Click to edit Master title style

Welcome to:

Case Studies

Heri Fadjari
Hasan Sadikin General Hospital
Bandung - Indonesia

Saturday, 24 March 2018 Fairmont Hotel, Jakarta

Case
Click#1
to edit Master title style
A 36 year old male came to your private practice with pale.
At PE the patient look well.
BP 110/60 mmHg, RR 20/min, HR 82/min.
No liver and spleen enlargement.
He had been treated with NSAID for OA of his knees over a year
by the previous physician.

7th Sysmex Scientific Seminar

Haemogram
Click to edit Master title style

7th Sysmex Scientific Seminar

What is the
Click to editcause
Masteroftitle
hisstyle
anemia?

1. Iron deficiency anemia (IDA)

2. Functional iron deficiency (FID)
3. Myelodysplastic syndrome
4. Hemolytic anemia
5. All of the above

7th Sysmex Scientific Seminar

Would
Click toyou
edittransfuse thestyle
Master title patient?

1. Yes
2. No
3. Uncertain

7th Sysmex Scientific Seminar

Oxygen delivery
Click to edit Master title style

DO2 = [1.39 x Hb x SaO2 + (0.003 x PaO2)] x CO

The

Rule

7th Sysmex Scientific Seminar

What would
Click to you treat
edit Master titlethis
stylepatient?

1. Iron supplementation
2. Continuing NSAID
3. Refer to the rheumatologist
4. Steroid

7th Sysmex Scientific Seminar

On day
Click to7edit
andMaster
28 of Iron supplementation
title style

7th Sysmex Scientific Seminar

Case
Click#2
to edit Master title style

A 43-year old man with an intermittent fever visited his physician four
days after the initial fever onset.
The man reported the following symptoms: shortness of breath,
productive cough, abdominal pain, diarrhea, night sweats and malaise.
Considering the man’s symptoms, a complete blood count was performed
to investigate a possible cause of his illness.

7th Sysmex Scientific Seminar

Initial study
Click to resultstitle style
edit Master

7th Sysmex Scientific Seminar

What is the
Click to editcause
Masteroftitle
hisstyle
anemia?

1. Iron deficiency anemia (IDA)

2. Functional iron deficiency (FID)
3. Myeloproliferative neoplasm
4. Hemolytic anemia
5. None of the above

7th Sysmex Scientific Seminar

What
Click would
to edit you typically
Master observe with a
title style
haematology analyser’s results during an acute
bacterial infection before the onset of anaemia?

1. A high Delta-He value

2. A high RET-He value
3. A low-to-negative Delta-He value
4. A low MicroR value
5. A differential counting

7th Sysmex Scientific Seminar

Case
Click#3
to edit Master title style
A 27-year-old male, admitted to hospital with fatigue in the last 2 months.
PE: pallor, spleen enlargement withou liver enlargement
Lab data:

7th Sysmex Scientific Seminar

What is the
Click to editmost likely
Master titlediagnosis?
style

1. Megaloblastic anemia
2. Iron deficiency anemia (IDA)
3. Anemia of inflammation (ACD)
4. Autoimmune hemolytic anemia (AIHA)
5. Thalassemia

7th Sysmex Scientific Seminar

Why
Clicknot megaloblastic
to edit anemia?
Master title style
• The reduced platelet count was observed here, which could the consequence of
an ineffective thrombopoiesis, caused by impaired DNA synthesis and assembly,
often associated with megaloblastic anaemias. However, it also leads to ineffective
erythropoiesis and therefore normal or reduced RET%/# values.
• RET% and RET# are both elevated indicating an adequate bone marrow response
to the anaemia.
• In addition, megaloblastic anaemia is associated with the presence of large RBC
containing large amounts of haemoglobin, and resulting in a large fraction of
hyperchromic RBC.
• Therefore, the normal HYPER-He and high RET%/# can be used to exclude a
megaloblastic anaemia in this patient.

7th Sysmex Scientific Seminar