Case Studies in Pediatric Hematology

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Author: Kyle D. Mills, DO, MLS(ASCP)SH
Reviewer: Michelle Butina, PhD, 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 corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), and corrected white blood cell (WBC) count.
  • Predict peripheral smear microscopic characteristics using basic hemogram parameters.
  • Correctly order the sequence of hematopoiesis, beginning with the hematopoietic stem cell.
  • Interpret common iron study results and state the blood lead level that currently represents toxicity.
  • Recall the diagnostic significance of erythrocyte/zinc protoporphyrin.
  • Identify laboratory testing panels that best assess for hematological conditions.
  • Categorize cytochemistry stains and immunophenotyping results in the setting of acute leukemias.
  • Identify characteristics of macrocytic anemias.
  • Define alpha and beta thalassemia and identify key characteristics of each.

Course Outline

  • Approaching “Case Studies in Pediatric Hematology”
      • Approaching Case Studies in Pediatric Hematology
  • Case 1: Candace, a Four-Week-Old Infant Born Prematurely
      • History of Present Illness (HPI) for Candace
      • Relevant Laboratory Studies for Candace
      • How would you describe the representative image of Candace’s peripheral blood smear?
      • Which hormone is responsible for the regulation of erythrocyte production?
      • Patient Diagnosis: Anemia of Prematurity
      • 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: Nicolás, an Eight-Month-Old Born in Mexico
      • History of Present Illness (HPI) for Nicolás
      • Which laboratory assay represents the amount of iron stored in the body?
      • Relevant Laboratory Studies for Nicholás
      • How would you describe the representative image of Nicholàs’ peripheral blood smear?
      • Patient Diagnosis: Iron Deficiency Anemia
      • 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: Patrick, a 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?
      • Identify the composition of the RBC inclusions seen in this image.
      • Patient Diagnosis: Lead Poisoning
      • Blood Lead Level Collection and Processing Issues
      • Federal regulations state that venous blood level testing has an error rate of ± _____ micrograms/dL or 10%, whichever is greater.
  • Case 4: Danielle, a 13-Year-Old Who Is Losing Weight
      • 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?
      • Which white blood cell abnormality would you expect to see on the peripheral blood smear of this patient?
      • Patient Diagnosis: Megaloblastic Anemia
      • Megaloblastic anemias result in abnormalities of cytoplasmic maturation.
      • Folic Acid versus Vitamin B12 (Cobalamin) Deficiency
  • Case 5: Benton, a 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?
      • Staining for myeloperoxidase (MPO) is significant in distinguishing myeloid blasts from lymphoid blasts, as MPO is present in granules of myeloid and ...
      • Patient Diagnosis: Acute Lymphoblastic / Lymphocytic Leukemia (ALL)
      • Review of Immunophenotyping and Cytochemistry Staining in Leukemias
  • Case 6: Theo, a 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
      • Haptoglobin increases in hemolytic processes.
  • References
      • References

Additional Information

Level of Instruction: Beginning

Intended Audience: Medical laboratory scientists, medical technologists, and technicians. This course is also appropriate for medical laboratory science students, pathology residents, and other healthcare personnel who are interested in the physiologic concepts surrounding pediatric hematology.

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 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.

Reviewer Information: Michelle Butina, PhD, MLS(ASCP)CM is currently the Program Director and Associate Professor for the Medical Laboratory Science Program, College of Health Sciences at the University of Kentucky in Lexington, Kentucky. Dr. Butina earned a PhD in Workforce Education from the University of Georgia in Athens, Georgia. She received a Masters of Science degree in Clinical Laboratory Science from Michigan State University in East Lancing, Michigan and a Bachelor of Science degree in Medical Technology from Winston-Salem State University in Winston-Salem North Carolina. 

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