1 / 94

History

History. 12 yo boy A month ago he had an upper resp infection Now presents with 3 week history of fatigue, easy bruising and nose bleeds Physical exam is normal except for a few scattered bruises on his legs. Labs. WBC: 2500 (normal 4000-10,000) HCT: 25 Normal MCV Platelets: 12,0000

zenia
Télécharger la présentation

History

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. History • 12 yo boy • A month ago he had an upper resp infection • Now presents with 3 week history of fatigue, easy bruising and nose bleeds • Physical exam is normal except for a few scattered bruises on his legs

  2. Labs • WBC: 2500 (normal 4000-10,000) • HCT: 25 Normal MCV • Platelets: 12,0000 • Reticulocyte count: 12,000 (normal 40-90,000) • LDH: normal

  3. Bone marrow biopsy

  4. Questions • What is the diagnosis? • What treatment options might you offer? • What is the suspected etiology? • Did leukemia enter your differential? How did you rule it out?

  5. History • 12 year old boy • Presents with 4 week history of fatigue, easy bruising, nose bleeds and low grade fever • On physical exam he appears ill, listless

  6. Labs • WBC 2500 • HCT: 25 • PLAT: 12,000

  7. Peripheral smear

  8. Bone marrow

  9. Questions • What is the diagnosis? • What are common treatment options? • What additional sites (besides the bone marrow) do you need to be concerned about?

  10. History • 75 yo woman presents with fatigue and diffuse joint pain for several years but worse recently • Physical exam reveals a chronically ill appearing woman. Joints appear swollen and stiff.

  11. Labs • WBC 5,000 • HCT: 29.5 • MCV: 78 (normal 82-95) • Platelets: 508,000 (normal 150-400,000) • ESR: 30 (normal < 20) • Total protein elevated

  12. Serum protein electrophoresis

  13. Questions • What is her protein problem? • What more information would you like?

  14. More labs • Iron: 20 (normal 30-160) • TIBC: 200 (normal 250-350) • % saturation 30% (normal 20-50) • Ferritin: 100 (normal 11-300)

  15. Questions • What is the diagnosis? • What are you going to do about it?

  16. More history • You diagnosed rheumatoid arthritis and started her on prednisone • Initially she seemed a lot better with less joint pain and more mobility • A year later she is feeling much more fatigued and has shortness of breath walking across the room

  17. Labs • WBC: 5000 • HCT: 23 • MCV: 72 • Platelets: 600,000

  18. More labs • Iron: 10 • TIBC: 350 • % saturation 4 % • Ferritin: 20

  19. Questions • What happened to this patient’s blood count • What are some possible diagnoses • What further workup are you going to do? • How would you treat this patient?

  20. HISTORY • 75 yo man who presents with severe back pain, nausea and vomiting, and a lot of fatigue over the past few months • Labs: • WBC: 4000 • HCT: 23.5 HGB: 7.8 • BUN 80 Creatinine 4.0

  21. SPEP

  22. Additional work up • Immunoelectrophoresis • Ig G kappa • Quantitative immunoglobins • Ig G: 5000 mg/dl • Ig A: 20 mg/dl • Ig M: 15 mg/dl

  23. X rays

  24. Questions • What stage is this person? • What treatments might you think about?

  25. History • 70 yo man comes in complaining of 6 month history of progressive fatigue • Has trouble concentrating • Notes some shortness of breath with exertion • On exam: distended neck veins, retinal hemorrhages, appears plethoric • Has a palpable spleen tip

  26. What diagnostic possibilities come to mind?

  27. Labs • WBC: 3000 • HCT: 34 • MCV: normal • Platelets: 110,000 • Total protein 10 (normal 6-8)

  28. SPEP

  29. Peripheral smear

  30. Peripheral smear

  31. Bone marrow

  32. Immunoglobulins • Ig G: 200 (normal 600-1600) • Ig A: 40 (normal 73-347) • Ig M: 3500 (normal 46-300)

  33. Questions • Would you expect: • Anemia? • Lytic bone lesions? • Lymphadenopathy • Hypercalcemia? • Hepatosplenomegaly • What complication does this patient have? • What would you do about it?

  34. History • 70 yo man comes in complaining of 6 month history of progressive fatigue • Has trouble concentrating • Notes some shortness of breath with exertion • On exam: distended neck veins, retinal hemorrhages, appears plethoric • Has a palpable spleen tip

  35. Labs • WBC: 16,000 (normal 5000-10,000) • HCT: 60 • MCV: 75 (normal 85-95) • Platelets: 550,000 (normal 150-450,000)

  36. Peripheral smear

  37. What is your differential?How would you rule each possibility out? • Hypoxia/lung disease • Tumors excreting erythropoietin • Smoker’s polycythemia • Spurious polycythemia

  38. Bone marrow

  39. Questions • What is the therapy for this condition? • What potential long term outcomes can occur? • What special instructions would you give this patient? • What other symptoms might you ask about?

  40. History • A healthy 22 year old woman comes into your clinic feeling well but complaining of a rash over the past week.

  41. Rash

  42. LABS • WBC: 8,000 • HCT: 37 • Platelets: 10,000

  43. Bone marrow aspiration

  44. Questions • What is the diagnosis? • Did you need the bone marrow to make it? • What are potential causes of this condition? • What are the common treatments used?

  45. History • 33 yo man comes in with a 2 month history of tightness in his chest and some shortness of breath and a dry cough • On questioning he admits to a 15 pound weight loss and feeling hot and sweaty at night • Exam reveals some rubbery non-tender nodes in his right axilla and supraclavicular area

  46. Chest X ray

  47. Questions • What is your differential diagnosis? • What would you do next? • What other labs might you think about?

  48. Node biopsy

  49. Pathology • Diffuse infiltration with large lymphoid cells which are CD 20 positive

  50. Questions • What stage is he? • What therapy would you offer him? • What can you tell him about his prognosis?

More Related