatigue, dizziness, fever, and an
unusually pale skin. The patient has also noted experiencing bleeding gums. His physician requested an
initial laboratory test of CBC which yielded the following results:

Parameter Test Result Parameter Test Result

RBC count: 1.8 x1012/L WBC Count: 2.0 x109/L
Hemoglobin 6.8 g/dL Platelet Count 49 x109/L
Hematocrit: 0.25 /L Retics Count 5 x109/L

Bone Marrow examination confirmed decreased levels of Red blood cells, white blood cell and platelets.

Questions:

1. Based on the initial findings what is the possible hematologic disorder / illness of the patient?
Support your answer
2. Elaborate the expected bone marrow examination results of patients with this condition.
3. What are the possible causes of this condition?
4. Discuss the pathophysiology and the laboratory tests to support the diagnosis
CASE STUDY 5
An 18 years old male patient suffering abdominal pain, and diarrhea was brought to the ER. It has also
been found that prior to the onset of pain, he has been experiencing fatigue, weakness, and shortness of
breath. Complete blood count yielded the following results:

Parameter Test Result Parameter Test Result

RBC count: 3.8 x1012/L WBC Count: 6.78 x109/L
Hemoglobin 10 g/dL Platelet Count 235 x109/L
Hematocrit: 0.30 /L

MCH 26 pg
MCV 78.9 fL
MCHC 33 g/dL

Stool analysis returned positive for presence of parasitic ova.

Peripheral Blood Film examination showed slight polychromasia, and slight anisocytosis.

Questions:

1. Based on the initial findings what is the possible hematologic disorder / illness of the patient?
Support your answer.
2. What are the possible causes of this condition?
3. Discuss the pathophysiology of the condition.
4. Aside from the ones listed above, what other Laboratory tests may be done for diagnosis?
CASE STUDY 6
A 18 years old female patient complained of fatigue, dizziness, and fever. On examination she was
observed to be jaundiced and the physician also assessed her to suffer from splenomegaly. CBC yielded
the following results:

Parameter Test Result Parameter Test Result

RBC count: 4.45 x1012/L WBC Count: 6.78 x109/L
Hemoglobin 14 g/dL Platelet Count 235 x109/L
Hematocrit: 0.35 /L

MCH 31.4 pg
MCV 78.6 fL
MCHC 40 g/dL

Reticulocyte count is at 9%, Bilirubin levels are increased

Blood film examination confirmed presence of polychromasia with some erythrocytes showing no
central pallor, anisocytosis was also noted.

Questions:

1. Based on the initial findings what is the possible hematologic disorder / illness of the patient?
Support your answer
2. What are the possible causes of this condition?
3. Discuss the pathophysiology of the condition.
4. Aside from the ones listed above, what other Laboratory tests may be done for diagnosis?