1 IMED2002 Blood count and blood cells_ePRAC WORKSHEET_Mar2021 v1

IMED2002 ePractical #1. 2021 The Blood Count and Blood Cells Welcome to the first ePractical “Blood” class. The Learning Outcomes of this session on “The Blood Count and Blood Cells” are to be able to:  Assess and interpret a full blood count  Use correct terminology to interpret abnormalities on a blood count  Assess and describe morphological abnormalities on a blood film  Diagnose common causes of anaemia from the interpretation of the blood count and film assessment. In this ePractical you will work through 4 cases of patients with anaemia. You will interpret changes seen on blood counts and on blood films. Each case is different. They are representative of disorders you will have learned about in the lectures. Resources for this ePractical are: 1. This Worksheet 2. Aperio eSlide Manager: https://eslide.hms.uwa.edu.au/Login.php Username: IMED.Student Password: IMEDpwd321% There will be a quiz following this ePractical. The structure is similar with clinical cases, each with a blood count and images of the blood film and multiple choice questions. The quiz will be available on LMS for IMED2002 students between 5 pm Thursday 11 th March and 5pm Monday 15th March 2021. IMED2002 ePractical #1. Page 1 The Blood Count and Blood Cells

IMED2002 ePractical #1. Page 2 The Blood Count and Blood Cells Aperio eSlide Manager: instructions (You can also refer to the video guide prepared for this purpose 1. Click on Courses 2. Click on the Folder icon for IMED2002 3. Click on the Eye icon for the “Blood Count and Blood Film” lesson

IMED2002 ePractical #1. Page 4 The Blood Count and Blood Cells Normal Blood Film (Slide I.5)

Case 1 Note: Questions 1 to 3 to be done from the ePRACT#1 – Active Learning Practical Class link A 29 year old female presents to her General Practitioner complaining of tiredness and shortness of breath. The General Practitioner performs a full blood count and the results are: Full Blood Count Parameter Result Normal Haemoglobin (Hb) 88 g/ L 115 - 155 g/ L White cell count 6.7 x10 9 / L 4 - 11 x10 9 / L Platelet count 480 x10 9 / L 150 - 400 x10 9 / L Red Cell Count 3.1 x10 12 / L 3.8 – 5.8 x10 12 / L Mean Cell Volume 73 fL 80 - 100 fL Haematocrit 0.31 0.38 – 0.47 Mean Cell Haemoglobin 25 pg 7 - 32 pg Neutrophils 4.0 x10 9 / L 1.0 - 4.0 x10 9 / L Lymphocytes 2.0 x10 9 / L 2.0 – 7.5 x10 9 / L Monocytes 0.4 x10 9 / L 0.1 – 1.0 x10 9 / L Eosinophils 0.2 x10 9 / L 0 – 0.4 x10 9 / L Basophils 0.1 x10 9 / L <0.1 x10 9 / L Reticulocytes 0.2% 0.2 - 2% 1. Which of the red blood cell parameters shows that the patient is anaemic? a. Haemoglobin (Hb) b. Mean Cell Volume c. Mean Cell Haemoglobin 2. How would you describe the size of the red blood cells in this patient? a. Macrocytic b. Microcytic c. Normocytic 3. What word best describes the platelet abnormality? a. Thrombocytopenia b. Thrombocytosis IMED2002 ePractical #1. Page 5 The Blood Count and Blood Cells

Case 1 Blood Film [Resource: Blood Film I.8 on Aperio eSlide manager] Please review the blood film image of Slide I.8 provided and answer the following questions. Note: Questions 4 to 6 and Question 9 to be done from the ePRACT#1 – Active Learning Practical Class link. Questions 7 and 8 to be answered on this worksheet. IMED2002 ePractical #1. Page 7 The Blood Count and Blood Cells

4. Compare the red blood cell size with a small lymphocyte. Are the red blood cells a. Large b. Normal c. Small 5. What best describes the colour of the red blood cell compared to those in normal (slide I5)? a. Hypochromic b. Normochromic c. Polychromatic 6. What are the morphological changes on the blood film (there may be more than one)? a. Elliptocytes b. Macrocytes c. Microcytes d. Pencil cells e. Spherocytes f. Target cells g. Tear drop red cells 7. Write a report of the blood film. ------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- IMED2002 ePractical #1. Page 8 The Blood Count and Blood Cells

1. Based on the red cell indices how would you describe the size of the red cells in this patient? a. Macrocytic b. Microcytic c. Normocytic 2. The white cell count is normal. Which word best describes the neutrophil abnormality? a. Neutropenia b. Neutrophilia c. Pancytopenia Case 2 Blood film [Resource: Blood Film I.18 on Aperio eSlide Manager] Please review the blood film I.18 and answer the following questions. IMED2002 ePractical #1. Page 10 The Blood Count and Blood Cells

3. On review of the blood film, which white cell abnormality is/are present? a. Basophilia b. Eosinophilia c. Hypersegmented neutrophils d. Lymphocytosis e. Monocytosis IMED2002 ePractical #1. Page 11 The Blood Count and Blood Cells

Case 3 Note: Questions 1 to 2 and Questions 4 to 7 to be done from the ePRACT#1 – Active Learning Practical Class link. Questions 3, 5 – 6 and Question 8 are to be done on this worksheet. A 79-year-old man presents to his General Practitioner feeling tired, unwell with abdominal pain and commenting that his eyes appear yellow. The General Practitioner performs a blood count and the results are: Parameter Result Normal Haemoglobin (Hb) 72 g/L 130 - 180 g/L White cell count 19.8 x 10 9 / L 4 – 11 x10 9 / L Platelet count 410 x 10 9 / L 150 - 400 x10 9 / L Red Cell Count 2.6 x 10 12 / L 4.5 – 6.0 x10 12 / L Mean Cell Volume 105 fL 80 - 100 fL Haematocrit 0.28 0.4 – 0.54 Mean Cell Haemoglobin 30 pg 27 - 32 pg Neutrophils 17.3 x 10 9 / L 2.0 - 7.5 x 10 9 / L Lymphocytes 1.2 x 10 9 / L 1.0 – 4.0 x 10 9 / L Monocytes 0.8 x 10 9 / L 00.1 – 1.0 x 10 9 / L Eosinophils 0.4 x 10 9 / L 0.1 – 0.4 x 10 9 / L Basophils 0.1 x 10 9 / L <0.1 x 10 9 / L Reticulocytes 10% 0.2 – 2.0% 1. Which of the following are evident on the blood count? a. Microcytosis b. Neutrophilia c. Polycythaemia d. Reticulocytosis e. Thrombocytosis 2. Which of the following best describes this patient’s anaemia? a. Macrocytic anaemia b. Microcytic anaemia c. Normocytic anaemia IMED2002 ePractical #1. Page 13 The Blood Count and Blood Cells

3. What is the likely mechanism/s causing the increased Mean Cell Volume? -------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- Case 3 Blood film [Resource: Blood Film RC17 on Aperio eSlide Manager] IMED2002 ePractical #1. Page 14 The Blood Count and Blood Cells

Case 4 Note: Questions 1 to 3 and Question 6 to be done from the ePRACT#1 – Active Learning Practical Class link. Questions 4 to 5 and Question 7 are to be done on this worksheet. A 50 year old presents to the hospital with fever, confusion and kidney failure. A full blood count was performed and the results were: Parameter Result Normal Haemoglobin (Hb) 91 g/L 130 - 180 g/L White cell count 7.6 x 10 9 / L 4 – 11 x10 9 / L Platelet count 50 x 10 9 / L 150 - 400 x10 9 / L Red Cell Count 2.8 x 10 12 / L 4.5 – 6.0 x10 12 / L Mean Cell Volume 96 fL 80 - 100 fL Haematocrit 0.30 0.4 – 0.54 Mean Cell Haemoglobin 30 pg 27 - 32 pg Neutrophils 5.1 x 10 9 / L 2.0 - 7.5 x 10 9 / L Lymphocytes 1.4 x 10 9 / L 1.0 – 4.0 x 10 9 / L Monocytes 0.8 x 10 9 / L 00.1 – 1.0 x 10 9 / L Eosinophils 0.3 x 10 9 / L 0.1 – 0.4 x 10 9 / L Basophils 0.1 x 10 9 / L <0.1 x 10 9 / L Reticulocytes 5% 0.2 – 2.0% 1. How would you describe the size of the red blood cells in this patient? a. Macrocytic b. Microcytic c. Normocytic 2. What word best describes the platelet abnormality? a. Thrombocytopenia b. Thrombocytosis c. Thrombophilia IMED2002 ePractical #1. Page 16 The Blood Count and Blood Cells

Case 4 Blood film [Resource: Blood Film RC12 on Aperio eSlide Manager] IMED2002 ePractical #1. Page 17 The Blood Count and Blood Cells

7. What are the possible causes of the symptoms and signs in this patient? --------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- The quiz will be available on LMS for IMED2002 students between 5 pm Thursday 11 th March and 5pm Monday 15th March 2021. IMED2002 ePractical #1. Page 19 The Blood Count and Blood Cells