Hmatology

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Slide 1
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OSCE PEDIATRICS
HEMATOLOGY

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Slide 2
Station 1
 This is the peripheral
smear of a 12 year old
female child who
presented with
pancytopenia. Also
shown is the bone
marrow picture of this
child. Kindly give the
diagnosis

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Slide 3
Answer Station 1
 Megaloblastic anemia

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Slide 4
Station 2
 What ancillary tests will you do to clinch the
diagnosis? Give any two.

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Slide 5
Answers Station 2
 LDH
 S. Bilirubin
 Vit B12 level
 S. Folic Acid levels

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Slide 6
Station 3
 What are the recommended dosages for the
treatment of Vitamin B 12 and Folic Acid deficiency

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Slide 7
Answers Station 3
 Vitamin B12: Intramuscular 100-200 mcg
biweekly or 1000 mcg weekly x 4 to 8 weeks,
followed by oral dose of 100 mcg per day.
 Folic acid: 0.5 to 1 mg or more daily; 5 mg
per week will also be effective. To be given
for 4-8 weeks.

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Slide 8
Station 4
 This is the peripheral smear
of a patient who came with
purpuric spots and
hemoglobin of 10, mildly
hypochromic microcytic
picture. Identify the cell
shown

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Slide 9
Answer Station 4
Giant Platelets

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Slide 10
Station 5
 This is the peripheral smear of a 4 year old child
who presented with a Hb of 10gm/dL, TLC 9000,
Platelet 30,000 and no organomegaly or
lymphadenopathy. The child had purpura but no
significant bleed. Was stable. Parents are well
educated and live in Delhi.
 What will be the drug to treat this patient?
 Will you do a bone marrow in this patient?

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Slide 11
Answers Station 5
 No treatment is required. Just observation
 No need for bone marrow

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Slide 12
Station 6
 Kindly counsel the parents of this child

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Slide 13
Answers Station 6
 Introduces himself and tries to make the parents
comfortable.
 Talks about the disease ITP
 Talks about the possibility of any other disease
 Talks about the need for injury prevention
 Tells about the warning signs when they have to
report to the hospital
 Talks about the self limiting nature of the disease

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Slide 14
Station 7
 Hb 10
 MCV 58
 MCH 23
 MCHC 32
 RBC Count 5.4
 RDW 13.5
 P/Smear As shown

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Slide 15
Questions Station 7
 Kindly comment on the peripheral smear and
identify the cell shown.
 Give your probable diagnosis in the patient with the
above indices and P/Smear

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Slide 16
Station 8
1. Identify the spot (Arrow)
2. Name the agents
used to stain this cell

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Slide 17
Answers Station 8
 Myeloblast with 3 prominent nuclei
 Stains- Myeloperoxidase, Non specific esterase
and Sudan black

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Slide 18
Station 9
A 5 yr boy c/o pallor and passing dark-colored urine. Three
days prior the patient had low-grade fever and dry cough.
Initial CBC revealed a Hemoglobin level of 4.5 g/dL, an Hct
of 14%, a WBC count of 9,100/mm3. (N76%, L14%, M8%,
E1%) and a platelet count of 372,000/mm3. The patient had
been diagnosed with Hemoglobin H disease since 18
months of age. He had received 2 blood transfusions when
he had fever and acute anemia. Both parents are
thalassemia carriers.
Physical examination: Temp- 38.3 C, Markedly pale
Heart: Syst. ejection murmur grade II/VI at lt upper sternum
Abdomen: Splenohepatomegaly

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Slide 19
Station 9 (contd)
 What is the diagnosis?
 What may be the trigger
for this crises?

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Slide 20
Answers Station 9
 Hb H/Hb CS disease with hemolytic crisis

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Slide 21
Station 10
 2 yr old child was evaluated for anemia
and found to have a reticulocyte count
of 20% and a PCV of 25%.
 Calculate the Reticulocyte production
index taking maturation time as 2 days
and assuming a normal PCV of 0.45
 What does this signify? (In terms of
production rate)

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Slide 22
Answers Station 10
 RPI- Reticulocyte % x Observed
PCV(0.25)
 Maturation time x Normal PCV (0.45)
 It comes = 5.5
 It signifies that production has increased to 5.5
times

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Slide 23
Station 11
18 month old child
with pallor and
cutaneous markers
at the back with an
abnormal skeletal
profile. P/S was
consistent with
macrocytic anemia
and pancytopenia.

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Slide 24
Questions Station 11
 What is the most probable diagnosis?
 Name the cutaneous marker.
 What malignancies are expected in this patient?

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Slide 27
Answer Station 12
 Band cell
 It’s a cell of neutrophil (Leukocyte) series in which
the nucleus appears to be folded and the joining
isthmus of the two lobules is > 1/3rd of the
maximum width of the largest lobule

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Slide 28
Station 13
 Give the full form of SQUID and what it is best used
for?
 Give the full form of NESTROF and what it is used
for?
 What is the principle used in NESTROF test?

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Slide 29
Answer Station 13
 SQUID- Super-conducting Quantum Interference
Device & Provides the most accurate and best-
validated non-invasive method for measuring liver
iron
 NESTROF- Naked Eye Single Tube Red Cell
Osmotic Fragility Test and it is usefull in screening
for beta-thalassaemia and some of the common
haemoglobinopathies
 The principle of NESTROF is based on the limit of
hypotonicity which the red cell can withstand.

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Slide 30
Station 14
 This child has a history of
polyuria, frequent otitis
media and bone pains
 What is the most
probable diagnosis?
 Name of the epidermis
layer where this cell is
found?
 What does it contain?

© 2003 By Default!
Slide 32
Station 15
 Identify the spot in
the marrow
 What is the
treatment for this?
Name two drugs

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