Clinical topics conference: Chapter 20, Blood and Lymphoid Tissue II

Click on a hyperlink.

  1. 2 year-old male with fever
  2. 60 year-old male with left upper quadrant pain and weight loss
  3. 22 year-old female with a 2 month history of fever, weight loss and night sweats
  4. 69 year-old male with fatigue

Clinical vignette 1

A 2 year old male presents with a chief complaint of fever. Physical examination is significant for pallor, petechiae, lymphadenopathy and hepatosplenomegaly. Laboratory finding show a hemoglobin of 6.4 gm/dl, platelet count of 7,000/ul and WBC count of 110,000/ul with 98% blasts on the peripheral smear.

Discussion topics

  1. Identify the abnormal clinical and laboratory findings.

  2. Discuss the differential diagnosis. What is the most likely diagnosis?

  3. What are the diagnostic criteria for acute leukemia? Discuss the usual clinical presentation of childhood ALL.

  4. Discuss the diagnostic evaluation of a patient presenting with acute leukemia. What other tests would you order on this patient?

  5. Describe the histologic findings you expect to see in the bone marrow?

  6. Discuss the prognosis of childhood ALL. What are the favorable and unfavorable prognostic indicators?

  • Go to top

    Clinical vignette 2

    The patient is a 60 year old male who presents with a chief complaint of left upper quadrant pain and weight loss. Physical examination is significant for moderate splenomegaly and lack of lymphadenopathy. Laboratory findings include a hemoglobin of 11.3 gm/dl, MCV 90, platelet count 540,000/ul, and WBC count 75,000/ul with a WBC differential of 54 segmented neutrophils, 4 bands, 5 lymphs, 6 monocytes, 4 eosinophils, 5 basophils, 5 metamyelocytes, 14 myelocytes, 2 promyelocytes and 1 blast.

    Discussion topics

    1. Identify the abnormal clinical and laboratory findings.

    2. Discuss the differential diagnosis. (Name the four chronic myeloproliferative disorders. List the key features of each disorder, with attention to the clinical and laboratory features which are important to the diagnosis of each disorder.)

    3. What is the most likely diagnosis in this case, and discuss what features are present which support your diagnosis.

    4. What further tests would you order in the diagnostic evaluation of this patient?

    5. Discuss the role of cytogenetics in the diagnosis and prognosis of myeloproliferative disorders.

    6. Discuss the clinical course of CML.

  • Go to top

    Clinical vignette 3

    A 22 year-old female presents with a 2 month history of fever, weight loss and night sweats. Physical examination was significant for a 3 cm firm, nontender left cervical neck mass. Chest X-ray revealed a mediastinal mass.

    Discussion topics

    1. Identify the abnormal clinical findings.

    2. Discuss the differential diagnosis. What is the most likely diagnosis?

    3. What further studies would you order in the diagnostic evaluation of this patient? (Include a discussion of the staging of lymphoma).

    4. Compare and contrast the clinical features of Hodgkin disease with non-Hodgkin lymphoma.

    5. What is the prognosis of Hodgkin disease? What are the complications of treatment for Hodgkin disease?

  • Go to top

    Clinical vignette 4

    A 69 year-old male presented with a complaint of fatigue. Physical examination was significant for generalized painless lymphadenopathy, moderate hepatosplenomegaly, pallor and few petechiae. Laboratory findings revealed a hemoglobin of 9.0 mg/dl, platelet count of 47,000/ul and WBC count of 280,000/ul, with a WBC differential of 2 segmented neutrophils, 1 band, 1 monocyte, 4 atypical lymphocytes and 92 lymphocytes, with smudge cells present on the peripheral blood smear.

    Discussion topics

    1. Identify the abnormal clinical and laboratory findings.

    2. Discuss the differential diagnosis. What is the most likely diagnosis?

    3. What further studies would you order in the diagnostic evaluation of this patient?

    4. What are the diagnostic criteria of this disorder?

    5. What do you expect to observe in the bone marrow? How do the bone marrow findings explain the clinical presentation and laboratory findings?

    6. Discuss the clinical course of this disorder. What is the prognosis and treatment? Is it curable?

    Reference

    1. Williams Hematology, Fifth Edition, McGraw-Hill, 1995.
  • Go to top