Hematology Clinical Case
Man, 39 years old, 1.75m and 76kg.
Enter into the urgencies with symptoms of fatigue and weakness.
CBC is held featuring:
Abdominal ultrasound: hepatomegaly
Is held Administration acetylsalicylic acid and control by CBC.
All viral tests were negative.
follows up with acetylsalicylic acid.
last one month the CBC presents:
continues for three months with acetylsalicylic acid, is carried out new blood count:
Discuss the case ... hypotheses of diagnosis?
Diagnosis: POLYCYTHEMIA, ESSENTIAL THROMBOCYTOSIS, IDIOPATHIC MYELOFIBROSIS
THERE ARE MANY OPTIONS IN DIFFERENCIAL DIAGNOSIS , IT WOULD BE NECESSARY MORE INFORMATION, ESPECEALLY HB AND HCT AND OTHERS FOR EXAMPLE :
ESR, CPR, VITAMIN B-12, ANA, PERIPHERAL BLOOD SMEAR, IRON STUDIES
in Reality would be convenient to perform a biopsy, but the patient is in Africa there is no means to perform the biopsy and there is no way to conduct examinations of complementary diagnosis. we have no means.
SO, HB AND HCT?
normal parameters, the only parameter was low folic acid that is already standard now. the hematologist say that we have wait for the pacient evolution, but i think the patient should be removed to a place where they can perform specific tests. Gracias Juan, pero de todas formas no puedo hacer mucho aparte de darle aspirina y esperar que el hematologista se decida. yo pienso quizas por las celulas nunca volveren a la normalidad y la hepatomegalia que será un Sx mieloproliferativo, pero lo tengo aqui en discusión a ver si hay más hipotesis.
Si, lo mejor seria que se le complementen mas exámenes, espero que tengas suerte con este paciente :-)
The high platelet count and control with Aspirin suggests either the patient has pain or trying to control the formation of clots. Either way, I think a blood smear should be done to look for abnormal platelets and a genetic test done for JAK mutations. My primary diagnosis for this patient would be essential thrombocytosis
Symptoms/labs entered: Generalized fatigue, thrombocytosis, leukocytosis and hepatomegaly. Here is the results generated by Physician Cognition's algorithms
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