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Hths 2231
Laboratory 5
Blood
Watch Movie: Anemia
Answer the movie questions on the worksheet.
Complete activities 1-2.
Activity #1:
• Go to the Patho lab page.
• Click on Hematopathology Images
• Click on Systemic Pathology
• Click on Hematopathology
• Review standard peripheral blood (6-12) and bone marrow slides (1-5).
Activity #2:
Complete the 15 case studies on the attached worksheet. Use the links
to the slides on the patho lab page to view slides that correlate to the
case studies.
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Hthsci 2231 Lab 5
Hths 2231
Laboratory 5
Blood
1. Anemia can be defined as:
2. What molecule in RBC’s carries oxygen to the cells of the body?
3. What percentage of RBC’s are replaced daily?
4. Anemia occurs when the balance between the ___________ of RBC’s and
the______________ of RBC’s is upset.
5. What is the incidence of anemia in industrialized countries?
6. The most common type of anemia is ____________________________ and is
caused by _____________________________ or ______________.
7. What vitamin deficiency is present in pernicious anemia?
8. In pernicious anemia, the size of the RBC’s will be _______________?
9. List two causes of folic acid deficiency.
10. List 3 causes of hemolytic anemia.
11. Beta-thalassemia is predominant in what population of people?
12. ___________ anemia is an example of anemia caused by insufficient production of
RBC’s.
Hthsci 2231
Laboratory 5
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Blood
Hthsci 2231 Lab 5
Hths 2231
Laboratory 5
Blood
Case #1. This bone marrow shows markedly reduced RBC’s, platelets, and
granulocytes. The patient had repeated exposure to benzene (bone marrow
toxic) in the manufacturing plant in which he was employed. Your diagnosis is?
(see case slide 1)
Case #2. A 5 year-old boy has been too tired to play with his friends for two
months. His mother is also worried that, whenever he falls or bumps
into anything, a big bruise forms. For the past two days he has had a high
fever. Physical exam shows bruising, a slightly enlarged spleen, and pain when
the physician presses on the child’s sternum.
A CBC was ordered with the following results:
Patient Values
Normal Values
WBC
75.6x10³/mm³
5.0-10.0x10³/mm³
RBC
2.41x10³/mm³
4.0-6.0 x 106 /mm³
Hb
7.0gm/dl
14-16gm/dl
Hct
21.0%
40-54%
MCV
87 fl
80-96 fl
MCH
29.0 pg.
27-32 pg.
MCHC
33.3 gm/dl
32-36 gm/dl
Platelets
29x10³/mm³
150-400x10³/mm³
The peripheral smear showed many immature lymphocytes (See case slide #2).
Your diagnosis is?
Case # 3. A 48year-old man has become progressively more fatigued at the end
of the day. This has been going on for months. In the past month he
has noted tingling and numbness in his hands and feet. He has also been
experiencing increasing gastrointestinal pain.
CBC results:
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Hthsci 2231 Lab 5
Hths 2231
Laboratory 5
Blood
Patient Values
Normal Values
WBC
12.1x10³/mm³
5.0-10.0x10³/mm³
RBC
2.69x10³/mm³
4.0-6.0 x 106 /mm³
Hb
10.6 gm/dl
14-16gm/dl
Hct
31.6%
40-54%
MCV
117.6 fl
80-96 fl
MCH
39.6 pg
27-32 pg
MCHC
33.7 gm/dl
32-36 gm/dl
Platelets
578x10³/mm³
150-400x10³/mm³
Peripheral smear: See case slide #3
a. From the slide and the RBC indices, how would you describe the
appearance of the RBC’s?
b. What disease would you suspect based on the patient’s symptoms and CBC
results?
c. What is the underlying cause of this disease?
d. Can you recommend treatment?
Case #4. A 27 year-old woman presented to you, her physician, with a
month-long history of chest pain. She complained of waking in night sweats,
itching, and recent weight loss. On physical examination, you noted
lymphadenopathy in the neck. You order a routine chest radiograph and a CBC.
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Hthsci 2231 Lab 5
Hths 2231
Laboratory 5
Blood
The chest x-ray shows a large anterior mediastinal mass. (See case slide 4a).
CBC results show a WBC count of 6350/mm³, Hgb 13.1 g/dL, Hct 39.5%, MCV
91 fL, and platelet count 215,000/mm³. (See normal values in case slides #2
and #3).
A biopsy of a lymph node shows small lymphocytes mixed with some large cells
with lobulated nuclei, or with multinucleated cells that have prominent nucleoli.
Some of these large cells appear to be lying in a space (lacunar Reed-Sternberg
cells). See slide 4b.
a. What is your diagnosis?
b. What treatment do you recommend?
c. What is the prognosis for your patient?
Case # 5. A 20 year-old African-American man comes to the emergency room
because of the onset of severe abdominal pain. He indicates to the admitting
clerk that he has recently moved to Utah from the east coast.
A CBC shows Hgb 4.8 g/dL, Hct 12.8%, MCV 80 fL, platelets 205,000/mm³, and
WBC count 9800/mm³ (See normal values in case #2 and #3). The differential
count shows 12 nucleated red blood cells per 100 WBC's. Examination of the
peripheral smear shows numerous sickled erythrocytes.
See case slides 5a and 5b.
a. What is the diagnosis from these findings?
b. The "crisis" in this patient was initiated by:
Case #6. A 52 year-old man had gradually increasing fatigue together with
discomfort in the left upper quandrant. Physical examination revealed an easily
palpable spleen and liver edge. A few slightly enlarged lymph nodes were
palpable in the neck.
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Hthsci 2231 Lab 5
Hths 2231
Laboratory 5
Blood
CBC results shows Hgb 13.2 g/dl, WBC 46.0 X 103/mm3, and platelet count
754 x10³/mm3 (See case slides 2 and 3 for normal values).
Peripheral blood smears demonstrated increased numbers of granulocytes,
mostly mature forms, as well as increased platelets. See case slides 6a and 6b.
Cytogenetic studies on a bone marrow aspirate identified the presence of the
Philadelphia chromosome.
What is your diagnosis of this case?
Case #7. A 72 year-old man has the following findings on a CBC:
Patient Values
Normal Values
WBC
7.5 x10³/mm³
5.0-10.0x10³/mm³
RBC
3.3x10³/mm³
4.0-6.0 x 106 /mm³
Hb
9.7 gm/dl
14-16gm/dl
Hct
29.9%
40-54%
MCV
70 fl
80-96 fl
MCH
23 pg
27-32 pg
MCHC
32 gm/dl
32-36 gm/dl
Platelets
239x10³/mm³
150-400x10³/mm³
The peripheral blood smear shows red blood cells with hypochromasia and
microcytosis. See case slide 7.
a. What is the diagnosis from these findings?
b. Can you recommend treatment?
Case #8. A 15 year-old girl was sent home from summer camp because of
weakness, lassitude, and sore throat. As her family physician, you found
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Hthsci 2231 Lab 5
Hths 2231
Laboratory 5
Blood
that on physical examination she had an inflamed pharynx, enlarged tonsils,
several enlarged and slightly tender lymph nodes in the neck, a palpable spleen,
and a tender palpable liver edge.
CBC showed Hgb 14.9 g/dl, WBC 12.5 x10³/mm³, and platelet count
282 x10³/mm³ (see case slide 7 for normal values). See case slide 8 for the
peripheral blood smear.
a. What is the predominant white blood cell type?
b. What is your diagnosis in this case?
c. What laboratory test would confirm your diagnosis?
d. How would you treat this patient?
Case #9. A 6 month-old infant is brought to the family physician. The child is
very lethargic. The physician noted an elevated heart rate and blood pressure.
A CBC showed Hgb 6.0 g/dl, Hct of 18%, and an MCV of 65. Peripheral blood
smear showed the following (see case slide 9).
a. Describe the RBC’s seen in the smear.
Hemoglobin electrophoresis showed diminished amounts of the hemoglobin beta
chain.
b. What is your diagnosis?
c. Can you recommend treatment?
Case #10. An 8 year-old child is brought to the emergency room with a
nosebleed that won’t stop. The physician noted a petechial rash upon physical
examination. CBC results showed a markedly decreased platelet level. The
bleeding time is prolonged. What is your diagnosis?
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Hthsci 2231 Lab 5
Hths 2231
Laboratory 5
Blood
Case #11. This 30 year-old man had noticed progressive weakness for one
month. On physical examination, a few small lymph nodes were palpable in both
axillae, and the tip of the spleen was palpable. There was also sternal
tenderness present.
CBC showed Hgb 10.2 g/dl, WBC 67.0 x10³/mm³ , and platelet count
36 x10³/mm³ (see case 7 for normal values). This peripheral smear
demonstrates myeloblasts with Auer rods ( See case slide 11).
What is your diagnosis?
Case #12. A 66 year-old man had been complaining of back pain for several
months, for which he had taken non-steroidal anti-inflammatory medications.
He had been treated for approximately six months for low back pain.
Radiographs revealed a lytic bone lesion in the right posterior iliac crest as well
as multiple lytic lesions of the skull and vertebral column.
See case slide 12a showing a lytic lesion of the skull.
Case slide 12b shows rounded lesions in the skull.
The CBC showed a WBC count of 5.0 x10³/mm³, Hgb 10.8 g/dL, Hct 32.2%,
MCV 89 fL, and platelet count 135,000/mm³ (See normal values case #7).
Serum chemistry results showed an elevated total serum protein with a normal
albumin level. Protein was present in the urine.
A bone marrow biopsy showed that the bone marrow is nearly replaced by
plasma cells and is virtually 100% cellular, rather than the 40% expected at this
site for the patient's age (See slide 12c).
a. What is your diagnosis in this case?
b. Why is the patient demonstrating lytic bone lesions?
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Hthsci 2231 Lab 5
Hths 2231
Laboratory 5
Blood
Case #13. John Smith bled more than his physicians anticipated during surgery.
In the recovery room, his blood pressure began to drop. A CBC showed the
following:
Patient Values
Normal Values
WBC
9.9 x10³/mm³
5.0-10.0x10³/mm³
RBC
3,81x10³/mm³
4.0-6.0 x 106 /mm³
Hb
11.1 gm/dl
14-16gm/dl
Hct
33.3%
40-54%
MCV
87 fl
80-96 fl
MCH
29 pg
27-32 pg
MCHC
33 gm/dl
32-36 gm/dl
Platelets
239x10³/mm³
150-400x10³/mm³
a. Describe this patient’s anemia
b. Why is the patient’s blood pressure dropping?
Case #14. A 65 year-old man was in good health except for mild hypertension.
At his last check-up, a CBC showed a markedly elevated white blood cell count
and physical examination revealed several slightly enlarged lymph nodes in the
neck and the axillae, and the spleen was palpable.
CBC results showed Hgb 12.8 g/dl, WBC 130 x10³/mm³, and platelet count
330 x10³/mm³ (See case slide 13 for normal values). The peripheral smear
shows increased numbers of small mature lymphocytes (See cse slide 14).
What is your diagnosis?
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Hthsci 2231 Lab 5
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Case #15. A 20 year-old college student presented to the emergency room
with general malaise, low-grade fever, and purplish discoloration on his face.
The facial discoloration developed rapidly during the time from when he left his
house to the time he arrived at the emergency room.
See case slide 15a
See case slide 15b
See case slide 15c
A CBC and blood cultures were drawn. A spinal tap was performed to obtain
cerebrospinal fluid. The patient was admitted to the intensive care unit. He
was begun on antibiotics and given fresh frozen plasma, cryoprecipitate,
and intravenous fluid.
The CBC showed an elevated WBC with a large percentage of immature
neutrophils. Gram stains from the CSF and blood cultures showed gramnegative diplococci. (See slide case 15d). A DIC screen came back positive.
a. What caused the purplish discoloration in this patient?
b. Explain what triggered Disseminated Intravascular Coagulation
(DIC) in this patient
c. Explain what happens in DIC. See the DIC links on the lab
webpage.
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Hths 2231
Laboratory 5
Blood
ANSWERS TO ANEMIA MOVIE WORKSHEET
1. Anemia can be defined as: A DEFICIT IN OXYGEN CARRYING RBCs
2. What molecule in RBC’s carries oxygen to the cells of the body?
IRON MOLECULES IN HEMOGLOBIN ATTRACT AND BIND OXYGEN
3. What percentage of RBC’s are replaced daily? 1%
4. Anemia occurs when the balance between the ___________ of RBC’s and
the______________ of RBC’s is upset.
PRODUCTION; DESTRUCTION
5. What is the incidence of anemia in industrialized countries? 8%
6. The most common type of anemia is ____________________________
and is caused by _____________________________ or ______________.
IORN DEFICIENCY ANEMIA; DIET LACKING IRON; HEMORRHAGES
7. What vitamin deficiency is present in pernicious anemia?
VITAMIN B12
8. In Pernicious anemia, the size of the RBC’s will be _______________?
OVERENLARGED OR MACROCYTIC
9. List two causes of folic acid deficiency.
MALNUTRITION; CHRONIC ALCOHOLISM
10. List 3 causes of hemolytic anemia.
FRAGILE RBCs; ANTIBODIES AGAINST RBCs; HYPERACTIVITY OF THE
SPLEEN
11. Beta-thalassemia is predominant in what population of people?
MEDITERRANEAN
12. ___________ anemia is an example of anemia caused by insufficient
production of RBC’s.
APLASTIC
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ANSWERS TO CASE STUDIES WORKSHEET
Case #1. This bone marrow shows markedly reduced RBC’s, platelets, and
granulocytes. The patient had repeated exposure to Benzene in the
manufacturing plant in which he was employed. Your diagnosis is? (see case
slide 1) APLASTIC ANEMIA DUE TO BENZENE EXPOSURE
Case #2. A 5-year-old boy has been too tired to play with his friends for two
months. His mother is also worried that, whenever he falls or bumps into
anything, a big bruise forms. For the past two days he has had a high fever.
Physical exam shows bruising, a slightly enlarged spleen, and pain when the
physician presses on the child’s sternum.
A CBC was ordered with the following results:
Patient Values
Normal Values
WBC
75.6x10³/mm³
5.0-10.0x10³/mm³
RBC
2.41x10³/mm³
4.0-6.0 x 106 /mm³
Hb
7.0gm/dl
14-16gm/dl
Hct
21.0%
40-54%
MCV
87 fl
80-96 fl
MCH
29.0 pg
27-32 pg
MCHC
33.3 gm/dl
32-36 gm/dl
Platelets
29x10³/mm³
150-400x10³/mm³
The peripheral smear showed many immature lymphocytes (See case slide #2).
1. Your diagnosis is? ACUTE LYMPHOCYTIC LEUKEMIA
Case # 3. A 48 year-old man has become progressively more fatigued at the
end of the day. This has been going on for months. In the past month he
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Hthsci 2231 Lab 5
Hths 2231
Laboratory 5
Blood
has noted tingling and numbness in his hands and feet. He has also been
experiencing increasing gastrointestinal pain.
CBC results:
Patient Values
Normal Values
WBC
12.1x10³/mm³
5.0-10.0x10³/mm³
RBC
2.69x10³/mm³
4.0-6.0 x 106 /mm³
Hb
10.6 gm/dl
14-16gm/dl
Hct
31.6%
40-54%
MCV
117.6 fl
80-96 fl
MCH
39.6 pg
27-32 pg
MCHC
33.7 gm/dl
32-36 gm/dl
Platelets
578x10³/mm³
150-400x10³/mm³
Peripheral smear: See case slide #3
e. From the slide and the RBC indices, how would you describe the
appearance of the RBC’s? MACROCYTIC, NORMOCHROMIC
f. What disease would you suspect based on the patient’s symptoms and CBC
results? PERNICIOUS ANEMIA
g. What is the underlying cause of this disease? VITAMIN B12
DEFICIENCY
h. Can you recommend treatment? VITAMIN B12 INJECTIONS
Case #4. A 27 year-old woman presented to you, her physician, with a
month-long history of chest pain. She complained of waking in night sweats,
itching, and recent weight loss. On physical examination, you noted
lymphadenopathy in the neck. You order a routine chest radiograph and a CBC.
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Hthsci 2231 Lab 5
Hths 2231
Laboratory 5
Blood
The chest x-ray shows a large anterior mediastinal mass. (See case slide 4a).
CBC results show a WBC count of 6350/mm³, Hgb 13.1 g/dL, Hct 39.5%, MCV
91 fL, and platelet count 215,000/mm³. (See normal values in case slides #2
and #3).
A biopsy of a lymph node shows small lymphocytes mixed with some large cells
with lobulated nuclei, or with multinucleated cells that have prominent nucleoli.
Some of these large cells appear to be lying in a space (lacunar Reed-Sternberg
cells). See slide 4b.
d. What is your diagnosis? HODGKIN DISEASE
e. What treatment do you recommend? CHEMOTHERAPY AND
RADIATION
f. What is the prognosis for your patient? 5 YEAR SURVIVAL RATE IS
82%
Case # 5. A 20 year-old African-American man comes to the emergency room
because of the onset of severe abdominal pain. He indicates to the admitting
clerk that he has recently moved to Utah from the east coast.
A CBC shows Hgb 4.8 g/dL, Hct 12.8%, MCV 80 fL, platelets 205,000/mm³, and
WBC count 9800/mm³ (See normal values in case #2 and #3). The differential
count shows 12 nucleated red blood cells per 100 WBC's. Examination of the
peripheral smear shows numerous sickled erythrocytes.
See case slides 5a and 5b.
c. What is the diagnosis from these findings? SICKLE CELL ANEMIA
(HGB SS).
d. The "crisis" in this patient was initiated by: DECREASED O2 DUE TO
HIGH ELEVATION
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Hthsci 2231 Lab 5
Hths 2231
Laboratory 5
Blood
Case #6. A 52 year-old man had gradually increasing fatigue together with
discomfort in the left-upper quandrant. Physical examination revealed an easily
palpable spleen and liver edge. A few slightly enlarged lymph nodes were
palpable in the neck.
CBC results shows Hgb 13.2 g/dl, WBC 46.0 X 103/mm3, and platelet count
754 x10³/mm³ (See case slides 2 and 3 for normal values).
Peripheral blood smears demonstrated increased numbers of granulocytes,
mostly mature forms, as well as increased platelets.
See case slides 6a and 6b.
Cytogenetic studies on a bone marrow aspirate, identified the presence of the
Philadelphia chromosome.
What is your diagnosis of this case? CHRONIC MYELOCYTIC LEUKEMIA
(CML)
Case #7. A 72 year-old man has the following findings on a CBC:
Patient Values
Normal Values
WBC
7.5 x10³/mm³
5.0-10.0x10³/mm³
RBC
3.3x10³/mm³
4.0-6.0 x 106 /mm³
Hb
9.7 gm/dl
14-16gm/dl
Hct
29.9%
40-54%
MCV
70 fl
80-96 fl
MCH
23 pg
27-32 pg
MCHC
32 gm/dl
32-36 gm/dl
Platelets
239x10³/mm³
150-400x10³/mm³
The peripheral blood smear shows red blood cells with hypochromasia and
microcytosis. See case slide 7.
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Hthsci 2231 Lab 5
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a. What is the diagnosis from these findings? HYPOCHROMIC
MICROCYTIC ANEMIA (FROM PROBABLE IRON DEFICIENCY).
b. Can you recommend treatment? ORAL IRON THERAPY. IN SEVERE
CASES BLOOD TRANSFUSION MAY BE NECESSARY.
Case #8. A 15 year-old girl was sent home from summer camp because of
weakness, lassitude, and sore throat. As her family physician, you found
that on physical examination she had an inflamed pharynx, enlarged tonsils,
several enlarged and slightly tender lymph nodes in the neck, a palpable spleen,
and a tender palpable liver edge.
CBC showed Hgb 14.9 g/dl, WBC 12.5 x10³/mm³, and platelet count
282 x10³/mm³ (see case slide 7 for normal values). See case slide 8 for the
peripheral blood smear.
a. What is the predominant white blood cell type? ATYPICAL
LYMPHOCYTES.
b. What is your diagnosis in this case? THE DIAGNOSIS IS
INFECTIOUS MONONUCLEOSIS.
c. What laboratory test would confirm your diagnosis? A SEROLOGIC
TEST (MONO SPOT) FOR HETEROPHILE ANTIBODIES
d. How would you treat this patient? TREAT SYMPTOMS.
Case #9. A 6 month-old infant is brought to the family physician. The child is
very lethargic. The physician noted an elevated heart rate and blood pressure.
A CBC showed Hgb 6.0 g/dl, Hct of 18%, and an MCV of 65. Peripheral blood
smear showed the following (see case slide 9).
a. Describe the RBC’s seen in the smear. RBC’S ARE MICROCYTIC WITH
VARIATION IN SIZE (ANISOCYTOSIS) AND ABNORMAL SHAPE
(POIKILOCYTOSIS). SOME RESEMBLE JIGSAW PUZZLE PIECES.
Hemoglobin electrophoresis showed diminished amounts of the hemoglobin
beta chain.
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d. What is your diagnosis? BETA-THALASSEMIA
e. Can you recommend treatment? BLOOD TRANSFUSIONS IN
COMBINATION WITH IRON CHELATION THERAPY. A
SPLENECTOMY WOULD REDUCE THE NEED FOR TRANSFUSIONS
AS THE RED BLOOD CELLS ARE HEMOLYZED IN THE SPLEEN.
Case #10. An 8 year-old child is brought to the emergency room with a
nosebleed that won’t stop. The physician noted a petechial rash upon physical
examination. CBC results showed a markedly decreased platelet level. The
bleeding time is prolonged. What is your diagnosis? IDIOPATHIC
THROMBOCYTOPENIC PURPURA (ITP)
Case #11. This 30 year-old man had noticed progressive weakness for one
month. On physical examination, a few small lymph nodes were palpable in both
axillae, and the tip of the spleen was palpable. There was also sternal
tenderness present.
CBC showed Hgb 10.2 g/dl, WBC 67.0 x10³/mm³, and platelet count
36 x10³/µL (see case 7 for normal values). This peripheral smear demonstrates
myeloblasts with Auer rods ( See case slide 11).
What is your diagnosis? ACUTE MYELOCYTIC LEUKEMIA (AML)
Case #12. A 66 year-old man had been complaining of back pain for several
months, for which he had taken non-steroidal anti-inflammatory medications.
He had been treated for approximately six months for low back pain.
Radiographs revealed a lytic bone lesion in the right posterior iliac crest as well
as multiple lytic lesions of the skull and vertebral column.
See case slide 12a showing a lytic lesion of the skull.
Case slide 12b shows rounded lesions in the skull.
The CBC showed a WBC count of 5.0 x10³/mm³, Hgb 10.8 g/dL, Hct 32.2%,
MCV 89 fL, and platelet count 135,000/mm³ (See normal values case #7).
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Serum chemistry results showed an elevated total serum protein with a normal
albumin level. Protein was present in the urine.
A bone marrow biopsy showed that the bone marrow is nearly replaced by
plasma cells and is virtually 100% cellular, rather than the 40% expected at this
site for the patient's age (See slide 12c).
a. What is your diagnosis in this case? MULTIPLE MYELOMA
b. Why is the patient demonstrating lytic bone lesions? MYELOMA CELLS
CAN PRODUCE ENZYMES THAT INFILTRATE BONE AND
STIMULATE OSTEOCLASTIC ACTIVITY.
Case #13. John Smith bled more than his physicians anticipated during surgery.
In the recovery room, his blood pressure began to drop. A CBC showed the
following:
Patient Values
Normal Values
WBC
9.9 x10³/mm³
5.0-10.0x10³/mm³
RBC
3,81x10³/mm³
4.0-6.0 x 106 /mm³
Hb
11.1 gm/dl
14-16gm/dl
Hct
33.3%
40-54%
MCV
87 fl
80-96 fl
MCH
29 pg
27-32 pg
MCHC
33 gm/dl
32-36 gm/dl
Platelets
239x10³/mm³
150-400x10³/mm³
a. Describe this patient’s anemia. NORMOCYTIC NORMOCHROMIC
ANEMIA DUE TO BLOOD LOSS.
b. Why is the patient’s blood pressure dropping? SHOCK DUE TO SUDDEN
BLOOD LOSS
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Case #14. A 65 year-old man was in good health except for mild hypertension.
At his last check-up, a CBC showed a markedly elevated white blood cell count
and physical examination revealed several slightly enlarged lymph nodes in the
neck and the axillae, and the spleen was palpable.
CBC results showed Hgb 12.8 g/dl, WBC 130 x10³/mm³, and platelet count
330 x10³/mm³ (See case slide 13 for normal values). The peripheral smear
shows increased numbers of small mature lymphocytes (See cse slide 14).
What is your diagnosis? CHRONIC LYMPHOCYTIC LEUKEMIA (CLL).
Case #15. A 20 year-old college student presented to the emergency room
with general malaise, low-grade fever, and purplish discoloration on his face.
The facial discoloration developed rapidly during the time from when he left his
house to the time he arrived at the emergency room.
See case slide 15a
See case slide 15b
See case slide 15c
A CBC and blood cultures were drawn. A spinal tap was performed to obtain
cerebrospinal fluid. The patient was admitted to the intensive care unit. He
was begun on antibiotics and given fresh frozen plasma, cryoprecipitate,
and intravenous fluid.
The CBC showed an elevated WBC with a large percentage of immature
neutrophils. Gram stains from the CSF and blood cultures showed gramnegative diplococci. (See slide case 15d). A DIC screen came back positive.
a. What caused the purplish discoloration in this patient? BLOOD
CLOTS FROM DIC.
b. Explain what triggered Disseminated Intravascular Coagulation
(DIC) in this patient. SEPSIS (BACTERIA IN THE
BLOODSTREAM) CAUSED BY GRAM NEGATIVE BACTERIA.
http://chpweb.weber.edu/hthsci/labpages/
Hthsci 2231 Lab 5
Hths 2231
Laboratory 5
Blood
THE SEPSIS IN THIS CASE WAS DUE TO BACTERIAL
MENINGITIS
c. Explain what happens in DIC. See the DIC links on the lab webpage.
MICROTHROMBI, IN RESPONSE TO A PREDISPOSING
CONDITION, FORM THROUGHOUT THE BODY. IN THIS
CASE THE GRAM NEGATIVE BACTERIA RELEASE
ENDOTOXINS THAT DAMAGE THE ENDOTHELIUM AND
ACTIVATE THE INTRINSIC AND EXTRINSIC CLOTTING
PATHWAYS. THE FORMATION OF THESE CLOTS USE UP
ALL OF THE CLOTTING FACTORS IN THE BODY. THE
CLOTS STIMULATE THE THROMBOLYTIC (FIBRINOLYSIS)
SYSTEM. WIDESPREAD CLOTS ARE FORMED BLOCKING
THE BLOOD SUPPLY TO THE BODY’S ORGANS. THE
CONTINUED STIMULATION OF THE FIBRINOLYTIC
SYSTEM CAUSES HEMORRHAGE. THE END RESULT IS CLOT
FORMATION THROUGHOUT THE BODY AND HEMORRHAGE.
http://chpweb.weber.edu/hthsci/labpages/
Hthsci 2231 Lab 5