Hematology Case Study B - History: A 44-year-old male was first

MEDT 4600 Hematology Review

Case Study B

History: A 44-year-old male was first seen in the VA hospital and then transferred to the city’s larger hospital for re-evaluation. He was not responding to treatment that was prescribed.

Lab results were:

WBC 122.2

RBC 2.48

HGB 8.2

HCT 26.0

MCV 90.7

MCH 32.9

MCHC 36.3

RDW 14.3

PLT 27

3

Coagulation:

Fibrinogen 67 mg/dl

PT 19.3 sec

INR 2.0

PTT 39.5 sec

FSP >40 µg/dl

D-dimer 4250 NG/ML

Question 1 – What do the above lab results indicate?

Additional testing

Peripheral Blood Smear Day 1:

Several large WBCs with a large amount of nucleus, bi-lobed nucleus and hypogranular.

These cells were reported as monocytes (monocytosis)

Peripheral Blood Smear Day 2:

On this day the MT performing the differential called the abnormal WBCs hypogranular

promyelocytes.

Question 2 – Based on the additional testing from Day 1, what is the best possible diagnosis?

Yet the results were different on Day 2, what is the best possible diagnosis based on the

peripheral blood smear results from Day 2?

Patient Outcome

Patient died about 3 months later