haematology case study assignment

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Hematopoiesis Case Studies

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Case studies are board-style questions with explanations and links to related articles featured in  Hematopoiesis , an e-newsletter that is sent to hematology trainees on a quarterly basis.

• A 73-Year-Old Man With Extensive Bruising
• A 2.5-Year-Old Girl With Fever and Pancytopenia
• 21-Year-Old With Duodenal Adenocarcinoma and a History of T- cell Lymphoma
• 78-Year-Old Woman with Thrombocytopenia and Splenomegaly
• 48-Year-Old Woman With Weight Loss, Hepatomegaly, and Splenomegaly
• Diagnosis of a 64-Year-Old Man With Anemia and Thrombocytopenia
• Prenatal Management of 21-Year-Old Woman to Reduce Risk of Severe Thrombocytopenia and Intracranial Hemorrhage
• Three-year-old Boy With Pancytopenia
• COVID-19 Management in Patients With Hematologic Malignancies
• 25-Year-Old Woman Referred to Clinic for Erythrocytosis
• 60-Year-Old Woman With Headache and Blurred Vision
• Chronic Immune Thrombocytopenia Purpura
• New Therapies for Acute Myeloid Leukemia
• Sickle Cell Disease – A 25-Year-Old in Transition
• Supportive Care in Multiple Myeloma
• Managing Toxicities in CAR T Cell Therapy
• Bicytopenia and Syndromic Features in a Four-Year-Old Child
• Emerging Therapies in Hemophilia
• 47-Year-Old Woman With New-Onset AML and Leukostasis
• The Smart Choice for Prevention of Recurrent Venous Thromboembolism
• 36-Year-Old Man with Severe Low Back Pain and BCP-ALL
• 52 Year-Old Woman with Fatigue and Neuropathy
• 29-Year-Old Woman with Postpartum Hemorrhage
• 30 Year-Old Female with Pancytopenia and Fatigue
• Progressive Fatigue and Cytopenias in a 70-Year-Old Man
• 32-year old man with neurologic changes and cytopenias
• 44-Year-Old Man with Fever, Abdominal Pain, and Pancytopenia
• Unexplained Thrombocytopenia in a Child
• Neutropenia in a Patient with Rheumatoid Arthritis
• 50-Year-Old Woman with Fibrous Capsule after Breast Augmentation
• 32-Year-Old Female with Multiple Ecchymoses
• 32-Year-Old Female with Anemia and Confusion
• GI Bleed in a Patient with Amyloidosis
• 32-Year-Old Man Admitted to Hospital With Diffuse Lymphadenopathy
• Image Challenge: 54-Year-Old Man With Abnormal Circulating Lymphocytes
• Image Challenge: Hematology Consult - Middle-Age Woman With Neutropenia and Splenomegaly
• Image Challenge: Hematology Consult - Middle-Age Man With Neuropathy and Splenomegaly
• Image Challenge: Bone Marrow Aspirate (August 2012)
• 65-Year-Old with History of Waldenström Macroglobulinemia (May 2012)
• Cervical Adenopathy, Weight Loss, and Night Sweats (February 2012)
• 12-Year-Old Boy With Normocytic Anemia and Bone Pain (August 2011)
• Putting Two and Two Together (May 2011)
• Four-Year-Old Male with Red Urine and Fever (February 2011)
• Intermittent Epistaxis in a Young Boy
• Prognostic Factors in Acute Lymphocytic Leukemia
• 55-Year-Old Male With Multiple Myeloma and Prognosis of Undetermined Significance
• 24-Year-Old Woman With Dark-Colored Urine
• Personalizing Anticoagulation: Determination of Warfarin Dosing
• Microcytic Anemia Refractory to Oral Iron Supplementation
• ITP is Also a Platelet Production Problem
• A 26-Year-Old Man With History of Fatigue, Fevers, and Gingival Bleeding
• Finding the Best Prognostic Outcome in a Patient With AML
• Bcl-6 and Its Relationship to Diffuse Large B-Cell Lymphoma
• A 78-Year-Old Man With Elevated Leukocytes and Anemia
• Flow Cytometry Pattern in APL
• Identifying One of the 5q- Syndrome Genes
• Do You Know JAK?

Table of Contents

Explore the latest case studies  and articles  from  Hematopoiesis .

• Announcing Hematopoiesis, Our New ASH Trainee Council Newsletter by Trainees and for Trainees
• A Primer on Advocacy for the Hematology Trainee
• Blood Smear: The Fifth Vital Sign in Hematology
• Chimeric Antigen Receptor T-cell Therapy: What Fellows Need to Know
• The Blood Sisters Project
• Case Study: A 73-Year-Old Man With Extensive Bruising
• Case Study: A 2.5-Year-Old Girl With Fever and Pancytopenia

The Biology Corner

Biology Teaching Resources

Blood Case Studies for Anatomy (Hematology)

I found this assignment online and re-created it to work for remote-learning, so that it is now in slide format. This format will also work when students are back to in-person learning. I plant to print the slides in color and then place them into dry-erase sleeves so that students can write on them with expo markers and then erase for the next class. This saves on color printing costs and paper.

Another thing that is preferable with in-person learning is the ability for students to work together and communicate what they know. Each group can get a single case (slide) and then we can share the images on the projector. They can point out to the class where the data is highlighted to indicate an abnormal values.

If using this as a remote assignment, I don’t think it would be too much to ask students to complete all of the slides. (Note: if you assign this on LMS, you will need to make a copy and remove the note on the slide that has the answer.)

Ideally, students will have already learned about various conditions, like sickle cell disease and anemia. I have Google slides and guided notes for these units. The remote version, Interactive Slides: Blood also explains the different types of blood cells and their functions.

Each slide shows a CBC (complete blood count) with values for each type of blood cell in the sample. The normal range is shown next to the patient values, so students can easily compare the two. The image of the blood slide does not reveal as many clues as the CBC panel, and is mainly there as a reference.

There are five cases, each showing a particular condition with the CBC counts. Students highlight any abnormalities in the patient’s blood. For example, Teddy has swollen lymph nodes and a high lymphocyte count. From the list of possibilities, the best fit for his disorder is mononucleosis. Each slide has the answer listed under speaker notes. If you are assigning the slides over LMS, make a copy that does not include the answers.

Shannan Muskopf

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9. Hematology Questions and Answers

• Published: August 2013
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Chapter 9 presents multiple-choice, board review questions on hematology including anemia, myeloid malignancies, coagulation disorders, and lymphoid malignancies. Full explanations are provided with the correct answers.

Multiple Choice (choose the best answer)

Anemias and Myeloid Malignancies

1. A 67-year-old man is evaluated for exertional dyspnea. He recalls that 3 years ago he was told that he had anemia. In reviewing his records, you note that at that time his hemoglobin level was 9.5 g/dL and his hematocrit was 33% with an increased mean corpuscular volume (MCV); the remainder of his complete blood cell count was normal. On physical examination, he had conjunctival pallor, normal heart and lung findings, no lymphadenopathy, no hepatomegaly or splenomegaly, and no petechiae or ecchymoses. Diagnostic testing results are shown in Table 9.Q1 .

Which of the following is the most likely explanation for these findings?

Acute myeloid leukemia (AML)

Vitamin B 12 deficiency

Hemolytic anemia

Myelodysplastic syndrome (MDS)

Primary myelofibrosis

2. A 45-year-old woman is admitted to the surgical service with severe arterial insufficiency of the right second toe. She has no prior medical history and takes no medications. Physical examination findings are normal except for mild splenomegaly and signs of early gangrene in the right second toe. All pulses are full and equal throughout. Diagnostic testing results are shown in Table 9.Q2 .

Which of the following is the most likely diagnosis?

Essential thrombocythemia

Philadelphia chromosome–negative chronic myeloid leukemia (CML)

Primary myelofibrosis (PMF)

3. A 22-year-old man is admitted to the hospital for an elective cholecystectomy. You are asked to see him because he had anemia on preoperative testing. He tells you that he has always been told by his physicians that he has mild anemia; his medical history is otherwise unremarkable. His vital signs are normal. His conjunctivae are mildly icteric, and the spleen is palpable in the left upper quadrant. Findings on the remainder of the physical examination are normal. Diagnostic testing results are shown in Table 9.Q3 .

Which of the following tests would most likely help confirm the diagnosis?

Hemoglobin electrophoresis

Osmotic fragility test

Direct and indirect antiglobulin (Coombs) tests

Bone marrow aspiration and biopsy

4. A 28-year-old black man with sickle cell disease presents to the emergency department with abdominal pain, chest pain, and shortness of breath. His dyspnea evolved over 36 hours after a visit with his niece and nephew. His history is significant for approximately 2 emergency department visits or hospital admissions per year for painful crises. Three years ago, he spent 4 weeks in the hospital after an episode of acute chest syndrome. He has been taking hydroxyurea but only intermittently because of financial concerns. His pulse is 116 beats per minute and regular, his blood pressure is 138/76 mm Hg, his respiratory rate is 18 breaths per minute, and his temperature is 38.3°C. Pulse oximetry shows 91% oxygen saturation with room air and 93% with 4 L of oxygen by nasal cannula. His lungs have scattered inspiratory crackles in the right midlung field. His spleen is not palpable. The remainder of the physical examination findings are normal. Diagnostic testing results are shown in Table 9.Q4 .

A chest radiograph shows a right middle and upper lobe air space infiltrate. The patient is given supplemental oxygen, adequate pain control, and intravenous antibiotics. Which of the following should you now order?

Hydroxyurea

Erythrocyte exchange transfusion

Plasma exchange

Anticoagulation with unfractionated heparin

Aggressive intravenous fluid hydration

5. A 70-year-old man presents with weakness of his right arm and leg. His symptoms began yesterday and are now resolved. He also reports a 6-month history of recurrent headaches and fatigue. He is a nonsmoker. His medical history is significant for high blood pressure. His blood pressure is 167/88 mm Hg, his oxygen saturation is 93% on room air, his face is plethoric, and a right carotid bruit is heard. Other findings on physical examination are normal. Diagnostic testing results are shown in Table 9.Q5 .

Carotid ultrasonography shows a 30% stenotic lesion in the right carotid. The patient is hospitalized and begins antiplatelet therapy. Which of the following should you order next?

JAK2 V617F mutation testing

Fluorescence in situ hybridization (FISH) for BCR-ABL testing

Arterial blood gas analysis

6. A 42-year-old woman with a history of systemic lupus erythematosus (SLE) presents with fatigue. She has been receiving anti–tumor necrosis factor therapy and has been managing the SLE well. However, she has recently experienced worsening fatigue. Her vital signs are normal. Her face and conjunctivae are jaundiced, and she has a fading butterfly rash on her face. The spleen is palpable on deep inspiration. Diagnostic testing results are shown in Table 9.Q6 , and the peripheral blood film is shown in Figure 9.Q6 .

Which of the following is the best interpretation of these data?

The hemolysis is predominantly intravascular.

The bone marrow is not responding to the anemia.

Direct Coombs testing results should be positive.

Urine hemoglobin testing results should be positive.

7. A 58-year-old woman with active rheumatoid arthritis presents with fatigue and joint pain. She received the diagnosis of rheumatoid arthritis 5 years earlier and has been taking prednisone 10 mg daily and methotrexate with folate weekly. She has had chronic fatigue and anemia. Her vital signs are normal. Her conjunctivae are pale, and she has active synovitis affecting both knees, her wrists, and elbows, with rheumatoid nodules on the extensor surface of her right forearm. The remainder of the physical examination findings are normal. Diagnostic testing results are shown in Table 9.Q7 .

Which of the following laboratory findings are consistent with this condition?

Elevated hepcidin, elevated ferritin, elevated total iron-binding capacity (TIBC), elevated serum iron

Elevated hepcidin, elevated ferritin, decreased TIBC, elevated serum iron

Decreased hepcidin, elevated ferritin, decreased TIBC, elevated serum iron

Elevated hepcidin, elevated ferritin, decreased TIBC, normal serum iron

Decreased hepcidin, elevated ferritin, elevated TIBC, normal serum iron

Coagulation

8. A 62-year-old man underwent right total knee replacement 8 days ago. Swelling has developed in his right lower extremity, and Doppler ultrasonography confirms the presence of a right superficial femoral vein thrombosis. His current medications include oxycodone and subcutaneous unfractionated heparin. Results of preoperative tests, including a complete blood cell count and liver and kidney function, were normal. Other laboratory data include the following: hemoglobin 12.2 g/dL, leukocyte count 8.5×10 9 /L, and platelet count 60×10 9 /L. In addition to stopping the use of subcutaneous heparin, what is the next most appropriate step in management of this patient?

Start low-molecular-weight heparin therapy.

Start intravenous therapeutic doses of heparin.

Start direct thrombin inhibitor therapy.

Start aspirin therapy.

9. A 45-year-old man presents with deep vein thrombosis of the right femoral vein. Three months ago, he received a diagnosis of systemic lupus erythematosus (SLE). In addition to confirming SLE, laboratory testing also documented the presence of a lupus anticoagulant (LAC). There is no family history of venous thrombosis. Current medications include hydroxychloroquine. Laboratory testing shows normal results for a complete blood cell count and for tests of liver and kidney function. Special coagulation testing confirms the persistence of an LAC. What is the most reasonable duration of warfarin anticoagulation for this patient?

10. A 20-year-old white woman has been admitted to the hospital with pulmonary embolism. She has no chronic illnesses and is receiving no medications except for combination estrogen-progesterone birth control pills that she started using approximately 1 year earlier. Results were normal for a complete blood cell count, baseline prothrombin time, activated partial thromboplastin time (aPTT), and tests of kidney and liver function. The patient is currently receiving therapeutic doses of intravenous unfractionated heparin, and her aPTT is therapeutic at 72 seconds. A panel of thrombophilia tests has been performed. Which of the following statements about her thrombophilia test results is correct?

DNA-based testing for factor V Leiden and prothrombin G20210A mutations are reliable.

Low antithrombin confirms a hereditary deficiency state.

A positive result on lupus anticoagulant (LAC) testing confirms antiphospholipid antibody syndrome.

Low protein S confirms the presence of a hereditary deficiency state.

11. A 62-year-old man with chronic atrial fibrillation has been treated with warfarin. He has no other chronic illnesses and is receiving no other medications long-term except for lipid-lowering agents. Results of his complete blood cell count and tests of renal and kidney function are normal. He checks his prothrombin time monthly and has kept the international normalized ratio (INR) within the therapeutic range (2–3) for the duration of his therapy with warfarin. He has heard about recent US Food and Drug Administration (FDA) approval of dabigatran, which requires no monitoring, and he would like a prescription for this new drug. Which of the following statements is true about the use of dabigatran in atrial fibrillation compared with the well-managed use of warfarin?

Switching to dabigatran would result in superior outcomes.

Switching to dabigatran would result in inferior outcomes.

Switching to dabigatran would provide no significant benefit.

Dabigatran is FDA approved for postoperative thromboprophylaxis for knee and hip replacement surgery.

Dabigatran is FDA approved as an anticoagulant for patients who have received a mechanical heart valve.

12. A 22-year-old woman is brought to the emergency department after having 1 witnessed tonic-clonic seizure. She had appeared confused for the preceding few hours. On examination, she is febrile and appears slightly confused; otherwise, neurologic and physical examination findings are normal. Laboratory testing results are shown in Table 9.Q12 , and the peripheral blood smear is shown in Figure 9.Q12 .

What is the most appropriate next step in management?

Red blood cell transfusion

Platelet transfusion

Gamma globulin administration

13. A 72-year-old man with chronic atrial fibrillation has been receiving dabigatran 75 mg twice daily for the past 6 months. He has not had any thrombotic or hemorrhagic complications. He has a history of colon polyps, for which he needs to undergo a colonoscopy with possible polypectomy. Apart from an irregular pulse, his physical examination findings are normal. Results were normal for a complete blood cell count and tests of renal and liver function. The calculated creatinine clearance is 28 mL/min. For how long should dabigatran use be discontinued before the colonoscopy?

No need to discontinue

Lymphoid Malignancies

14. At her annual physical examination, an asymptomatic 68-year-old woman has lymphocytosis (32×10 9 /L) with a normal hemoglobin level and platelet count. On examination, she has 1-cm lymphadenopathy in the cervical region and no palpable liver or spleen enlargement. A peripheral blood smear shows identically appearing mature lymphocytes with smudge cells. Flow cytometry of the peripheral blood lymphocytes shows a monoclonal B population with dim expression of λ light chain and CD20 that is positive for expression of CD5, CD19, and CD23. Which of the following is the best next step in her management?

Combination chemoimmunotherapy

Chlorambucil therapy

Allogeneic peripheral blood stem cell transplant

Combination monoclonal antibody therapy

Active monitoring for disease progression and complications

15. Ten years ago, a previously healthy 20-year-old woman presented to her physician with a 2-month history of pruritis, drenching night sweats, unintentional weight loss, and nonproductive cough. On examination, she had 2-cm cervical lymphadenopathy. A computed tomographic scan showed a 12-cm-diameter anterior mediastinal mass. An excisional biopsy of a cervical lymph node showed nodular sclerosing Hodgkin lymphoma. After she was treated with ABVD (doxorubicin [ A driamycin], b leomycin, v inblastine, and d acarbazine) combination chemotherapy followed by involved field radiotherapy, the disease was in complete remission. Now you see her for the first time for an annual physical examination. The disease remains in complete remission. Compared to her peers, this patient is at increased risk of which of the following conditions?

Breast cancer

Coronary artery disease

Hypothyroidism

Skin cancer

All of the above

16. An 80-year-old man is admitted to the hospital after falling on an icy sidewalk and fracturing his hip. He undergoes open reduction and internal fixation of the fracture. At surgery, there does not appear to be any bone disease at the fracture site. The patient was previously asymptomatic. Physical examination findings are otherwise unremarkable. Serum protein electrophoresis and immunofixation show an IgM κ monoclonal protein (0.3 g/dL). The complete blood cell count and serum creatinine levels are normal. Skeletal survey shows no additional bone defects. Which of the following statements is true for this patient?

He has multiple myeloma and requires treatment.

He has a lower risk of a clinically significant lymphocytic or plasma cell malignancy than patients with an IgG monoclonal protein.

He requires a radioisotope bone scan to evaluate his bone integrity.

He requires regular follow-up and serial measurements of his monoclonal protein level.

He has a 10% annual risk of multiple myeloma.

17. A 75-year-old African American man was seen last week by his primary care physician for mild dyspnea. He has also noted intermittent peripheral edema. During the evaluation, an electrocardiogram showed low-voltage QRS complexes in the limb leads. The troponin T level was elevated (0.07 ng/mL). This finding suggested the need for a coronary angiogram, which showed no significant coronary artery disease. An echocardiogram showed diffuse left ventricular thickening with a granular texture to the myocardium and a septal thickness of 2.5 cm (normal <1.1 cm). The complete blood cell count results were normal. Serum and urine protein electrophoresis and immunofixation were unremarkable. Serum free light chain levels were not increased. What is the most likely diagnosis?

AA amyloidosis

Light chain–related amyloidosis

Hypertrophic obstructive cardiomyopathy

Amyloidosis due to transthyretin deposition

Amyloidosis due to β 2 -microglobulin deposition

18. A 55-year-old man presented to his primary care physician for evaluation of fatigue. He was previously healthy with the exception of chronic musculoskeletal low back pain, for which he occasionally takes nonsteroidal anti-inflammatory drugs. On examination, he is pale. Complete blood cell count results are as follows: hemoglobin 8.3 g/dL, mean corpuscular volume 73 fL, leukocyte count 6.9×10 9 /L, and platelet count 398×10 9 /L. Results of the fecal occult blood test are positive. During upper and lower endoscopy, a 1.2×2.5-cm ulcerative lesion is noted in the lesser curvature of the stomach. The lesion is biopsied and identified as a MALT lymphoma. Which of the following is characteristic of MALT lymphoma?

Most cases are treated with anthracycline-based chemotherapy.

It is caused by chronic stimulation with Chlamydophila psittaci .

Radiotherapy is necessary in most cases.

It frequently undergoes transformation to a large-cell lymphoma.

The combination of amoxicillin, omeprazole, and clarithromycin is the most appropriate first-line treatment.

19. A 73-year-old woman presented to the emergency department with new-onset back pain, confusion, and constipation over the past week. Her past medical history is significant only for hypertension. On examination, she is slightly pale with slow cognition and point tenderness over the lumbar spine. Plain films of the lumbar spine show osteolytic lesions in L2, L3, and L5. Laboratory values are as follows: hemoglobin 9.3 g/dL, leukocyte count 4.6×10 9 /L with a normal differential count, platelet count 230×10 9 /L, creatinine 1.6 mg/dL, total calcium 13.1 mg/dL, albumin 3.6 g/dL, and total protein 9.1 g/dL. What is the most likely diagnosis?

Metastatic breast cancer

Hydrochlorothiazide use

Multiple myeloma

Primary hyperparathyroidism

Milk alkali syndrome

20. A 48-year-old man presents to the emergency department with a 6-week history of progressively worsening abdominal pain and night sweats. Physical examination findings were significant for palpable bilateral 2-cm axillary lymph nodes and diffuse abdominal tenderness with no rebound or guarding. Computed tomography of the abdomen and pelvis showed retroperitoneal and mesenteric lymphadenopathy. Excisional biopsy of an axillary node was positive for diffuse, large B-cell lymphoma. Positron emission tomography showed fluorodeoxyglucose-avidity in the axillary, mesenteric, and retroperitoneal lymph nodes. Results of the bone marrow examination were normal. Which of the following is the best next step?

Combination therapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP)

Observation

Combination therapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)

Autologous stem cell transplant

Involved field radiotherapy

1. Answer d.

MDS most commonly manifests as isolated macrocytic anemia. MDS can evolve to include pancytopenia over several years; the typical peripheral smear findings include a dimorphic erythrocyte population (microcytes and oval macrocytes) with an overall prominent macrocytosis and an MCV around 110 fL. The chronicity of MDS—in particular, anemia preceding the diagnosis of pancytopenia by several years—is in contrast to the typically acute manifestation of AML, which is therefore an unlikely possibility in this patient. Primary myelofibrosis, a myeloproliferative neoplasm, causes fibrosis in the bone marrow, resulting in extramedullary hematopoiesis and significant splenomegaly, and typically does not cause a macrocytic anemia. Vitamin B 12 deficiency can cause a megaloblastic anemia and manifest with slowly evolving macrocytic anemia and eventually pancytopenia, but the peripheral smear would not show a dimorphic erythrocyte population. (See Tefferi and Vardiman in the “Suggested Reading” list.)

2. Answer a.

Extreme thrombocytosis may be reactive and occur with severe iron deficiency or inflammatory states (with elevated erythrocyte sedimentation rates) or after splenectomy; patients are typically asymptomatic. Clonal thrombocytosis is related to a myeloproliferative neoplasm, which usually causes splenomegaly. Typical bone marrow findings include a hypercellular bone marrow with increased atypical megakaryocytes in clusters. Essential thrombocythemia may cause extreme thrombocytosis (platelet count >1,000×10 9 /L); however, it can also occur less commonly with polycythemia rubra vera (typically with erythrocytosis), the cellular phase of PMF, or rarely CML. The normal karyotype makes CML much less likely since it typically manifests with the Philadelphia chromosome t(9;22). Increased reticulin fibrosis would have been seen on the bone marrow biopsy if the patient had PMF. (See Tefferi in the “Suggested Reading” list.)

3. Answer b.

When a patient presents with premature gallstones, one should consider whether they may be due to pigment gallstones from chronic hemolysis causing indirect hyperbilirubinemia. The presence of microspherocytes is consistent with hereditary spherocytosis, and the diagnostic test is an osmotic fragility test, which identifies a congenital membrane defect. Typically, acquired warm autoimmune hemolytic anemia, which produces positive Coombs test results, can cause spherocytes as well; however, the history of lifelong anemia makes this diagnosis unlikely. A hemoglobin electrophoresis would help in diagnosing thalassemia or a hemoglobinopathy; however, these conditions do not manifest with microspherocytes on the peripheral blood film. There is no indication for a bone marrow biopsy since the reticulocyte response is appropriate and no other cytopenias are apparent. (See Gallagher in the “Suggested Reading” list.)

4. Answer b.

The patient has acute chest syndrome, a sickle cell anemia complication that is an indication for urgent red cell (not plasma) exchange transfusion to decrease the hemoglobin S level to less than 30% to 35%. Gentle fluid resuscitation is appropriate (along with oxygen support and antibiotics, since about one-third of acute chest syndrome events are initiated by or associated with bacterial pneumonia). Aggressive fluid resuscitation, leading to overhydration, might cause pulmonary edema and worsen the oxygenation. Pulmonary embolism is possible, but full anticoagulation is not warranted until embolism is documented. Use of hydroxyurea might have prevented this crisis, but it is of no value for the acute condition. (See Vij and Machado in the “Suggested Reading” list.)

5. Answer a.

Polycythemia may be secondary, as with erythropoietin- mediated causes such as chronic hypoxemia, living at high altitude, and high oxygen affinity hemoglobinopathies. Polycythemia vera is a myeloproliferative neoplasm that can manifest with arterial thrombosis secondary to hyperviscosity from the increased concentration of erythrocytes. The low erythropoietin rules out erythropoietin-mediated causes, leaving the presumptive diagnosis of polycythemia vera. With JAK2 V617F mutation testing of peripheral blood, results are positive for approximately 90% of patients who have polycythemia vera. FISH for BCR-ABL testing would screen for chronic myeloid leukemia, which does not manifest with polycythemia. Although bone marrow aspiration and biopsy would be helpful, it is not immediately necessary and could be considered later. (See Patnaik and Tefferi in the “Suggested Reading” list.)

6. Answer c.

Hematologic complications of SLE include anemia of chronic disease, pure red cell aplasia, and warm autoimmune hemolytic anemia (WAIHA). The presentation and laboratory data suggest hemolysis, and the blood smear shows spherocytes. These findings are consistent with WAIHA, which causes extravascular hemolysis. The reticulocytosis suggests that the bone marrow response is adequate. In intravascular hemolysis, the urine is positive for hemoglobin. (See Packman in the “Suggested Reading” list.)

7. Answer d.

Rheumatoid arthritis is a chronic inflammatory disorder that may lead to anemia of chronic disease. Anemia of chronic disease results from the effect of elevated cytokines on hematopoiesis, including upregulation of hepcidin, leading to increased ferritin from iron malutilization and downregulation of ferroportin, the main iron exporting system. Transferrin is also downregulated, leading to decreased TIBC and normal to decreased serum iron levels. (See Weiss and Goodnough in the “Suggested Reading” list.)

8. Answer c.

The timing and degree of thrombocytopenia are consistent with immune-mediated heparin-induced thrombocytopenia type II. Unfractioned heparin and low-molecular-weight heparin are contraindicated. Aspirin would not be the sole management agent for established thrombosis. The most appropriate step is to start a direct thrombin inhibitor.

9. Answer d.

Presentation with a vascular thrombosis and persistence of a LAC for 12 weeks or more satisfies the criteria for an antiphospholipid syndrome. This patient has a high risk for recurrent venous thrombosis on discontinuing anticoagulation; thus, long-term warfarin is recommended with periodic reassessment for safety.

10. Answer a.

DNA-based testing is reliable for patients receiving heparin or warfarin and for patients who have acute thrombosis. However, acute thrombosis and heparin can cause lower antithrombin activity results, which should be verified at another time, when heparin and acute thrombosis are not factors. A single positive test result for LAC does not confirm antiphospholipid syndrome; follow-up testing at 12-week intervals is required to demonstrate persistence of LAC. Acute thrombosis and estrogen use can lower protein S levels; thus, abnormally low results require follow-up confirmation.

11. Answer c.

Among patients randomly assigned to receive dabigatran, overall outcomes were noninferior when compared with the well-managed use of warfarin, thus providing no significant advantages. The group of patients that derived the most benefit from dabigatran was the group with INRs outside the recommended therapeutic range. Dabigatran is FDA approved only to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation.

12. Answer d.

Plasma exchange is the treatment of choice for thrombotic thrombocytopenic purpura (TTP). Although red blood cell transfusion may be indicated, it does not address the underlying pathogenesis of TTP. Platelets are thought to be contraindicated in TTP because of the theoretical possibility of worsening the TTP. Gamma globulin is ineffective in increasing the platelet count in TTP.

13. Answer d.

Dabigatran is cleared through the kidneys. It has a prolonged half-life in patients who have a creatinine clearance less than 30 mL/min compared with patients who have a creatinine clearance greater than 30 mL/min.

14. Answer e.

Chronic lymphocytic leukemia (CLL) is a clonal lymphoproliferative disorder of mature lymphocytes. The clinical diagnosis requires a B-lymphocyte count of more than 5×10 9 /L. Peripheral blood smears typically show smudge cells, which are lymphocytes that have broken during processing of the slide. The clinical course of CLL is chronic in most patients. For those with early-stage disease, standard practice is to withhold treatment until the disease is active or progressive. However, patients need to be monitored for disease progression, autoimmune complications, infections, and second cancers.

15. Answer e.

Hodgkin lymphoma therapy is curative in about 80% of cases. However, there are late complications of therapy, particularly in those treated before modern chemotherapy and radiotherapy. At 15 years, the risk of death from other causes surpasses that of risk of death from Hodgkin lymphoma. Patients are at higher risk of secondary malignancies, cardiovascular disease, thyroid disorders, and infertility than the general population. Many of these conditions can be attributed to chemotherapy and radiotherapy.

16. Answer d.

This patient has monoclonal gammopathy of undetermined significance (MGUS), the most common dysproteinemia. In MGUS, the M protein level is typically less than 3 g/dL, the bone marrow has less than 10% plasma cells, and the hemoglobin, creatinine, calcium, and bone radiographs are normal. The risk of progression to a lymphocytic or plasma cell malignancy is about 1% per year. Patients with an IgM or IgA monoclonal protein are at higher risk of progression than those with an IgG protein. Patients with MGUS need to be observed.

17. Answer d.

The patient has senile cardiac amyloidosis. This syndrome is usually isolated to the heart with few clinically significant deposits elsewhere, and the echocardiographic findings are often out of proportion to the degree of symptoms. Transthyretin is the protein causing the amyloid deposits; most patients have wild-type transthyretin.

18. Answer e.

With combination antibiotic therapy, 70% of gastric MALT lymphomas are cured. In cases refractory to antibiotics, tumors may carry the t(11;18) translocation, and involved field radiotherapy is effective. Combination chemotherapy is reserved for advanced disease. The majority of cases are associated with Helicobacter pylori infection.

19. Answer c.

This patient has multiple myeloma with evidence of end-organ damage from the plasma cell proliferative disorder (hypercalcemia, renal failure, anemia, and osteolytic bone lesions). The other answer choices are possible causes of hypercalcemia, but only multiple myeloma accounts for all the presenting symptoms, including the elevated level of total protein.

20. Answer a.

This patient has advanced-stage, diffuse, large B-cell lymphoma, and R-CHOP chemotherapy is the standard of care. Rituximab is an anti-CD20 monoclonal antibody that improves overall survival when added to CHOP chemotherapy for aggressive B-cell lymphomas. For patients whose disease relapses or is refractory, autologous stem cell transplant is the standard therapy. Radiotherapy can be used in combination with chemotherapy in early-stage (I-IIA) nonbulky disease but is not standard therapy for advanced disease.

Suggested Reading

Gallagher PG . Red cell membrane disorders. Hematology Am Soc Hematol Educ Program.   2005 :13–8.

Packman CH . Hemolytic anemia due to warm autoantibodies.   Blood Rev.   2008 Jan;22(1):17–31. Epub 2007 Sep 27.

Google Scholar

Patnaik MM , Tefferi A . The complete evaluation of erythrocytosis: congenital and acquired.   Leukemia.   2009 May;23(5):834–44. Epub 2009 Mar 19.

Tefferi A . Annual clinical updates in hematological malignancies : a continuing medical education series: polycythemia vera and essential thrombocythemia: 2011 update on diagnosis, risk-stratification, and management. Am J Hematol. 2011 Mar;86(3):292–301.

Tefferi A , Vardiman JW . Myelodysplastic syndromes.   N Engl J Med.   2009 Nov 5;361(19):1872–85.

Vij R , Machado RF . Pulmonary complications of hemoglobinopathies.   Chest.   2010 Oct;138(4):973–83.

Weiss G , Goodnough LT . Anemia of chronic disease.   N Engl J Med.   2005 Mar 10;352(10):1011–23.

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A Laboratory Guide to Clinical Hematology

(5 reviews)

Valentin Villatoro, University of Alberta

Michelle To, University of Alberta

Copyright Year: 2019

Publisher: University of Alberta Libraries

Language: English

Formats Available

Conditions of use.

Learn more about reviews.

Reviewed by Weiran Shan, Research Scientist, University of Virginia on 12/3/20

This book described blood disease from several aspects; such as morphology, causes, blood metabolic pathways, and included many histological images. read more

Comprehensiveness rating: 4 see less

This book described blood disease from several aspects; such as morphology, causes, blood metabolic pathways, and included many histological images.

Content Accuracy rating: 4

Relevance/Longevity rating: 3

Good for reference.

Clarity rating: 5

Some images' clarification is not well understood.

Consistency rating: 4

Good consistency.

Modularity rating: 4

Good modularity.

Organization/Structure/Flow rating: 5

Organization is good.

Interface rating: 4

Good interface, no display issues.

Grammatical Errors rating: 4

Grammatical good.

Cultural Relevance rating: 5

No cultural offensive.

Good reference book for people looking for hemopathy acknowledgement.

Reviewed by Lisa Wright CMA(AAMA) MT, SH, Professor of Medical Assisting, Bristol Community College on 5/27/20

This is an excellent reference to guide students through the identification of normal and abnormal blood cell morphology. I do not teach Hematology but as former clinical lab science student I would have found this resource helpful. It is clear... read more

Comprehensiveness rating: 5 see less

This is an excellent reference to guide students through the identification of normal and abnormal blood cell morphology. I do not teach Hematology but as former clinical lab science student I would have found this resource helpful. It is clear and concise and has a format that is engaging and visually appealing.

Content Accuracy rating: 5

The lab manual offers accurate and error free guidance with many clear and useful images. The images offer a clear demonstration of the concepts that are required for an entry level hematology laboratory scientist.

Relevance/Longevity rating: 5

Cellular morphology does not need much updating other than an occasional terminology update. This manual appears to be current and relevant and has a strong workplace relevance for a hematology laboratory scientist.

The manual is written in a clear and easily understood format and integrates concepts in concise paragraphs outlining cause and laboratory test results.

Consistency rating: 5

The manual is consistent chapter to chapter which adds to its ease of use. It would be easy to integrate into course assignments and is an efficient way to review and reinforce learning.

Modularity rating: 5

The modality is what I like like best about this manual. It can be used at the bench side as a quick reference and also as a study tool.

The topics are presented in a logical clear fashion and is easy to switch from one topic to another.

Interface rating: 5

Interfaces beautifully which saves student time and frustration while following up on questions or reviewing for a practical.

Grammatical Errors rating: 5

No grammatical errors found.

The text is culturally sensitive and not offensive in any way.

This manual is easy to use and access. It covers the full range of concepts covered in a Hematology course and is flexible in application as it can be used in several situations.

Reviewed by Sona Kumar, MLT & MLS Program Director, Associate professor, Louisiana State University of Alexandria on 4/30/20

The first chapter simply started with the picture and names of different red blood cells in the maturation series. It is assumed that the reader has a prior knowledge of all blood cells. It would be appropriate if there was a chapter on... read more

Comprehensiveness rating: 2 see less

The first chapter simply started with the picture and names of different red blood cells in the maturation series. It is assumed that the reader has a prior knowledge of all blood cells. It would be appropriate if there was a chapter on Hematopoiesis, general lab safety, microscopy, slide preparation, staining to name a few. Some information regarding anemia's, leukemia's, RBC indices demands inclusion in the beginning of book. Importance of discussing different abnormal cells (RBC, WBC) and its relation with disease states is missing. Some very basic background information is missing that make it hard on the reader to correlate different topics. Another key thing that is lacking is the end of chapter review questions and case studies. It would be good to know if this book follows certain MLT or MLS certification exam content guidelines.

Content is accurate with few grammatical errors.

As this is a open textbook where content can be easily updated, I do not see any issue with relevance.

Clarity rating: 3

Loved ‘TAILS’ (section I.,subsection 2). If the 1st letter of each diseased state was typed in BOLD, it would give more clarity to the reader. Even though the outline is easy to steer but going through each section, I was searching for information as to why the content is presented. There is no correlation between each sections.There is no formal introduction in each section. Abbreviations are listed at some places without the explanation eg. CLL (section I.,subsection 1), EDTA, RNA,DNA.

Overall the text is internally consistent with the content presented.

The text is presented in sections and subsections with clear titles which makes it easy to navigate. The majority of content in each subsection is presented in points, which makes it easy to apprehend, unlike long sentences or paragraphs. Picture collection is great!.

Organization/Structure/Flow rating: 4

Presentation of topics is well structured. A chapter on the introduction to various cell lines, Hematopoiesis flowchart, safety and microscopy is expected in the beginning of the book.

Interface rating: 2

The downloaded PDF version of the book has spacing issues throughout. Pg.3 is redundant. Images in the PDF seems to overlap; they should be neatly spaced. Some pages have image missing. It has instructions to view image online but this could be issue for some readers without internet access. Various sections/subsection pages have a number at the top (e.g. Pg. 22 has number 1, Pg. 32 has number 2 on the top of page). Is that a chapter number? If it is, then the numbering is missing from ‘Contents’ section. Either remove it from each chapter/section or include it in contents.

Incorrect spelling 'pronoroblast' 2nd image (Section I ,subsection I) Chapter 80 – Capitalize 'i' in 'igM'

No culturally insensitive or offensive information presented.

Currently, I would not use this textbook as a 'Required textbook' for my class.

Reviewed by Elizabeth Duck, Assistant Professor in Medical Laboratory Science Program, Louisiana State University of Alexandria on 4/20/20

Text appears to be missing a comprehensive introduction to Clinical Hematology that may be useful for students (basics of laboratory safety, quality assessment, specimen collection, and roles/responsibilities of the Hematology department in... read more

Text appears to be missing a comprehensive introduction to Clinical Hematology that may be useful for students (basics of laboratory safety, quality assessment, specimen collection, and roles/responsibilities of the Hematology department in patient care), no comprehensive glossary is present (some terms are presented to students without explanation), no detailed explanation of various key disorders of hemostasis and thrombosis (aPTT, PT, HIT, HUS, HELLP, DIC, etc.), and other areas of hematological analysis are missing (body fluid analysis, cell counts). Other than the previously mentioned concerns, text appears to cover all other areas of Clinical Hematology.

Errors appear to be rare in the text.

Content of text appears to be up-to-date and text is arranged in such a way that necessary updates will be relatively easy to implement. Text would be a great supplemental resource or a great review resource for students.

Clarity rating: 2

The majority of the text appears to be written as though the reader already has some understanding of Clinical Hematology concepts. Overall, minimal explanation/context is present for most of the complex concepts presented; no introductions or conclusions of concepts presented . There is also no glossary present for clarity of some terms.

The text appears to be internally consistent in terms of terminology and framework.

This book appears to be well organized. The table of contents link make finding a specific page in the book very easy, the chapters are consistent with the titles, and the bold words catch a readers eye to important data.

The topics in the text are presented in a logical, clear fashion. Each chapter flows well and progresses well into more advanced concepts/skills without causing confusion.

The downloaded PDF version of the text has a few display features that may distract the reader; there are continuous page spacing issues throughout the text, the text in various tables is quite small and may be hard to read for some readers, and instructions for how to use eBook are unclear/confusing/possibly missing information. Another confusing feature is that not all images are present, the reader is given the following error "An interactive or media element has been excluded from this version of the text. You can view it online here:...". The PDF also has several hyperlinks that might cause issues for reader accessibility guidelines. Pages 284-285 are distorted.

Minor grammatical errors present throughout text.

The text does not appear to be culturally insensitive or offensive in any way.

The addition of a comprehensive glossary section, chapter learning outcomes/objectives, review questions, and case studies may be useful to students. Text would make a great review source for students.

Reviewed by Leah Gautreaux, MLT Program Director/Instructor, Fletcher on 12/12/19

Does not explain RBC, Hct, Hb. Students may not be fully aware of what these basic terms mean. Other than that, the book seems pretty comprehensive. In the Plt section, there are no images of normal platelets on PBS. RBC indices are also used... read more

Comprehensiveness rating: 3 see less

Does not explain RBC, Hct, Hb. Students may not be fully aware of what these basic terms mean. Other than that, the book seems pretty comprehensive.

In the Plt section, there are no images of normal platelets on PBS. RBC indices are also used as a quality control check which is not mentioned in the part of the text that explains this.

Nucleus description for Basophilic Normoblast states: “indistinct nuclei or not visible” Contradicts 6:1 nucleus to cytoplasm ratio stated earlier.

May-Hegglin Anomaly is described as a Plt disorder but is listed under WBC: Non-Malignant Leukocyte Disorders

MCV calculation indicates units for HCT is “L/L”. These are the SI units, but HCT is usually reported as “%”.

I see no blatant problems with relevance.

Clarity rating: 4

I like the outline version of this book. I think students would also find it very helpful and easy to navigate.

Not all terms are explained fully. Ex. There is no obvious explanation for some basic terms such as CBC, RBC, Hct, and Hb which would be helpful for students. Other terms like spectrin are used without explanation as well. Students may not be familiar with these terms.

The book provides tips to remember certain material such as the Microcytic Disease states: TAILS is suggested as a way to remember the disorders.

The text is consistent with format throughout. Terminology is used consistently throughout as well. I could find no discrepancies with the use of terms from one part of the text to another.

This book is divided into small sections that are easily navigable. The content is kept simple and minimal. At times, the minimalistic nature could hinder a student who is unfamiliar with some of the terminology. I feel there should be a better explanation of some terms.

For the most part, topics are presented in a logical, clear fashion. An exception to this would be the introduction of the granulocytes; in particular eosinophils and basophils. A student who is unaware that granulocytes originate from the same cell line, may be confused at the sudden appearance of eos and basos in the maturation sequence.

Interface rating: 3

On the downloaded version, the pages are off. It looks like the page breaks are not honored. The images are very clear even when enlarged which is important with a textbook such as this. On the download version, many of the images can be viewed through links. This could be problematic in the absence of internet access. Even with access, the pictures download slowly and are difficult to navigate.

Grammatical Errors rating: 3

I found quite a few grammatical and/or spelling errors: 6 from pages 22 to 32.

I found no culturally biased information.

I would like to use this text as a secondary resource for my students, however, I do not feel it is ready as stand-alone, primary resource.

Table of Contents

• I. Red Blood Cells: Normal Morphology
• II. Red Blood Cells: Abnormal RBC Morphology
• III. Red Blood Cells: Abnormal RBC Inclusions
• IV. Red Blood Cells: Hypochromic, Microcytic Anemias
• V. Red Blood Cells: DNA Metabolism Abnormalities & Bone Marrow Failure
• VI. Red Blood Cells: Introduction to Hemolytic Anemias
• VII. Red Blood Cells: Hemoglobinopathies
• VIII. Red Blood Cells: Extrinsic Defects Causing Hemolytic Anemias
• IX. Red Blood Cells: Intrinsic Defects of the RBC Membrane Causing Hemolytic Anemia
• X. White Blood Cells and Platelets: Normal Morphology
• XI. White Blood Cells: Non-Malignant Leukocyte Disorders
• XII. White Blood Cells: Acute Leukemia
• XIII. White Blood Cells: Mature Lymphoid Neoplasms
• XIV. White Blood Cells: Myeloproliferative Neoplasms (MPN)
• XV. White Blood Cells: Myelodysplastic Syndromes (MDS)

Ancillary Material

About the book.

This is eBook will be constantly updated, edited, and reviewed as new emerging information arises.

About the Contributors

Valentin (Tino) Villatoro , MEd (HSE), BSc (MLS), MLT Assistant Professor & Clinical Coordinator Division of Medical Laboratory Science Department of Laboratory Medicine and Pathology Faculty of Medicine and Dentistry, University of Alberta

Michelle To Student Division of Medical Laboratory Science Department of Laboratory Medicine and Pathology Faculty of Medicine and Dentistry, University of Alberta

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Case report

Journal of Hematology & Oncology welcomes well-described reports of cases that include the following:

• Unreported or unusual side effects or adverse interactions involving medications
• Unexpected or unusual presentations of a disease
• New associations or variations in disease processes
• Presentations, diagnoses and/or management of new and emerging diseases
• An unexpected association between diseases or symptoms
• An unexpected event in the course of observing or treating a patient
• Findings that shed new light on the possible pathogenesis of a disease or an adverse effect

Case reports submitted to Journal of Hematology & Oncology should make a contribution to medical knowledge and must have educational value or highlight the need for a change in clinical practice or diagnostic/prognostic approaches. The journal will not consider case reports describing preventive or therapeutic interventions, as these generally require stronger evidence.

Authors are encouraged to describe how the case report is rare or unusual as well as its educational and/or scientific merits in the covering letter that accompanies the submission of the manuscript.

For case reports, Journal of Hematology & Oncology requires authors to follow the CARE guidelines . The CARE checklist should be provided as an additional file. Submissions received without these elements will be returned to the authors as incomplete.

Preparing your manuscript

The information below details the section headings that you should include in your manuscript and what information should be within each section.

Please note that your manuscript must include a 'Declarations' section including all of the subheadings (please see below for more information).

Title page 

The title page should:

• "A versus B in the treatment of C: a randomized controlled trial", "X is a risk factor for Y: a case control study", "What is the impact of factor X on subject Y: A systematic review, A case report etc."
• or, for non-clinical or non-research studies: a description of what the article reports
• if a collaboration group should be listed as an author, please list the Group name as an author. If you would like the names of the individual members of the Group to be searchable through their individual PubMed records, please include this information in the “Acknowledgements” section in accordance with the instructions below
• Large Language Models (LLMs), such as ChatGPT , do not currently satisfy our authorship criteria . Notably an attribution of authorship carries with it accountability for the work, which cannot be effectively applied to LLMs. Use of an LLM should be properly documented in the Methods section (and if a Methods section is not available, in a suitable alternative part) of the manuscript
•  indicate the corresponding author

The Abstract should not exceed 350 words. Please minimize the use of abbreviations and do not cite references in the abstract. The abstract must include the following separate sections:

• Background: why the case should be reported and its novelty
• Case presentation: a brief description of the patient’s clinical and demographic details, the diagnosis, any interventions and the outcomes
• Conclusions: a brief summary of the clinical impact or potential implications of the case report

Keywords 

Three to ten keywords representing the main content of the article.

The Background section should explain the background to the case report or study, its aims, a summary of the existing literature.

Case presentation

This section should include a description of the patient’s relevant demographic details, medical history, symptoms and signs, treatment or intervention, outcomes and any other significant details.

Discussion and Conclusions

This should discuss the relevant existing literature and should state clearly the main conclusions, including an explanation of their relevance or importance to the field.

List of abbreviations

If abbreviations are used in the text they should be defined in the text at first use, and a list of abbreviations should be provided.

Declarations

All manuscripts must contain the following sections under the heading 'Declarations':

Ethics approval and consent to participate

Consent for publication, availability of data and materials, competing interests, authors' contributions, acknowledgements.

• Authors' information (optional)

Please see below for details on the information to be included in these sections.

If any of the sections are not relevant to your manuscript, please include the heading and write 'Not applicable' for that section. 

Manuscripts reporting studies involving human participants, human data or human tissue must:

• include a statement on ethics approval and consent (even where the need for approval was waived)
• include the name of the ethics committee that approved the study and the committee’s reference number if appropriate

Studies involving animals must include a statement on ethics approval and for experimental studies involving client-owned animals, authors must also include a statement on informed consent from the client or owner.

See our editorial policies for more information.

If your manuscript does not report on or involve the use of any animal or human data or tissue, please state “Not applicable” in this section.

If your manuscript contains any individual person’s data in any form (including any individual details, images or videos), consent for publication must be obtained from that person, or in the case of children, their parent or legal guardian. All presentations of case reports must have consent for publication.

You can use your institutional consent form or our consent form if you prefer. You should not send the form to us on submission, but we may request to see a copy at any stage (including after publication).

See our editorial policies for more information on consent for publication.

If your manuscript does not contain data from any individual person, please state “Not applicable” in this section.

All manuscripts must include an ‘Availability of data and materials’ statement. Data availability statements should include information on where data supporting the results reported in the article can be found including, where applicable, hyperlinks to publicly archived datasets analysed or generated during the study. By data we mean the minimal dataset that would be necessary to interpret, replicate and build upon the findings reported in the article. We recognise it is not always possible to share research data publicly, for instance when individual privacy could be compromised, and in such instances data availability should still be stated in the manuscript along with any conditions for access.

Authors are also encouraged to preserve search strings on searchRxiv https://searchrxiv.org/ , an archive to support researchers to report, store and share their searches consistently and to enable them to review and re-use existing searches. searchRxiv enables researchers to obtain a digital object identifier (DOI) for their search, allowing it to be cited. 

Data availability statements can take one of the following forms (or a combination of more than one if required for multiple datasets):

• The datasets generated and/or analysed during the current study are available in the [NAME] repository, [PERSISTENT WEB LINK TO DATASETS]
• The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
• All data generated or analysed during this study are included in this published article [and its supplementary information files].
• The datasets generated and/or analysed during the current study are not publicly available due [REASON WHY DATA ARE NOT PUBLIC] but are available from the corresponding author on reasonable request.
• Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.
• The data that support the findings of this study are available from [third party name] but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of [third party name].
• Not applicable. If your manuscript does not contain any data, please state 'Not applicable' in this section.

More examples of template data availability statements, which include examples of openly available and restricted access datasets, are available here .

BioMed Central strongly encourages the citation of any publicly available data on which the conclusions of the paper rely in the manuscript. Data citations should include a persistent identifier (such as a DOI) and should ideally be included in the reference list. Citations of datasets, when they appear in the reference list, should include the minimum information recommended by DataCite and follow journal style. Dataset identifiers including DOIs should be expressed as full URLs. For example:

Hao Z, AghaKouchak A, Nakhjiri N, Farahmand A. Global integrated drought monitoring and prediction system (GIDMaPS) data sets. figshare. 2014. http://dx.doi.org/10.6084/m9.figshare.853801

With the corresponding text in the Availability of data and materials statement:

The datasets generated during and/or analysed during the current study are available in the [NAME] repository, [PERSISTENT WEB LINK TO DATASETS]. [Reference number]  

If you wish to co-submit a data note describing your data to be published in BMC Research Notes , you can do so by visiting our submission portal . Data notes support open data and help authors to comply with funder policies on data sharing. Co-published data notes will be linked to the research article the data support ( example ).

All financial and non-financial competing interests must be declared in this section.

See our editorial policies for a full explanation of competing interests. If you are unsure whether you or any of your co-authors have a competing interest please contact the editorial office.

Please use the authors initials to refer to each authors' competing interests in this section.

If you do not have any competing interests, please state "The authors declare that they have no competing interests" in this section.

All sources of funding for the research reported should be declared. If the funder has a specific role in the conceptualization, design, data collection, analysis, decision to publish, or preparation of the manuscript, this should be declared.

The individual contributions of authors to the manuscript should be specified in this section. Guidance and criteria for authorship can be found in our editorial policies .

Please use initials to refer to each author's contribution in this section, for example: "FC analyzed and interpreted the patient data regarding the hematological disease and the transplant. RH performed the histological examination of the kidney, and was a major contributor in writing the manuscript. All authors read and approved the final manuscript."

Please acknowledge anyone who contributed towards the article who does not meet the criteria for authorship including anyone who provided professional writing services or materials.

Authors should obtain permission to acknowledge from all those mentioned in the Acknowledgements section.

See our editorial policies for a full explanation of acknowledgements and authorship criteria.

If you do not have anyone to acknowledge, please write "Not applicable" in this section.

Group authorship (for manuscripts involving a collaboration group): if you would like the names of the individual members of a collaboration Group to be searchable through their individual PubMed records, please ensure that the title of the collaboration Group is included on the title page and in the submission system and also include collaborating author names as the last paragraph of the “Acknowledgements” section. Please add authors in the format First Name, Middle initial(s) (optional), Last Name. You can add institution or country information for each author if you wish, but this should be consistent across all authors.

Please note that individual names may not be present in the PubMed record at the time a published article is initially included in PubMed as it takes PubMed additional time to code this information.

Authors' information

This section is optional.

You may choose to use this section to include any relevant information about the author(s) that may aid the reader's interpretation of the article, and understand the standpoint of the author(s). This may include details about the authors' qualifications, current positions they hold at institutions or societies, or any other relevant background information. Please refer to authors using their initials. Note this section should not be used to describe any competing interests.

Footnotes can be used to give additional information, which may include the citation of a reference included in the reference list. They should not consist solely of a reference citation, and they should never include the bibliographic details of a reference. They should also not contain any figures or tables.

Footnotes to the text are numbered consecutively; those to tables should be indicated by superscript lower-case letters (or asterisks for significance values and other statistical data). Footnotes to the title or the authors of the article are not given reference symbols.

Always use footnotes instead of endnotes.

Examples of the Vancouver reference style are shown below.

See our editorial policies for author guidance on good citation practice

Web links and URLs: All web links and URLs, including links to the authors' own websites, should be given a reference number and included in the reference list rather than within the text of the manuscript. They should be provided in full, including both the title of the site and the URL, as well as the date the site was accessed, in the following format: The Mouse Tumor Biology Database. http://tumor.informatics.jax.org/mtbwi/index.do . Accessed 20 May 2013. If an author or group of authors can clearly be associated with a web link, such as for weblogs, then they should be included in the reference.

Example reference style:

Article within a journal

Smith JJ. The world of science. Am J Sci. 1999;36:234-5.

Article within a journal (no page numbers)

Rohrmann S, Overvad K, Bueno-de-Mesquita HB, Jakobsen MU, Egeberg R, Tjønneland A, et al. Meat consumption and mortality - results from the European Prospective Investigation into Cancer and Nutrition. BMC Medicine. 2013;11:63.

Article within a journal by DOI

Slifka MK, Whitton JL. Clinical implications of dysregulated cytokine production. Dig J Mol Med. 2000; doi:10.1007/s801090000086.

Article within a journal supplement

Frumin AM, Nussbaum J, Esposito M. Functional asplenia: demonstration of splenic activity by bone marrow scan. Blood 1979;59 Suppl 1:26-32.

Book chapter, or an article within a book

Wyllie AH, Kerr JFR, Currie AR. Cell death: the significance of apoptosis. In: Bourne GH, Danielli JF, Jeon KW, editors. International review of cytology. London: Academic; 1980. p. 251-306.

OnlineFirst chapter in a series (without a volume designation but with a DOI)

Saito Y, Hyuga H. Rate equation approaches to amplification of enantiomeric excess and chiral symmetry breaking. Top Curr Chem. 2007. doi:10.1007/128_2006_108.

Complete book, authored

Blenkinsopp A, Paxton P. Symptoms in the pharmacy: a guide to the management of common illness. 3rd ed. Oxford: Blackwell Science; 1998.

Online document

Doe J. Title of subordinate document. In: The dictionary of substances and their effects. Royal Society of Chemistry. 1999. http://www.rsc.org/dose/title of subordinate document. Accessed 15 Jan 1999.

Online database

Healthwise Knowledgebase. US Pharmacopeia, Rockville. 1998. http://www.healthwise.org. Accessed 21 Sept 1998.

Supplementary material/private homepage

Doe J. Title of supplementary material. 2000. http://www.privatehomepage.com. Accessed 22 Feb 2000.

University site

Doe, J: Title of preprint. http://www.uni-heidelberg.de/mydata.html (1999). Accessed 25 Dec 1999.

Doe, J: Trivial HTTP, RFC2169. ftp://ftp.isi.edu/in-notes/rfc2169.txt (1999). Accessed 12 Nov 1999.

Organization site

ISSN International Centre: The ISSN register. http://www.issn.org (2006). Accessed 20 Feb 2007.

Dataset with persistent identifier

Zheng L-Y, Guo X-S, He B, Sun L-J, Peng Y, Dong S-S, et al. Genome data from sweet and grain sorghum (Sorghum bicolor). GigaScience Database. 2011. http://dx.doi.org/10.5524/100012 .

Figures, tables and additional files

See  General formatting guidelines  for information on how to format figures, tables and additional files.

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Journal of Hematology & Oncology is the official journal of the Chinese American Hematologist and Oncologist Network .

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• Product Description

This compendium of 200 case studies is the result of a unique collaboration of leading hematologists, hematopathologists, and oncologists. It serves as both a case-based guide to the diagnosis and management of patients suffering from hematologic conditions and a valuable teaching tool.

The editors have compiled an invaluable collection of cases covering common and rare entities—from anemias and acute leukemias to plasma cell, platelet and coagulation disorders. Cases are presented in an easy-to-follow format, grouped by related conditions. The final two sections present 27 self-study challenge cases that include answers (with images) provided by the authors of each case.

A broad range of topics in hematology and coagulation are covered in this CaseSet, including:

• Myeloproliferative Disorders
• Myelodysplastic Syndromes
• Lymphoproliferative Disorders
• Lymphomas and Their Mimicks
• Plasma Cell Disorders
• Platelet Disorders
• Hematologic Infectious Diseases
• Other Hematologic Disorders
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• Other Hemostasis Disorders

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The Haematology curriculum for medical students is shown below. Click the image for a full-size version. To see an interactive version, click here .

Core Topics

This course is targeted at medical students and junior doctors.

Learning objectives: Describe normal coagulation Learn how to take a

Malignant Haematology

This course is designed to aid doctors who are preparing

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Our library of white papers and case studies help keep you abreast of the latest information in laboratory science and provide best practice examples of how integrated clinical care teams have identified challenges and addressed them in collaborative ways to achieve measurably better healthcare performance.

Hematology analyzers count and characterize blood cells for the screening and monitoring of disease. Analyzers vary in capabilities, sophistication and detection technologies. Since their invention in the 1950s, automated hematology analyzers have become increasingly sophisticated, allowing more precise and accurate CBC and WBC differential results.

The Complete Blood Count (CBC) is one of the most frequently performed laboratory tests. Many diseases can cause abnormalities in the Red Blood Cell (RBC) count; therefore, RBC concentration, as part of CBC, is frequently used in the diagnostic phase for many conditions and as a screening test. Review the technologies hematology analyzers utilize for counting and measuring volumes of RBCs.

The platelet (PLT) count plays a critical role for the diagnosis, treatment and monitoring of patients with many hematological and non-hematological diseases. Inaccuracy in PLT counting can have significant clinical impact, especially at the transfusion trigger levels. If the PLT count is falsely elevated, it could result in a missed PLT transfusion. On the other hand, if the PLT count is falsely decreased, it may lead to unnecessary PLT transfusion with all the hazards associated with it.

Since the first paper discussing the use of Sigma metrics in clinical laboratories was published in 2000, the concept of measuring analytical performance on the Sigma scale has been gaining popularity. The Six Sigma quality management system provides an objective estimate of quality based on defined tolerance limits. However, there are challenges associated with the use of Sigma metrics in the clinical laboratory, particularly in the hematology laboratory. As with any tool, its usefulness depends on proper use and interpretation.

As modern hematology laboratories may use various types of hematology analyzers depending on workload, technical resources, and staff, it is important for the user to understand inter-platform variability. This study has shown negligible inter-platform variability between the three studied instruments; CELL-DYN Emerald 22, CELL-DYN Ruby and CELL-DYN Sapphire, and demonstrated substantial equivalence of hematology results between them.

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Multiple Myeloma Methods and Protocols - Essay Example

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