Case Studies in Pediatric Hematology

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Author: Kyle D. Mills, DO, MLS(ASCP)SH
Reviewers: Joshua J. Cannon, MS, MLS(ASCP)CMSHCM and Rebecca Sacks, MLS(ASCP)CM

This course will expose the reader to six case studies in pediatric hematology. These cases involve hematopathology prevalent from birth to the beginning of adulthood (age 18). Each case begins with the history of present illness or HPI. After you have been given the opportunity to review pertinent laboratory studies, the concept will be reviewed, and the patient’s case will be explained with a focus on physiologic concepts in hematology.

Continuing Education Credits

Objectives

  • Calculate mean cell volume, mean cell hemoglobin concentration, and corrected white blood cell count.
  • Predict peripheral blood smear findings using complete blood count results.
  • Describe cytochemistry stain and immunophenotyping results for acute leukemias.
  • Identify characteristics of macrocytic anemias.
  • Differentiate alpha and beta thalassemia.

Course Outline

  • Approaching “Case Studies in Pediatric Hematology”
      • Approaching Case Studies in Pediatric Hematology
  • Case 1: Four-Week-Old Infant Born Prematurely
      • History of Present Illness (HPI) for Candace
      • Relevant Laboratory Studies for Candace
      • How would you describe the image of Candace’s peripheral blood smear?
      • Patient Diagnosis: Anemia of Prematurity
      • Which hormone is responsible for the regulation of erythrocyte production?
      • Review of Hematopoiesis
      • Review of Hematopoiesis, continued
      • Match the listed peripheral blood cells with their correct progenitor cell lineage, either myeloid or lymphoid.
  • Case 2: Eight-Month-Old Born in Mexico
      • History of Present Illness (HPI) for Nicolás
      • Relevant Laboratory Studies for Nicholás
      • How would you describe the representative image of Nicolás' peripheral blood smear?
      • Patient Diagnosis: Iron Deficiency Anemia
      • Which laboratory assay represents the amount of iron stored in the body?
      • True or False: In iron deficiency anemia, as serum iron decreases, total iron binding capacity (TIBC) increases.
      • Comparing Iron Studies in Iron Deficiency Anemia versus Anemia of Chronic Disease
  • Case 3: Five-Year-Old with Stomach Pain
      • History of Present Illness (HPI) for Patrick
      • Relevant Laboratory Studies for Patrick
      • How would you describe the representative image of Patrick’s peripheral blood smear?
      • Patient Diagnosis: Lead Poisoning
      • Identify the composition of the RBC inclusions seen in this image.
      • Blood Lead Level Collection and Processing Issues
      • Which of the following is not appropriate for blood lead level collection and processing?
  • Case 4: 13-Year-Old with Weight Loss
      • History of Present Illness (HPI) for Danielle
      • Relevant Laboratory Studies for Danielle
      • How would you describe the representative image of Danielle’s peripheral blood smear?
      • Patient Diagnosis: Megaloblastic Anemia
      • Which white blood cell abnormality would you expect to see on the peripheral blood smear of this patient?
      • True or False: Megaloblastic anemias result in abnormalities of cytoplasmic maturation.
      • Folic Acid versus Vitamin B12 (Cobalamin) Deficiency
  • Case 5: 2-Year-Old with "Flu" for a Month
      • History of Present Illness (HPI) for Benton
      • Relevant Laboratory Studies for Benton
      • How would you describe the representative image of Benton’s peripheral blood smear?
      • Patient Diagnosis: Acute Lymphoblastic/Lymphocytic Leukemia (ALL)
      • Review of Immunophenotyping and Cytochemistry Staining in Leukemias
      • True or False: Staining for myeloperoxidase (MPO) is significant in distinguishing myeloid blasts from lymphoid blasts, as MPO is present in granules ...
  • Case 6: 12-Month-Old with Dark Urine
      • History of Present Illness (HPI) for Theo
      • Relevant Laboratory Studies for Theo
      • How would you describe the representative images of Theo’s peripheral blood smear?
      • Hemoglobin Structure
      • Hemoglobin Structure, continued
      • Patient Diagnosis: Beta Thalassemia Major
      • Key Points of Alpha Thalassemia
      • Key Points of Beta Thalassemia
      • True or False: Haptoglobin increases in hemolytic processes.
  • References
      • References

Additional Information

Level of Instruction: Intermediate
Intended Audience: Medical laboratory scientists, medical laboratory technicians, laboratory supervisors, and laboratory managers. This course is also appropriate for MLS and MLT students and pathology residents.
Author Information: Kyle D. Mills, DO, MLS(ASCP)SH, completed his professional medical education at the University of Pikeville - Kentucky College of Osteopathic Medicine in Pikeville, Kentucky, in 2018. He is currently pursuing a residency in internal medicine at the University of Louisville in Louisville, Kentucky. Dr. Mills also holds a Bachelor of Health Science in Clinical Laboratory Sciences degree from the University of Kentucky and is an American Society for Clinical Pathology (ASCP) certified Medical Laboratory Scientist (MLS) and Specialist in Hematology (SH). Before attending medical school, Dr. Mills worked on the laboratory bench as a generalist and led a medical laboratory technician program.
The author has no conflict of interest to disclose. 
Reviewer Information:
Joshua J. Cannon, MS, MLS(ASCP)CMSHCM received his Bachelor of Science and Master of Science in Medical Laboratory Science from Thomas Jefferson University in Philadelphia, PA. He holds Medical Laboratory Scientist and Specialist in Hematology certifications through the ASCP Board of Certification. He was a professor at Thomas Jefferson University for seven years before transitioning into his current role as Education Developer at MediaLab by Vastian. His areas of expertise and professional passions include clinical hematology and interprofessional education.
Rebecca Sacks, MLS(ASCP)CM is a Lead Medical Laboratory Scientist in Hematology at South County Hospital in Wakefield, Rhode Island. She earned her Bachelor of Science in Marine Biology from the University of Rhode Island and an Associate of Science in Clinical Laboratory Science from Bristol Community College. She most recently started tutoring Medical Laboratory Science students at Bristol Community College as well as volunteering as a Subject Matter Expert with AMT.

This course is part of:
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Hematopoiesis cell types scheme_Shutterstock
Macrocytic Ovalocytes
all high wbc
Heinz bodies_arrows
100_microcytes
Basophilic stippling.
hypersegmented neutrophil_shutterstock_JB
microcytes hypochromic