TAILIEUCHUNG - Ebook Practical flow cytometry in haematology - 100 worked examples: Part 2

The analysis of blood, bone marrow and tissue fluid specimens requires a multi–faceted approach with the integration of scientific data from a number of disciplines. No single discipline can operate in isolation or errors will occur. Flow cytometry is in a privileged position in that it can provide rapid analysis of specimens and it is often the first definitive investigation to produce results and help formulate a working diagnosis. | 48 Case 48 A 75-year-old male was admitted to the infectious diseases unit on account of confusion dysuria and fever on a background of progressive night sweats and weight loss. He had a past history of atrial fibrillation hypertension and type II diabetes mellitus. An initial assessment showed no clinical focus of infection and a CXR was normal. He was treated with broad-spectrum intravenous antibiotics but the fever persisted. Blood and urine cultures revealed no growth and screening tests for atypical infection were negative. Laboratory data Hb 95 g L MCV 89 fl WBC X 109 L neutrophils X 109 L platelets 69 X 109 L. ESR 80mm hour. U Es Na 128mmol L K L urea 19mmol L creatinine 126 pmol L. LFTs and bone profile bilirubin 41 pmol L AST 167 U L ALT 57U L GGT 49U L ALP 1103 U L calcium mmol L phosphate mmol L albumin 22 g L globulins 34 g L with no paraprotein detected. Serum LDH 4340 U L CRP 103 mg L. Coagulation screen PT 16 s APTT 33 s TT s fibrinogen g L D-dimer 3443 ng mL. A CT scan of chest abdomen and pelvis was undertaken because of the possibility of an intra-abdominal abscess or occult tumour but apart from small volume para-aortic lymphadenopathy this was unremarkable. MRI of brain showed features of small vessel arterial disease but no evidence of tumour abscess subdural haematoma or venous sinus thrombosis. There were no serological features of a systemic vasculitis and no vegetations were seen on echocardiography. The patient continued to deteriorate but a diagnosis was elusive. In view of progressive anaemia and thrombocytopenia a haematology opinion was requested. There were no new specific clinical findings but the patient remained febrile and confused. The blood film showed no blasts or abnormal lymphoid cells but occasional nucleated red cells and myelocytes were seen. A bone marrow aspirate and a trephine specimen were taken. Bone marrow aspirate The bone marrow aspirate showed a population of very large .

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• Practical flow cytometry in haematology
• Practical flow cytometry
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• Bone marrow cytology
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