Topics in Clinical Biochemistry and Haematology (Haematology)
Instructions:

it is a case study divided into 2 different cases this is the information given to me”You are a trainee biomedical scientist working in the haematology laboratory and working through the registration portfolio. One section of the portfolio requires the presentation of patient case studies and as you have worked in routine haematology and coagulation your supervisor presents you with the following two cases to examine. Work through each of them answering the questions given with each case.
Feedback on case will be provided on the accompanying feedback sheet. Feedback on Case 2 will be written on the work at the appropriate questions.”
I will attach the whole assignment and the materials given. I am waiting for your response for any queries.
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Referencing Requirements:
avoid wikipedia, referencing up to 7 years only (up to 2005), no more than 5 books, the rest are academic scientific article, avoid online sources. If its possible could you aID some diagrams and tables if needed, in the legends for the diagrams and tables dont write more than 4 sentences.

Topics in Clinical Biochemistry and Haematology Workbook 2012-13
You are a trainee biomedical scientist working in the haematology laboratory and working through the registration portfolio. One section of the portfolio requires the presentation of patient case studies and as you have worked in routine haematology and coagulation your supervisor presents you with the following two cases to examine. Work through each of them answering the questions given with each case.
Feedback on case will be provided on the accompanying feedback sheet. Feedback on Case 2 will be written on the work at the appropriate questions.
Case 1
John is a 64 year old Caucasian man. He has been to see his family doctor because he is finding that he gets out of breath after less than 15 minutes when he works in his garden. He has always been a keen gardener and has not previously had problems of this kind. Over the last month this has become so bad that he is now almost unable to work in the garden at all.
The doctor examined John, looking particularly for signs of respiratory or cardiovascular disease. John has never been a smoker and considers himself to be in good health. He retired two years ago from his job in the steel industry. He rarely visits his doctor and is not currently on any medications although about 2 weeks ago he was treated for a cut he suffered whilst gardening which had become infected. As far as can be determined John has not been in contact with tuberculosis.

The physical examination revealed the following features:
Blood Pressure 124/76 mmHg
Respiratory rate 20 / minute
Regular pulse, slightly raised
Jaundiced sclerae
Pallor
Ankle oedema
Palpable spleen
Full blood count results
Hb 5.4 g/dL
MCV 118 fL
WBC 7.9 x 10 9 / L
Platelets 450 x 10 9 /L
RCC 2.04 x 10 12 / L
Reticulocytes 299 x 10 9 /L

A blood film showed polychromasia and spherocytes

Further investigations showed:
Bilirubin 53 µmol / L
Haptoglobins – undetectable
LDH 1635 IU / L

A Coombs test is performed and the cells show some aggregation

Mr. Johnson was referred to a specialist and treated with corticosteroids and folic acid
A red cell transfusion was considered to be a last resort treatment
Mr Johnson responded to the drug treatment and his haematology returned to normal within a couple of months.
Answer the following questions on this case. Use the number of marks per question as a guide to the expected length of your answer. Your answer in total should not exceed 2,000 words.
Questions
What is the differential diagnosis? (20 marks)

Explain the significance of the full blood count and biochemistry results (20 marks)

What is the origin of the abnormalities seen on the blood film? (20 marks)

Explain the underlying pathology of John’s condition and comment on any likely causes for this based on his history (40 marks)

Topics In Clinical Biochemistry and Haematology

Case 1: Feedback Comments

What is the differential diagnosis? (20 marks)
Has information been considered appropriately and thoroughly?

Explain the significance of the full blood count and biochemistry results (20 marks)

What is the origin of the abnormalities seen on the blood film? (20 marks)

Explain the underlying pathology of John’s condition and comment on any likely causes for this based on his history (40 marks)
Overall Comments

 
Case 2
Read through the case presentation and answer the questions taking into account the marks allocation when considering the length of your answer. Work through the case in order, further information will be given for you to consider and which gives greater insight into the patient’s condition. 10 marks will be given for presentation, conciseness of answers and appropriate use of the literature
Claire is a 30 year old research assistant who has just returned from a conference in Malaysia. About 5 hours after arriving back in the UK she started to develop chest pain which became very severe. She called her family doctor who examined her and decided to send her to A&E.
Full examination and history gave the following details:
Claire considers herself to be in good health, she is not overweight and has never smoked. She does have the occasional alcoholic drink. In the last 30 months Claire has been pregnant twice and has miscarried on both occasions.
The pain was primarily located on the right side and became worse with deep inspiration
Evidence of reduced air entry into right lung
Hypoxemia (O2 saturation 88%)
A number of tests were carried out
A chest radiograph, ECG and coagulation screen were all normal
A D-dimer test was requested giving a value of 5460 µg/mL

What is your differential diagnosis of Claire’s acute condition based on the above information? What clinical investigation could be carried out to confirm the acute problem? (10)

Explain the aetiology of the chest pain which Claire is suffering (10)

Discuss the clinical rational for the request for D-dimer testing. Explain giving molecular detail the origin of D-dimers in the blood (30)

Several months later Claire contacts her doctor with some information. Her first cousin has recently returned from a holiday in New Zealand and suffered a deep vein thrombosis. She has also learned that another of her first cousins has miscarried for the second time.
How should this new information be followed up?
What further tests could be carried out to confirm a diagnosis? (10)

Does this new information help to understand Claire’s previous pregnancy problems? Explain the pathology underlying this? (20)

Claire’s job means that she does need to travel long-haul occasionally. She is also keen to start a family. She discusses this with her doctor.
What action or advice should be taken with regard to the following situations? (10)
a) Taking a long-haul flight
b) The chances of her having a successful pregnancy
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