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The patient is a 16 year old male with a two year
history of intermittant weakness and recurrent infections.
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The patient now presents with extreme weakness,
jaundice, and abdominal pain of unknown origin. The patient relates that
his urine is dark in color in the morning sometimes, but this occurs much
more frequently now.
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Splenomegaly was found. No hepatomegaly was noted.
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CBC
WBC
with differential
RBC
Morphology
Bone
Marrow results
Other
Tests (including Flow Cytometry)
Other
Tests
Sucrose
Hemolysis Test
PNH
Flow Cytometry Test
Bone
Marrow Results
Biospy Results:
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The marrow is markedly hypocellular for the patient's
age - estimated at 5% cellular overall. The majority of the biopsy specimen
is composed of empty marrow fat spaces.
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There are several small clusters of hematopoieitic
precursors seen throughout the specimen.
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These clusters are mostly composed of erythroid
precursors and frequently contain small numbers (4 to 8) blasts.
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The clot specimen is also very hypocellular, containing
only 2 to 3 small clusters of hematopoietic cells.
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More mature myeloid cells including myelocytes
and metamyelocytes are seen.
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Eosinophilic myelocytes are prominent.
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An increased number of plasma cells and mast cells
are seen.
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Stainable iron is increased without ringed sideroblasts.
Aspirate smear:
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20% erythroid, 10% myeloid, 60% lymphoid, 4% plasma
cells,
0% eos, 4% erythroblast, 0% myeloblast, 0%
promyelocyte,
2% myelocyte, 0% metamyelocyte
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Hypocellular marrow spicules
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Diagnostic impression: Severe aplastic anemia
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Go to this case results:
CBC
WBC
with differential
RBC
Morphology
Other
Tests (including Flow Cytometry)
Sucrose
Hemolysis Test
Patient Test Result - Negative
Principle of test - Whole blood is incubated
in a low ionic strength sucrose solution. At this low ionic strenght the
binding of complement is promoted (particularly C3) to the erythrocyte
surface. Under these conditions the ability of erythrocytes to remain intact
is strained. Normal erythrocytes do not hemolyze under these conditions
since they contain an inhibitor of the complement MAC complex, but erythrocytes
from patients with PNH do not have this protein (and others) and are extremely
sensitive to complement-mediated lysis and hemolyze. (See
tutorial on PNH)
Select:
A
new case study
Go to this case results:
CBC
WBC
with differential
RBC
Morphology
Bone
Marrow results
Other
Tests (including Flow Cytometry)