A 73-year-old woman is reviewed in the pre-op clinic prior to an elective hip replacement. Her past medical history includes polymyalgia rheumatica and ischaemic heart disease. Screening blood tests are ordered and the full blood count is reported as follows:
What is the most likely diagnosis?
Correct Answer D: Such a lymphocytosis in an elderly patient is very likely to be caused by chronic lymphocytic leukaemia. Steroids tend to cause a neutrophilia. It would be unusual for a viral illness to cause such a marked lymphocytosis in an elderly person.
Chronic lymphocytic leukaemia:
Chronic lymphocytic leukaemia (CLL) is caused by a monoclonal proliferation of well-differentiated lymphocytes which are almost always B-cells (99%).
Features:
Complications:
Investigations:
A 67-year-old man is diagnosed with myelofibrosis.
What is the most common presenting symptom of myelofibrosis?
Correct Answer A: Myelofibrosis - most common presenting symptom - lethargy.
Whilst all the above may be seen in myelofibrosis lethargy is the most common.
Myelofibrosis:
Overview:
Laboratory findings:
Which one of the following malignancies may be associated with HTLV-1?
Correct Answer A:
Haematological malignancies: infections:
Viruses:
Bacteria:
Protozoa:
Each one of the following may cause eosinophilia, except:
Correct Answer B:
Eosinophilia:
Causes of eosinophilia may be divided into pulmonary, infective and other: Pulmonary causes:
Infective causes:
Other causes:
A 51-year-old female is referred to the haematology clinic with a haemoglobin of 19.2 g/dl. She is a non-smoker.
Her oxygen saturations on room air are 98% and she is noted to have mass in the left upper quadrant.
What is the most useful test to establish whether she has polycythaemia rubra vera?
Correct Answer E: Polycythaemia rubra vera - JAK2 mutation.
The discovery of the JAK2 mutation has made red cell mass a second-line investigation for patients with suspected JAK2-negative polycythaemia rubra vera.
Polycythaemia rubra vera: features: Polycythaemia rubra vera (PRV) is a myeloproliferative disorder caused by clonal proliferation of a marrow stem cell leading to an increase in red cell volume, often accompanied by overproduction of neutrophils and platelets.
It has recently been established that a mutation in JAK2 is present in approximately 95% of patients with PRV and this has resulted in significant changes to the diagnostic criteria. The incidence of PRV peaks in the sixth decade.
Following history and examination, the British Committee for Standards in Haematology (BCSH) recommend the following tests are performed:
If the JAK2 mutation is negative and there is no obvious secondary causes the BCSH suggest the following tests:
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