BMJ Elective Case Log

A-55-year old female has presented to our hospital with a generalized lymphadenopathy  and her complete blood count showing very low WBC count (2100 cells/microL) and her differential count of lymphocytes count is showing 45% and neutrophil count is 50% and hemoglobin is 5.9 gm%, MCV 90.1, MCH 27.8, MCHC 9.9. Previously, the patient had a differential count for lymphocyte 56% with the around same low Total WBC count.  We are suspicious of the case might of CLL or NHL. We have tried to know the absolute lymphocyte count (ALC) in an attempt to see if the first criteria in diagnosing CLL ( Absolute B lymphocyte count in the peripheral blood ≥5000/microL [5 x 109/L], with a preponderant population of morphologically mature-appearing small lymphocytes.) is met. Even though the total number of WBC is less than the 5000, we tried to calculate ALC with the following formula: ALC (cells/microL)  =  WBC (cells/microL)  x  percent lymphocytes  ÷  100                                   =

A 65-year-old-male with a history of cerebrovascular accident from 2 weeks was referred to our hospital with the complaints of diminished appetite and drowsiness since last night. He is a smoker since past 30 years. He had no history of hypertension and diabetes mellitus. On examination, his blood pressure was 140/40 mmHg, pulse was irregular and the rate was 52/min, SPO2 98% with O2. On cardiac auscultation, s1 and s2 were clear and audible.     On admission, patients electrocardiogram demonstrated irregular rhythms with right bundle branch block and left axis deviation (figure 1).  Figure 1  Laboratory results showed pH 7.43, hemoglobin 9.2 gm%, total leucocyte count 19800/mcL, serum K+ 7.5 mEq/L, serum urea 176 mg/dl, serum creatinine 3.6 mg/dl while his liver function tests were normal. Patient’s chest radiograph showed bilateral bronchopneumonia (figure 2).   Figure 2 Echocardiography showed concentric left ventricular hypertrophy with the ejection frac

A 55-year-old man developed sudden severe right sided chest pain at 1:00 AM. He thought the pain was related to gas and took acid reducing agents such as proton pump inhibitors but when the pain didn't get relieved by early morning he got admitted to a city hospital and the ECG (figure 1) was suggestive of an acute myocardial infarction. And a second ECG was done in the evening which showed qs pattern on the v1, v2, v3 and v4 (figure 2). His chest radiograph was done (figure 3). His past history was significant for a type II diabetes mellitus (on medication) for last 6 years and hypertension (on medication) for last 10 years. Figure 1 Figure 2 Figure 3 He was not thrombolyzed but a coronary angiography was planned and was done eventually on the same day around 8 P.M. The coronary angiography revealed (figure 4, 5, 6, 7, 8, 9, 10) 30% plaque in proximal & mid part of LM, 95% stenosis in LAD and minor irregularity in LCX distal part and he was advised stenting but