Haematology Case Study Analysis - Clinical Findings and Diagnosis

This assignment presents a detailed haematology case study analysis, focusing on two patients. Patient A, a 25-year-old female, exhibits symptoms including miscarriages, fatigue, and hair loss. Her FBC, ESR, CRP, and coagulation profiles are analyzed, revealing potential indicators of lupus, confirmed by positive ANA, APLS, and ADSDNA tests. The analysis also discusses the role of various coagulation tests. Patient B's blood film is examined, noting abnormalities in erythrocytes and lymphocytes suggestive of microcytic anemia and a possible viral infection. The assignment also includes an assessment of PT and aPTT results for multiple patients and provides recommendations for diagnostic testing. Furthermore, the document includes a case study of a 14-year-old female with symptoms of infectious mononucleosis, supported by FBC, LFT, and Paul Bunnell antibody test results. Finally, the document also discusses the importance of hemostatic agents and antithrombotics in treating various medical conditions.

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)

3HAEMATOLOGY CASE STUDY ANALYSIS
ROTEM-analyzer, TEM international, Muenchen, Germany and ii) TEG-analyzer,
Haemonetcis Corp., Braintree, MA, United States (De Pietri et al. 2018).
Answer to the question number 3
Based on the patient’s analysis and assessment results, I will exclude one of the Anti-
Phospholipid Antibodies (APLS) and Anti-Double Stranded DNA antibodies (ADSDNA)
factor assays. Both factor assays are to determine autoimmune diseases and neither
techniques is able to screen a disease alone (Perricone 2015). Thus, in my opinion, it is
redundant to use both of them together while using Anti-nuclear Antibody (ANA) factor
assays. Additionally, I will also assess only activated Partial Thromboplastin Time (aPTT)
test and not Mixing Study (50:50) aPTT test. It might be relevant and useful to perform
Mixing Study (50:50) aPTT test if we are only using activated Partial Thromboplastin Time
(aPTT) and Prothrombin Time (PT). Hence, with regards to this case study, we can also
exclude the Mixing Study (50:50) aPTT test.
Answer to the question number 4
Patient for this case study is a female of 14 year old who is living in Liverpool. She visited
the General Practitioner (GP) because she was off-colour for few weeks. Her symptoms
include mild fever, muscle aches, fatigue and sore throat. After the inspection, her GP
reported that she had swelling in both sides of her neck and her GP confirms the presence of
lymphadenopathy. She was advised to undertake other diagnostic tests which includes Full
Blood Count (FBC), Liver Function Tests (LFT) and Prothrombin time (PT). From the data
FBC results, it can be seen that patient has a lower haemoglobin level (100 g/L) than normal
range which is indicative of iron deficiency or mild anaemia. The patients White Blood cell
Count (WBC) and platelets were within normal range which are 8.0 X 109/L and 325 X
109/L. Interestingly, lymphocytes count of the patient is more than 50 percent of total white
cell count which is 5.1 X 109/L. The patient’s other testing parameters (Mean Cell Volume,

4HAEMATOLOGY CASE STUDY ANALYSIS
Mean Corpuscular Haemoglobin, Prothrombin Time, activated Partial Thromboplastin Time,
D Dimer, and Fibrinogen) are all within respective normal range. The patient has
inflammation in her system which is indicated by the higher than normal Erythrocyte
Sedimentation Rate (ESR) and C-Reactive Protein (CRP) values. Furthermore, the patient has
higher than normal alkaline phosphatase in her blood level which is 180 IU/L. This indicates
that patient has problem with her liver or gallbladder like jaundice or hepatitis (Sharma, Pal
and Prasad 2014). This assumption is further strengthen by the fact that patient’s aspartate
aminotransferase level in blood is also higher than normal (Gonzalez et al. 2015) and the
value is 55 IU/L. Patient was also undergone to the Paul Bunnell antibody test and was tested
positive in this test. This test is commonly performed to detect the presence of infectious
mononucleosis which mainly occurred in adolescence and among young adults (Mule 2018).
Patient also have elevated number of lymphocytes which indicates the possibility of
mononucleosis (Chew 2015). Patient’s alkaline phosphatase and aspartate aminotransferase
suggests that patients have liver dysfunction. Studies have suggested that liver abnormalities
like jaundice or hepatitis are sometimes associated with mononucleosis (Moniri et al. 2017).
Apart from that, patient’s GP has detected that she has lymphadenopathy along with mild
fever, muscle aches, fatigue and sore throat. All this symptoms are indicative of the presence
of infectious mononucleosis or glandular fever. Hence, from above discussion and patient’s
assessment data it can be inferred that the patient is most likely suffering from infectious
mononucleosis or glandular fever.
Answer to the question number 5
The blood film that will be discussed here is from Patient B. The blood film were stained by
Romanowski strain and were viewed under 400 time magnification. At a first glance, the
blood film appears to be normal. Erythrocytes, white blood cells and platelets are present in
normal ratio. Although, there are some abnormalities, deformities and irregularities can be

5HAEMATOLOGY CASE STUDY ANALYSIS
observed. Firstly, at the top centre of the blood film a lymphocyte can be seen with a single
large nucleus. Another, white blood cell can be partially seen in the left side which might be a
lymphocyte or monocyte. The top centre lymphocyte has an abnormal outer cell structure
which is indicative of viral infection. The RBC’s are slightly smaller in size than normal.
Interestingly, the RBC in this blood film have a large zone of central pallor. This condition
suggests the condition of microcytic anaemia (smaller than normal size) and hypochromic
(lower haemoglobin in every RBC) (Hennek et al. 2016). Additionally, the RBC’s in this film
are varying in size and shape. This evidence indicative of the condition poikilocytosis
(varying RBC shape) and anisocytosis (varying RBC size) (Ceciliani 2017).
Answer to the question number 6
Determined results of PT and aPTT tests for the patient A, B, C, D, and E are mentioned
below:
Table 1: PT and aPTT results for the patient A, B, C, D, and E
Patient A
(Control)
Patient B Patient C Patient D Patient E
PT (Sec) 19±2 14±0 17.5±0.5 14±2 17.5±0.5
aPTT (Sec) 17 15 16 16 18

6HAEMATOLOGY CASE STUDY ANALYSIS
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7HAEMATOLOGY CASE STUDY ANALYSIS
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