This is a 55 year old woman who has fatigue.

Her onl
other symptom is a craving for chewing ice cubes. Ap
from being pale her examination is normal.

Test results
Hgb 77 g/L
MCV 66f/L
RBC 3.2 x1012/L
WBC 5.6 x106/L
Plat 525 x109/L

Blood film

Which one of the following tests would best define

the type of anemia she has ?
A. Hgb electropheresis
B. Serum iron and iron-binding capacity
C. Serum ferritin
D. Serum transferrin
E. Bone marrow iron

A 44 year old executive is sent to you for an insu

examination. He is fit, but on examination he has
hypertension.

Test results
Hgb 135 g/L
MCV 65 fL
RBC 5.4 x1012/L
WBC 6.5 x106/L
Plat 355 x109/L

Blood film

A 44 year old executive is sent to you for an insu

examination. He is fit, but on examination he has
hypertension.

Test results
Hgb 135 g/L
MCV 65 fL
RBC 5.4 x1012/L
WBC 6.5 x106/L
Plat 355 x109/L

Blood film
microcytosis
hypochromia
target
teardrop
basophilic stippling

Which test is likely to give a diagnosis in this case ?

A. Serum ferritin
B. Serum transferrin
C. Sickle Cell screen
D. Hgb electropheresis
E. Liver function tests

This is an 18 year old boy who you are investigating

Jaundice. He has this intermittently for some time. H
family are Christian Scientists. Physical exam shows
jaundice and splenomegaly

Test results
Hgb 99 g/L
MCV 100 fL
RBC 3.7 x1012/L
WBC 3.4 x106/L
Plat 117 x109/L
Retic count: elevated

bili 35 mol/L

Which of the following would be most helpful in

identifying this young mans problem ?
A. Reticulocyte count
B. Osmotic fragility test
C. DAT (Coombs test)
D. Bone marrow test
E. Family studies

This is an 18 year old boy who you are investigating

Jaundice. He has this intermittently for some time. H
family are Christian Scientists. Physical exam shows
jaundice and splenomegaly

Test results
Hgb 99 g/L
MCV 100 fL
RBC 3.7 x1012/L
WBC 3.4 x106/L
Plat 117 x109/L

bili 35 mol/L
blood film
polychromasia
spherocytes

A 46 year old diplomat is referred to you because o

abnormal blood results. On review of these you su
the cause and order appropriate blood tests.

Test results
Hgb 142 g/L
MCV 105 fL
RBC 4.9 x1012/L
WBC 6.7 x106/L
Plat 105 x109/L

Blood Film

A 46 year old diplomat is referred to you because o

abnormal blood results. On review of these you su
the cause and order appropriate blood tests.

Test results
Hgb 142 g/L
MCV 105 fL
RBC 4.9 x1012/L
WBC 6.7 x106/L
Plat 105 x109/L

Blood Film
Macrocytosis
Target cells
stomatocytes

What tests would you order on receiving these

results ?
A. Serum B12 and folate
B. Bone marrow aspirate
C. Serum lipid studies
D. Liver function tests
E. Thyroid function tests

A 65 year old woman is referred to you because of m

loss. Her family physician had received tests which inc
bilirubin of 28 mol/L and an LDH of 1560 U/L. He wa
puzzled by these results.

Test results
Hgb 85 g/L
MCV 110 fL
RBC 3.9 x1012/L
WBC 2.4 x106/L
Plat 89 x109/L
Retic count low

A 65 year old woman is referred to you because of m

loss. Her family physician had received tests which inc
bilirubin of 28 mol/L and an LDH of 1560 U/L. He wa
puzzled by these results.

Test results
Hgb 85 g/L
MCV 110 fL
RBC 3.9 x1012/L
WBC 2.4 x106/L
Plat 89 x109/L

Blood Film
Macrocytosis
oval macroytes
hypersegmented
neutrophils

Which one of the following tests is most

appropriate ?
A. Liver function
B. Thyroid function
C. RBC folate
D. Serum B12
E. Bone marrow aspirate

A 65 year old woman complains of back pain. Her Xshow diffuse osteoporosis. She also complains of incr
thirst and drowsiness.

Test results
Hgb 103 g/L
MCV 99 fL
RBC 3.8 x1012/L
WBC 3.4 x106/L
Plat 125 x109/L
Retic normal

A 65 year old woman complains of back pain. Her Xshow diffuse osteoporosis. She also complains of incr
thirst and drowsiness.

Test results
Hgb 103 g/L
MCV 99 fL
RBC 3.8 x1012/L
WBC 3.4 x106/L
Plat 125 x109/L

Blood Film
rouleaux
background
staining

Which one of these tests would most likely

lead to the diagnosis ?
A. Serum osmolarity
B. Serum viscosity
C. Serum protein electrophersis
D. Serum TSH
E. Serum PTH

You admit a 36 year old woman with pneumonia. She

fever, shortness of breath and requires oxygen. She i
noted to be anemic.

Test results
Hgb 115 g/L
MCV 115 fL
RBC 2.2 x1012/L
WBC 8.4 x106/L
Plat 246 x109/L
Retic count:
elevated

You admit a 36 year old woman with pneumonia. She

fever, shortness of breath and requires oxygen. She i
noted to be anemic.

Test results
Hgb 115 g/L
MCV 115 fL
RBC 2.2 x1012/L
WBC 8.4 x106/L
Plat 246 x109/L

Blood Film
RBC agglutination

These test results would help you choose which

one of these antibiotics ?
A. Cephalexin
B. Penicillin G
C. Azithromycin
D. Sulfamethoxazole
E. Ciprofloxacin

An 18 year old woman has symptoms of cystitis. After

cultures are taken she is given Sulfamethoxazole. Her
symptoms improve but she becomes short of breath.
later on follow-up her investigation shows.

Test results
Hgb 75 g/L
MCV 107fL
RBC 2.8 x1012/L
WBC 8.9 x106/L
Plat 377 x109/L

Blood Film

An 18 year old woman has symptoms of cystitis. After

cultures are taken she is given Sulfamethoxazole. Her
symptoms improve but she becomes short of breath.
later on follow-up her investigation shows.

Test results
Hgb 75 g/L
MCV 107fL
RBC 2.8 x1012/L
WBC 8.9 x106/L
Plat 377 x109/L

Blood Film
polyychromasia
blister
bite cells

What type of anemia is causing this problem ?

A. An idiosyncratic drug reaction
B. An allergic drug reaction
C. Marrow suppressive effect
D. Immune hemolysis
E. Oxidative hemolysis

You are called to see this 29 year old primip in the c

room. The obstetrician is concerned about her platel
count. She is well but a bit hypertensive.

Test results
Hgb 115 g/L
MCV 91 fL
RBC 4.1 x1012/L
WBC 14.5 x106/L
Plat
52 x109/L

You are called to see this 29 year old primip in the c

room. The obstetrician is concerned about her platel
count. She is well but a bit hypertensive.

Test results
Hgb 115 g/L
MCV 91 fL
RBC 4.1 x1012/L
WBC 14.5 x106/L
Plat
52 x109/L

Blood Film
polychromasia
rbc fragments
thrombocytopenia

What diagnosis is most likely ?

A. ITP ( immune thrombocytopenia )
B. TTP ( thrombotic thrombocytopenic purpura)
C. PIH (pre-eclampsia)
D. Benign thrombocytopenia of pregnancy
E. DIC (disseminated intravascular coagopathy)

This 35 year old man is sent to you because of unusu

blood results. His complaints are of fatigue and an ep
itchy rash.

Test results
Hgb 115 g/L
MCV 105 fL
RBC 3.8 x1012/L
WBC 9.2 x106/L
Plat 420 x109/L

Blood Film

You are asked to asses a 72 year old woman for anem

and splenomegaly. She has been losing weight for 1 y
She has had 2 episodes of gout.

Test results
Hgb 99 g/L
MCV 96 fl
RBC 3.4 x1012/L
WBC 3.65 x106/L
Plat 560 x109/L
Retic: low

You are asked to asses a 72 year old woman for anem

and splenomegaly. She has been losing weight for 1 y
She has had 2 episodes of gout.

Test results
Hgb 99 g/L
MCV 96 fl
RBC 3.4 x1012/L
WBC 3.65 x106/L
Plat 560 x109/L

Blood Film
thromboytosis
tear drop cells
leukoerythroblstic

What test would give a definitive diagnosis ?

A. LAP score
B. Osmotic fragility
C. Hgb electropheresis
D. Bone scan
E. Bone marrow biopsy

splenomegaly

Hematologic conditions
Myelofibrosis
Some hemolytic anemias
Myeloproliferative conditions
leukemia
Lymphomas

Non-hematologic
Congestive (cirrhosis)
Infiltrative: malignant, non-malignant
Infectious (mono)
Inflammatory:

Lymphadenopathy
Abnormal in size, consistency, number
Generalized
Localized

uptodate

This 24 year old man has acute abdominal pain. He h

been feeling well for 5 days. After a baseball game he
acute upper abdominal pain and was quite tender in
abdomen. The surgeon asks you to see the patient.

Test results
Hgb 136 g/L
MCV 88 fL
RBC 4.9 x1012/L
WBC 17.3 x106/L
Plat 110 x109/L

Blood Film

This 24 year old man has acute abdominal pain. He h

been feeling well for 5 days. After a baseball game he
acute upper abdominal pain and was quite tender in
abdomen. The surgeon asks you to see the patient.

Test results
Hgb 136 g/L
MCV 88 fL
RBC 4.9 x1012/L
WBC 17.3 x106/L
Plat 110 x109/L

Blood Film
variant lymphocytes
atypical
reactive

What is the disorder most likely responsible for

his condition ?
A. Acute leukemia
B. Pancreatitis
C. Malaria
D. Infectious mononucleosis
E. Liver abcess

This 55 year old man is referred for unexplained ele

White cell count. He feels well. Examination is norm

Test results
Hgb 139 g/L
MCV 93 fL
RBC 5.1 x1012/L
WBC 29 x106/L
Plat 178 x109/L

Blood Film

This 55 year old man is referred for unexplained ele

White cell count. He feels well. Examination is norm

Test results
Hgb 139 g/L
MCV 93 fL
RBC 5.1 x1012/L
WBC 29 x106/L
Plat 178 x109/L

Blood Film
Lymphocytosis
Smudge cells

What test would confirm your diagnosis ?

A. Mono spot test

B. LAP score
C. Bone marrow biopsy
D. Immunophenotyping
E. Skeletal survey

This 36 year old man is admitted to hospital with gen

bruising and bleeding. He is febrile. There are many b
and petichia present.

Test results
Hgb 92 g/L
MCV 81 fL
RBC 3.4 x1012/L
WBC 5.2 x106/L
Plat 13 x109/L

Blood Film

This 36 year old man is admitted to hospital with gen

bruising and bleeding. He is febrile. There are many b
and petichia present.

Test results
Hgb 92 g/L
MCV 81 fL
RBC 3.4 x1012/L
WBC 5.2 x106/L
Plat 13 x109/L

Blood Film
Cytopenias
Blasts

What disease is most responsible for his

condition ?
A. Septicemia
B. Drug reaction
C. Infectious mononucleosis
D. Chronic leukemia
E. Acute leukemia

This is a 35 year old male who is found to

have persistent leukocytosis. His family
physician wants you to rule out a Chronic
leukemia.
Test Results
Blood Film
HGB 146 g/L
MCV
92 fL
RBC 5.5x1012/L
WBC 25X106/L
Plat
465x109/L

This is a 35 year old male who is found to

have persistent leukocytosis. His family
physician wants you to rule out a Chronic
leukemia.
Test Results
Blood Film
HGB 146 g/L
Normocytic
MCV
Normochromic
92 fL
RBC 5.5x1012/L
Neutrophilia
WBC 25X106/L
Metamyelocyte
Plat
465x109/L

What test would be most cost effective in

helping to establish a diagnosis ?
A. Immunophenotyping
B. Leukocyte alkaline phosphatase
C. Bone marrow aspirate
D. Cytogenetics
E. Blood cultures

A 25 year old female university student is

found to have a very low hemoglobin. She
in fact feels fairly well. Physical exam
shows
pallor only.

Blood Film
Test Results
HGB 7.1 g/L
MCV 80 fL
RBC 2.7x1012/L
WBC 6.3x106/L
Plat 345x109/L

A 25 year old female university student is

found to have a very low hemoglobin. She
in fact feels fairly well. Physical exam
shows
pallor only.

Blood Film
Test Results
HGB 7.1 g/L
Irreg contracted
MCV 80 fL
Burr cells
RBC 2.7x1012/L
WBC 6.3x106/L
Plat 345x109/L

Which test do you think will give the

diagnosis ?
A. Iron studies
B. Reticulocyte count
C. Endocrine studies
D. Liver function
E. Renal function

A 50 y.o male presents with an elevated

hematocrit, splenomegaly, and pruritus
following shower
Test results
Hb 195, HCT 0.60
Platelets 500
WBC 7.0

Which test is indicated?

A. iron studies
B. B12 levels
C. Serum epo
D. Jak 2 mutation testing
E. BCR-ABL testing