MDS Case Study 2017 by Dr.Hafizuddin https://padlet.com/hafizuddinmohamedfauzi/MDS2017 en-us 2017-07-26 08:19:42 UTC 2017-08-02 09:13:33 UTC hello@padlet.com Part 1 CASE STUDY hafizuddinmohamedfauzi https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179483966 GROUP 1  (Q1- Q
Mr K , a 66 yo male coplaint of fatigue, malaise, anorexia and hemoptysis of recent onset. FBC was ordered, showed anemia and left shifted in IG. Other hematopoietic cells showed dysplastic features.

FBC RESULT

  • Rbc  1.6
  • Hb   5.8
  • Hct  0.17 L/L
  • WBC  10.5
  • Plt  39
  • Retic 0.8%

Differential Count

  • Segmented neut 44%
  • 7% band
  • 6% lymp
  • 28% eosi
  • 1% meta
  • 1% mylocytes
  • 9% promyelocytes
  • 4% blasts

FBP 

  • marked hyposegmentation and hypogranulation of neutrophils
  • RBC anisopoikilocytosis, tear drop, ovalocytes, schistocytes
]]> 2017-07-26 08:20:43 UTC https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179483966 Question 1   hafizuddinmohamedfauzi https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179483995 In what cell lines is cytopenia present? and what abnormalities are present in the differential?]]> 2017-07-26 08:21:07 UTC https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179483995 Question 2 hafizuddinmohamedfauzi https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179484011 What evidence of dyspoiesis is seen in the leukocyte morphology]]> 2017-07-26 08:21:34 UTC https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179484011 Question 3 hafizuddinmohamedfauzi https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179484013 Calculate the MCV.What peripheral blood findings are helpful to rule out megaloblastic anemia?]]> 2017-07-26 08:21:40 UTC https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179484013 Part 2 CASE STUDY hafizuddinmohamedfauzi https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179484034 BMAT was performed
 
  • 75% cellularity
  • myeloid hyperplasia with 9% blast
  • 26% promyelocytes
  • 18% myelocytes
  • 6%metamyelocytes
  • 4% band
  • 37% eosi
  • M:E ratio 12:1

The myelocytes were hypogranular and some with binucleated

Erythroid precursor showed megaloblastoid changes

Mega adequate but showed abnormal form with nuclear separartion and monolobated.
]]> 2017-07-26 08:22:00 UTC https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179484034 Question 4 hafizuddinmohamedfauzi https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179484038 What features of the differential resemble CML? What helps to distinguish this from CML?]]> 2017-07-26 08:22:09 UTC https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179484038 Question 5 hafizuddinmohamedfauzi https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179484042 How would u classify the marrow cellularity and which of the hematopoietic cell line exhibit dyshematopoiesis in the bone marrow?]]> 2017-07-26 08:22:17 UTC https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179484042 Question 7 hafizuddinmohamedfauzi https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179484046 Identify at least 2 features of the bone marrow that are compatible with a diagnosis of MDS]]> 2017-07-26 08:22:24 UTC https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179484046 Question 8 hafizuddinmohamedfauzi https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179484066 What chemistry test wud be helpful to rule out megaloblastic anemia?]]> 2017-07-26 08:22:52 UTC https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179484066 Question 6 hafizuddinmohamedfauzi https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179484103 What does the M:E ration indicate?
What is the normal ratio?]]> 2017-07-26 08:24:00 UTC https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179484103 Question 8 Answer roslinaremli https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179487278 1. Serum B12
2. RBC Folate
3. Serum homocysteine 
4. Serum methylmalonic acid

By Roslina]]> 2017-07-26 09:42:43 UTC https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179487278 Q2 hilmi https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179488072 hyposegmentation of neutrophils (pseudo pelger hue
hypogranulation of neutrophils.
presence of immature cells of myeloid series i.e. myelocytes, metamyelocytes, promyelocytes, blasts. 
eosinophilia

]]> 2017-07-26 09:58:37 UTC https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179488072 Question 1 https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179497423 Cytopenia present in two cells lineage (bicytopenia) - Erythrocytic and megakaryocytic lineage.

Abnormalities: 

Presence of immature cells of myeloid series (blasts,promyelocyte,myelocyte,metamyelocyte) and increase neutrophilic band.
Lymphopenia.
Eosinophilia.

~ Afif ~]]> 2017-07-26 13:29:06 UTC https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179497423 Answer Q4:by nurul https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179497633 Differential count:complete spectrum of myeloid series (promyelocytes,myelocytes,meta&band form.
Eosinophilia 
Blast less than 10% (cml-cp)
Bone marrow: hypercellular with myeloid dysplasia
Morphology of cells:neutrophils in mds is hypogranular and bilobed while in cml neutrophilia with normal morphology,erythroid in mds is megaloblastoid while in cml erythroid is normal size,megakaryocytes in mds is abnormal form but in cml normal form of mega
Cytogenetics:cml show presence of t9:22 philadelphia chr,but not present in mds.]]> 2017-07-26 13:31:46 UTC https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179497633 Question 7 answer-Redzuan https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179501162
- hypercellular bone marrow

- erythroid : megaloblastoid changes of precursor

- myeloid : hypogranular with some binucleated

- megakaryocytes : monolobated with nuclear separation]]> 2017-07-26 14:22:32 UTC https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179501162 Question 5- https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179507734 Cellularity-
Hypercellular, normocellular, hypocellular, aplastic. 
Cellularity is increased for age. 
All cell line exhibit dyshematopoetic features
Increased in blast, promyelocyte, eosinophil.  ]]> 2017-07-26 15:57:32 UTC https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179507734 Question 6 Answer https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179522076 The M:E ratio is the relative number of myeloid lineage cells to nucleated erythroid precursors in marrow. It indicates myeloid hyper/hypoplasia or erythroid hyper/hypoplasia. In this case increased marrow cellularity with increased M:E ratio indicates myeloid hyperplasia. M:E ratio normally 2:1-4:1.
S Ponnalagi]]> 2017-07-26 20:23:43 UTC https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179522076 Question 3 maryamjaiz https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179531850 MCV= HCT( in L/L) / RBC ( in x 10 ^12/ L)   x 1000
MCV =   0.17 / 1.6 x 1000
          = 106.5

RED CELL; (dyserythropoeitic features in bone marrow precursor)
-Red cells can have more than 1 population, normochromic/ovalomacrocytosis. 
-Presence of sideroblast may present with variable population of HCMC population
-Presence of basophilic stippling, megaloblastoid nucleated red cells

WCC
-Instead of hypersegmented neutrophils; granulocytes display reduced or absent granulation and reduced segmentation ( pseudo pelger huet)

PLT
Usually morphology normal

~maryam jameelah ]]> 2017-07-26 23:33:25 UTC https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179531850 hafizuddinmohamedfauzi https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179937033 2017-08-02 09:13:33 UTC https://padlet.com/hafizuddinmohamedfauzi/MDS2017/wish/179937033