Hematology Case 47

Presented By Dr Mohammad Moharram

Released on 1-1-2021

Patient Data

35 year old male

Clinical Data

History: High grade fever for 7 days.

Mild cough

Chronic epigastric pain that became acute and severe 2 days ago.

History of travel to India.

On Examination : Temperature: 39.5°C

Yellowish sclera.

Clear chest on examination.

Soft lax abdomen / No tenderness.

Related Laboratory Results

  • CBC:

- WBC: 4.8x103 /uL (Neutrophils: 3.8x103 /uL - Lymphocytes: 0.4x103 /uL - Monocytes: 0.2x103 /uL - Eosinophils: 0.3x103 /uL - Basophils: 0.06x103 /uL).

- HGB: 12.2g/dL - MCV: 83.3fL -MCH: 28.6 pG - MCHC: 34.4%

- Platelet: 27x103 /uL

  • Amylase and Lipase : Normal.

  • Total bilirubin : 45 umol/L (R.R.: 5.1-20.5) - Direct bilirubin: 15.7 umol/L (R.R.: 1.7-8.6)

  • ALT: 70 u/L (R.R.: 17-63) - ALP: 100 u/L (R.R.:30-91) - GGT: 110 u/L (R.R.: 7-50) - ALB: 24 g/L (R.R.: 35-50) .

  • Negative PCR swab for COVID-19

Provisional Diagnosis

Fever + Cough + lymphopenia ; suspected case of COVID-19

Case Picture(s) / Photo(s)

Thick Peripheral Blood Smear (Giemsa)

Thin Peripheral Blood Smear (Giemsa)

Comment / Findings

Thick peripheral blood smear show gametocyte stage of plasmodium vivax

Thin peripheral blood smear show gametocyte stage , schistocyte stage and ring form stage of plasmodium vivax.

Final Diagnosis

A case of malaria vivax (plasmodium vivax)

Additional Note

Patient responded dramatically to anti malarial treatment and laboratory tests normalized after 6 days of therapy.

Post therapy laboratory results: -Platelet: 163x103 /uL - Total bilirubin : 19 umol/L (R.R.: 5.1-20.5) - Direct bilirubin: 4.9 umol/L (R.R.: 1.7-8.6) - ALT: 22 u/L (R.R.: 17-63) - ALP: 47 u/L (R.R.:30-91) - GGT: 22 u/L (R.R.: 7-50) - ALB: 30 g/L (R.R.: 35-50) .