A 12-year-old girl returns from a trip to Africa with her family and is found to have jaundice. She had been taking antimalarial medication as a prophylaxis. Upon examination, her complete blood count reveals a hemoglobin level of 80 g/L, and her blood film shows the presence of Heinz bodies and blister cells. What disorder is associated with these findings?
A 35-year-old woman, who underwent splenectomy three years ago for chronic ITP, visits the clinic with complaints of petechial rash and gum bleeding. Her blood test results show a WBC count of 6.3 ×109/L (normal diff), haemoglobin level of 115 g/L, and a platelet count of 3 ×109/L. The presence of accessory spleens has been ruled out. What would be the most suitable treatment option for her condition?
A 25-year-old woman comes to the Emergency Department complaining of shortness of breath. She had a bone marrow transplant for Hodgkin’s lymphoma six months ago and requires regular blood transfusions. She suspects that she may be anemic and is requesting a transfusion to be arranged.
Investigations:
Haemoglobin (Hb) – 80 g/l (normal range: 120-160 g/l)
White cell count (WCC) – 2.8 × 109/l (normal range: 4.0-11.0 × 109/l)
Platelets (PLT) – 110 × 109/l (normal range: 150-400 × 109/l)
Neutrophils – 1.2 × 109/l (normal range: 2.5-7.58 × 109/l)
Blood film – unremarkable
Coombs’ test – negative
Epstein-Barr virus (EBV) bone marrow donor status – negative
EBV bone marrow recipient pretransplant status – negative
What type of blood should be arranged for this patient?
A 50-year-old woman is being evaluated after being diagnosed with a pulmonary embolism. She was recently hospitalized for a severe case of community-acquired pneumonia that required ventilation and ICU admission. Although she responded well to intravenous antibiotics, she experienced increased shortness of breath just before discharge. A CTPA was ordered, revealing a pulmonary embolism, and she was promptly started on dalteparin. What would be the most suitable course of action now?
A 45-year-old woman presents to the emergency department with acute abdominal pain and vomiting. She has a medical history of hypothyroidism and vitiligo. On examination, she has a fever, tachycardia, and tenderness in the right iliac fossa. She also has bruising and petechiae on her back and extremities and reports frequent nosebleeds over the past 2 weeks. Laboratory investigations reveal thrombocytopenia, leukocytosis, and elevated CRP. The surgical team recommends preparing her for theatre.
What is the appropriate next step in managing this patient?
A 23-year-old man awaiting stem cell transplant for acute myeloid leukaemia has become unwell over the past two days and arrives with a Glasgow Coma Scale of 4 in the emergency department. His girlfriend who is present with him reports that he has had severe headaches and been sitting in bed but gradually became more confused. He was struggling to breathe and began to seize causing her to call the ambulance.
On examination, he is intubated and has bilateral coarse crepitations. His pupils are reactive but he is sedated and does not respond to pain. There is papilloedema bilaterally and haemorrhages are seen in the right eye. He is warm and well perfused but his right arm is cold and pale. He is transferred to the intensive care unit.
Hb 115 g/l
Platelets 300 * 109/l
WBC 110 * 109/l
Troponin 12,345 (normal range <20)
CRP 60 mg/l
Chest x-ray bilateral pulmonary infiltrates, small right sided effusion
What medical treatment should be initiated to correct his underlying pathology?
A 70-year-old man presents to the clinic with a four-month history of abdominal swelling and discomfort along with breathlessness. Upon examination, he appears unwell and pale. The liver is palpable 12 cm below the right costal margin, and the spleen is palpable 15 cm below the left costal margin. No lymphadenopathy is detected. The following investigations were conducted:
Hb 59 g/L (130-180)
RBC 2.1 ×1012/L –
PCV 0.17 l/l –
MCH 30 pg (28-32)
MCV 82 fL (80-96)
Reticulocytes 1.4% (0.5-2.4)
Total WBC 23 ×109/L (4-11)
Normoblasts 8% –
Platelets 280 ×109/L (150-400)
Neutrophils 9.0 ×109/L (1.5-7)
Lymphocytes 5.2 ×109/L (1.5-4)
Monocytes 1.3 ×109/L (0-0.8)
Eosinophils 0.2 ×109/L (0.04-0.4)
Basophils 0.2 ×109/L (0-0.1)
Metamyelocytes 5.1 ×109/L –
Myelocytes 1.6 ×109/L –
Blast cells 0.4 ×109/L –
The blood film shows anisocytosis, poikilocytosis, and occasional erythrocyte tear drop cells. What is the correct term for this blood picture?
A 28-year-old male with Hodgkin’s lymphoma and a bulky mediastinal mass at diagnosis has undergone combination chemotherapy and radiotherapy to the mediastinum. What aspects of his health will require long-term monitoring?
A 65-year-old woman presents to the Emergency Department with increasing confusion and headaches, along with multiple bruises on her shins and arms. She has a temperature of 38 °C and a petechial rash over her chest. On examination, she has bronchial breathing at the right base and 1-cm palpable hepatosplenomegaly. Her blood tests reveal a haemoglobin level of 55 g/l, a white cell count of 18 × 109/l, and a platelet count of 20 × 109/l, among other abnormalities. She is started on treatment for suspected acute promyelocytic leukaemia (APL) and concurrent pneumonia, but three days into her admission, she develops a fever and progressive shortness of breath. What is the best course of action, given the likely diagnosis?
A 56-year-old man presents to the Emergency Department (ED) with increasing peripheral oedema and shortness of breath. He has severe exercise intolerance and struggles to move around his home.
Upon examination, signs of chronic liver disease (CLD) and biventricular cardiac failure are present. His blood pressure (BP) is 112/68 mmHg, with a pulse of 83 beats per minute (bpm). The diagnosis is cardiomyopathy, and he admits to being unable to reduce his alcohol consumption.
What factor will have the greatest impact on his prognosis?