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

Answer Station 1
Megaloblastic anemia

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

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

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

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.

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

Answer Station 4
Giant Platelets

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?

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

Station 6
Kindly counsel the parents of this child

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

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

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

ANSWER 7 :MICROCYTIC HYPOCHROMIC

ANAEMIA WITH TARGET CELL : BETA THALASEMIA TRAIT

Station 8

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

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

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)

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

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.

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

Answers Station 11
Fanconi anemia Caf au lait spot Acute leukemia

Station 12
Identify the spot with arrow? Define it

Answer Station 12
Band cell Its 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

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?

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.

THANK YOU!!!

 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?

Answer Station 14
Langerhans cell Histiocytosis Prickle layer Birbeck granules

Station 15
Identify the spot in the marrow What is the treatment for this? Name two drugs

Answer Station 15
LD Body Amphotericin B & Sodium Stibogluconate, Multifosein