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WBC review

Please say true or false for each part of the question.


1. A patient was found to have normal Hb and platelets but WBC
19x109/l with 90%netrophils, 10% lymphocytes, peripheral
blood film shows toxic granulation, which of the following will
have this result?
a. Pneumococcal pneumonia TRUE - bacterial
b. Gangrene of the foot TRUE Sepsis/Inflammation
c. Infectious mononucleosis FALSE Lymphocytes would be
high
d. Ethnic variation FALSE e. Pregnancy TRUE Dilution anaemia, body responds by
mildly increasing WBC and platelets
2. An 18 year old student is found to be febrile and his blood film
shows atypical lymphocytes. This could be due to:
a. Toxoplasmosis TRUE
b. HIV infection TRUE
c. CMV infection TRUE
d. EB virus infection TRUE
e. Acute lymphocytic leukemia FALSE
Choose best answer in the following;
Question 3 7 are all related
3. A 46 year old lady presents with weight loss and abdominal
enlargement. She has history of drenching night sweats and
has been fevers of 38-39OC. Significant findings on
examination was hepatosplenomegaly but no
lymphadenopathy. Hb 9.8g/dl, WBC 98x109/l, differential 15%
neutrophils, 5% bands, 15% myelocytes, 40%
metamyelocytes, 15% basophils , 5% oesinophils and 5%
lymphocytes, no blasts; platelets 566x109/l. What is the most
likely diagnosis?
a. Chronic lymphocytic leukemia
b. Acute myeloid leukemia
c. Chronic Myeloid leukemia
d. Septicaemia
e. Drug reaction
4. Which will be the investigation that will give a definitive
diagnosis?
a. Cytochemical staining on blood
b. FISH analysis on blood
c. Immunophenotyping of blood
d. Neutophil alkaline phosphatase score
e. Lactate dehydrogenase
5. Which will be the optimal treatment for this patient?

a. Combination chemotherapy
b. Allogenic stem cell transplant
c. Empiric antibiotics
d. Imatinib
e. Hydroxyurea
6. After 3 years on the same drug and in haematologic and
cytogenetic remission review Showed mild splenomegaly and
Hb 9.4g/dl, WBC 20.5x109/l, platelets 88x109/l and blood film
shows predominant neutrophilia with left shift and 5% blasts.
What is the most probable diagnosis now?
a. Acute myeloid leukemia
b. Blastic phase
c. Accelerated phase
d. Sepsis
e. Richters transformation
7. What would be the most optimal treatment now
a. Combination chemotherapy
b. Increase doses of current therapy
c. Allogenic stem cell transplant
d. Intravenous antibiotics
e. Observation
Extended matching Questions:
For each clinical history, choose the most appropriate specific
answer. One answer only
List A
8. A 4year old boy is noted to have
extensive bruising on his legs and
forearms, his mother has noticed in
the past week he is listless and noted
bleeding of his gums on brushing his
teeth. She got worried when he
started limping. His paediatrician
finds on examination generalized
lymphadenopathy with generalized
petechiae and ecchymoses. Hb
5g/dl., WBC 47.8 6x109/l with 78%
blasts with high nuclear cytoplasmic
ratio, no cytoplasmic granules;
platelets 23x109/l
ACUTE LYMPHOBALSTIC
LEUKEMIA
9. A 47 year old woman has a history of
breast cancer and treated with
chemotherapy and radiation ten
years ago. She currently has a
history of epistaxis and gum bleed
with extensive ecchymoses. Hb

List B
a. Acute Myeloid
Leukaemia
b. Acute
pormelocytic
Leukemia
c. Chronic
Myelocytic
Leukemia
d. Acute
Lymphoblastic
Leukemia
e. Chronic
Lymphocytic
Leukemia
f. Viral infection
g. Bacterial sepsis
h. Reactive
lymphocytosis
i. Toxic
neutrophilia
j. Herpes Zoster
infection

8.7g/dl, WBC 10.3x109/l, platelets


33x109/l, blood fillm shows 65%
blasts with numerous Auer rods.
ACUTE PROMYELOID LEUKEMIA
10.
A 63 year old man went for an
insurance check and FBC done
showed Hb 12.3g/dl, WBC 28.6x109/l,
differential shows left shift of
neutrophils with basophilia, no blasts
seen, platelets 556x109/l.
11.
A 80 year old man presents
with a rash on his left anterior torso
which he says is extremely painful,
the rash is vesicular and in a
dermatomal distribution. Blood
investigation reveal Hb 11.1g/dl,
WBC 55x109/l, 90% lymphocytes,
platelets 156x109/l
HERPES ZOSTER INFECTIONunderlying = chronic
lymphocytic leukemia

CHRONIC
MYELOCYTIC
LEUKEMIA

12.
A 54 year old lady went to the
dentist and had a tooth extraction.
After 2 weeks she still had oozing
from the tooth bed. She also was now
having a fever and feeling unwell so
she visited her GP. Blood test done
showed Hb 9.8g/dl, WBC 23x109/l,
platelets16x109/l, peripheral film
showed 50% blasts which contained
Auer rods.
ACUTE MYELOID LEUKEMIA
13.
A 4 year old girl is brought to the ER due to fever. Lab
data:
WBC 15.2 x 109/l; Hgb 12.0 g/dL; PLT 200 x 109/l; Differential results:
58% neutrophils, 25% bands, 10% lymphs, 7% monos
The appearance of her WBCs are shown.

Which of the following best describes her results?


a.
regenerative left shift
b.
degenerative left shift
c.
neutrophilic leukemoid reaction
d.
leukoerythroblastic reaction
14.
How did you rule out the other possibilities (b,c,d)?
15.
Her results are indicative of:
a.
viral infection
b.
acute lymphocytic leukemia
c.
bacterial infection
d.
normal findings
16.
This 2 year old male has had multiple infections since
age of 1 year. Infections have included pneumonias, skin
infections andabscesses of the lung due primarily to
staphylococci. His bloodsmear shows white blood cells that
are normal in appearance.
What is his most likely disorder?
a.
Pelger-Huet anomaly
b.
May-Hegglin anomaly
c.
Alder-Reilly anomaly
d.
Chediak-Higashi anomaly
e.
Chronic Granulomatous disease
17.
A 55 year old male comes to the ER with a temperature
0
of103 F. His lab findings: WBC 74.8 x 109/l; Hgb 11.5 g/dL; PLT
305 x 109/l; LAP is high, Diff: 44% neutrophils, 40% bands, 5%
metamyelocytes, 7% myelocytes 1% lymph,3% monos. His
WBC abnormalities are shown.

Bone Marrow
a. What is his most likely disorder and its cause? Leukomoid
reaction causing sepsis.
b. How did you rule out CML? The LAP is high
18.
This 53 year year old male had noticed the onset of easy
fatigability and bruising. He saw his doctor when hedeveloped
a boil in the perianal area. His CBC and subsequent bone
marrow exam (shown) were abnormal. Lab data: WBC 78.0
x109/l; Hgb 7.3 g/dL, PLT 59 x109/l.

Bone
Marrow
a. What
is the most likely diagnosis?

ACUTE MYELOID LEUKEMIA


b. What further testing would you suggest. FISH
c. Which of the following marker panels do you expect will be
positive in this case?
i. CD13, CD33, CD34
ii.
CD2, CD3, CD4
iii.
CD10, CD19, CD20
19.
A 24 year old woman was admitted due to weakness
and a severe nosebleed that she could not stop. Lab findings
revealed anemia and severe thrombocytopenia (PLT 18 x109/l).
Her WBC was normal but her diff had 2% neutrophils, 40%
blasts and 58% blast-like cells with intense granulation. Some
cells had bundles of bodies in the cytoplasm. Coagulation
results showed prolonged PT/APTT tests, a lowfibrinogen level,
and a positive Dimer test.
a.
b.
c.
d.

Which type of acute leukemia do you suspect? M3


What do you think the bodies are? AUER RODS
What is the significance of her coagulation results? DIC
What cytogenetic abnormality would you expect? T15 17

20.
This 72 year old male was discovered to have an
elevatedWBC count 4 years ago. He has never received
therapyfor his disorder. Physical examination showed no
palpable lymphadenopathy. Lab data: WBC 50.7 x109/l; Hgb
13.9 g/dL, PLT 223 K/uL. Diff:10% neytrophils, 89%
lymphocytes, 1% monocytes.
His blood smear is shown.

a. What is his most likely diagnosis and why? PRECSENCE OF


SMUGE CELL+LYMPHOCYTOSIS
b. Are these usually malignant T or B cells? B CELLS 90%