6BM039 - Essentials in Hematology and Clinical Pathology

Assignment Task

Case study

A 71-year-old Caucasian man reported to his GP with shortness of breath and diffuse unexplained bruising over his arms and legs. The GP noted an enlarged spleen, and ordered a full blood count and blood film. He had previously been fit and in good health, wasn’t on any medication, was eating a good, balanced diet and had never smoked.

The biomedical scientist preparing the blood film noted some unusual cells on the blood film, and mindful that the FBC had noted unidentifiable myeloid cells, made some enlargements for the consultant to look at.

A sample of peripheral blood was analyzed by flow cytometry. After lysing the red cells, the sample was incubated with a KO-labelled antibody against CD45 (a pan leukocyte marker) and an APC-labelled antibody against CD34 (a hematopoietic stem cell marker, an antigen expressed on immature blood cells).

A plot of CD45-KO fluorescence against side scatter permitted the identification of lymphocytes (purple), granulocytes (red), monocytes (green), cell debris and platelets (grey) and an abnormal population (blue) which is not normally found in healthy samples. A plot of CD34-APC fluorescence against side scatter is shown on the right (with the colours transferred from the plot on the left).

Early in the seemester, you will be set a case study for which you will have to submit an abbreviated case report 1 of around 800 words in the following four sections as follows:

• Data analysis 
• Differential diagnosis
• Justification of the diagnosis by “reverse reasoning” (see below) (3 marks) • Reference citations and list

Data analysis

Your assessment task is to write a report on the given patient case study to include an appraisal of the presentation and results from any laboratory tests, a differential diagnosis and any further tests that would be needed to clarify the diagnosis, a brief summary of the disease biology and an appraisal of a study showing the effectiveness of an up-to-date treatment. You should support your report with citations to scientific articles published in peer-reviewed journals using the Department’s Harvard referencing system.

Data interpretation

Marks will be awarded for identifying the relevant parameters in any tests carried out so far rather than woodenly commenting on each one, and for interpreting them together rather than as isolated entities. (Note that relevant parameters may include those in the normal range.)

Disease biology and treatment

A brief summary of the most likely disorder should be given, along with an appraisal of a primary paper that demonstrates the effectiveness of a current treatment. The paper could be of a clinical trial showing improved outcome over previous therapy, an experimental paper showing proof-of-principle in an animal model, cell culture model or phase I trial or other suitable study. You should summarize the aims of the paper, the work they undertook to achieve those aims and how they established it was a success.

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