Haematology case study analysis

Running head: HAEMATOLOGY CASE STUDY ANALYSIS
Haematology case study analysis
Name of the Student
Name of the University
Author Note:

1HAEMATOLOGY CASE STUDY ANALYSIS
Answer to the question number 1
Concerned patient for this test result is 25 year old female living in Liverpool. At the time of
the test, the patient already had three miscarriages during a period of three year. At the same
timeframe, she was suffering from hair loss, pain in feet and hand, and fatigue. She also had
mouth ulcers in her palate. The same test were performed fifteen weeks earlier and there is no
significant difference between the two tests. From the patient’s Full Blood Count (FBC), it
can be seen that the patient had lower (110 g/L) than normal haemoglobin level. Lower
haemoglobin level is a common anomaly for normal FBC test and it is generally indicative of
iron deficiency or anaemia (Lopez et al. 2016). Along with that, patient also had low white
blood cell (WBC) and platelets count which are 3.5 X 109/L and 95 X 109/L respectively.
Low WBC count is indicative of neutropenia whereas low platelet count is indicative of
thrombocytopenia. The patient was also assessed for Erythrocyte Sedimentation Rate (ESR)
and C-Reactive Protein (CRP). Patient’s ESR is 29 mm/hr which is twice of the normal range
and CRP value is 5.2 mg/L which is also higher than the normal range. ESR and CRP are the
oldest biological marker to identify inflammation in human body (Ansar and Ghosh 2013).
Thus, it can be said that the patient has inflammation. Additionally, the patient was assessed
on various coagulation factor assays. Patient’s Prothrombin Time (PT), D Dimer, Fibrinogen,
ADAMSTS13 and C3 (Complement) values were in normal range which are 12 seconds, 0.3
mg/L, 3.4 g/L, 75% and 1 g/L respectively. However, patient has slightly higher aPTT and
Dilute Russel Viper Venom Time (DRVVT) value. Furthermore, patient has been detected
positive for the test of Anti-Nuclear Antibodies (ANA), Anti-Phospholipid Antibodies
(APLS) and Anti-Double Stranded DNA antibodies (ADSDNA). Positive ADSDNA test
suggest a higher risk of auto immune disease Lupus, although 25 percent patient with lupus
test negative for this test (Wichainun et al. 2013). Furthermore, patient has tested positive for
the ANA test which is generally used by physician as a screening tool for lupus (Yu,

2HAEMATOLOGY CASE STUDY ANALYSIS
Gershwin and Chang 2014). Almost every patient with active lupus test positive in this test.
However, sometimes a small percentage of people with other autoimmune diseases also test
positive for this test. Nevertheless, the patient has also tested positive for APLS which also
confirms the diagnosis of lupus. This test also signifies higher risk of miscarriage and blood
clots. Therefore, form the above discussion, it can be said that the patient has tested positive
in screening test for lupus and also has other associated symptoms like miscarriage, fatigue,
hair loss and joint pain. Along with that the patient has tested positive in APLS and
ADSDNA. The patient’s FBC analysis, ESR and CRP results are also suggestive of this.
Hence, to conclude, it can be said that patient has the most compatibility and chance for lupus
autoimmune disease.
Answer to the question number 2
Haemorrhage and thrombosis are plays huge role in high mortality rate of traumatic injuries,
stroke and ischemic heart diseases. For this reason hemostatic agents and anithrombotics are
essential to this treatment. However, traditional methods like PT/INR and aPTT are not
developed enough to provide all the needed information to a medical practitioner to treat and
diagnose their patients timely (Lancé 2015). These tests only provides the information about
the starting time of clotting but not the maximum thrombin formation or hemostatic capacity
of clot formation. Although, measurement of these data are technologically possible right
now. Presently, the clot waveform analysis (CWA), thrombin generation test (TGT) and the
viscoelastic tests (TEG/ROTEM) are gaining momentum as global clotting test. Viscoelastic
tests are particularly effective against haemorrhage whereas thrombin generation is very
much useful against arterial and venous thrombosis (Snegovskikh et al. 2018). These
techniques are in the threshold of widespread clinical use. Although, further research and
evidence is needed to validate this new techniques properly. At present, there are only 2
semi-automated thromboelastometry devices are commercially available. These are i)