Hematology Case 54
Hematology Case 54
Embedded Files
Presented By Dr Mohammad Moharram - Dr Shehab S. Alhammadi
Released on 30-04-2021Patient Data
Patient Data
27 year old male
Clinical Data
Clinical Data
History:
History of fever and chills 4 months ago.
Patient visited many health care facilities during the last 3 month & received medications but without significant improvements.
Fatigue and Weight loss (10 Kg in the last 2 months).
On examination:
Patient looks ill and pale
No cyanosis or jaundice.
Hepatomegaly and splenomegaly without pain or tenderness.
No L.N. enlargement.
Related Laboratory Results
Related Laboratory Results
CBC:
- WBC: 1.19x103 /uL (Neutrophils: 0.33x103 /uL - Lymphocytes: 0.77x103 /uL - Monocytes: 0.09x103 /uL).
- HGB: 6.5g/dL - MCV: 73.2fL -MCH: 22pG - MCHC:30.1%
- Platelet: 201x103 /uL
Malaria test (Thin , Thick Slides and strips): Negative for 4 times. (3 of them at peak of fever)
Total bilirubin : 16 umol/L (R.R.: 5.1-20.5) - Direct bilirubin: 2.4 umol/L (R.R.: 1.7-8.6)
AST: 49 u/L (R.R.: 15-41) - ALT: 68 u/L (R.R.: 17-63) - ALP: 90 u/L (R.R.:30-91) - GGT: 40 u/L (7-50) - ALB: 20 g/L (R.R.: 35-50).
BUN: 3.9 mmol/L (R.R.: 2.5-6.4) - Creatinine: 52 umol/L (R.R.: 55-113).
Na: 134 mmol/L (R.R.: 135-144) - K: 4.5 mmol/L (R.R.: 3.5-5.1) - Ca: 2.01 mmol/L (R.R.: 2.2-2.5).
LDH: 192 u/L (R.R.: 98-192)
Serum Iron: 2 umol/L (5-30.5) - Serum Ferritin: 1990 ng/mL (R.R.: 13-150)
Vitamin B12: 506 pg/mL (R.R.: 180-914) - Serum folate: 24.6 nmol/L (R.R.: 7-30).
Provisional Diagnosis
Provisional Diagnosis
?? Chronic Malaria
Case Picture(s) / Photo(s)
Case Picture(s) / Photo(s)
Bone Marrow Aspirate Slides
Bone Marrow Aspirate Slides
Bone Marrow Trephine biopsy Slides
Bone Marrow Trephine biopsy Slides
Comment / Findings
Comment / Findings
Bone Marrow Aspirate:
Leishman Donovan Bodies are seen both intracellular and extracellular. Increased Macrophages and histiocytes, few of them contain intracellular L.D. bodies. Relatively increased plasma cells, some of them show dysplastic features.
Bone Marrow Trephine biopsy:
There is increased histiocytes highlighted by CD68. Foci of intracellular microorganisms consistent with leishmania promastigotes are seen.
Final Diagnosis
Final Diagnosis
Bone marrow infiltration by Leishmaniasis.
Additional Note
Additional Note
Patient received anti-Leishmania treatment and discharged medically free after 10 days for follow up in outpatient clinic.
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