General and Systemic Histopathology, C601&C602

    Virtual Slide: A 56 year-old woman with a positive hemoccult test.

    This 56 year-old woman is being seen because she had a positive screening occult blood test. She is well apart from mild hypertension, supposedly treated with diuretics. Two weeks ago she reports suffering a thrombosed superficial varicose vein in her left leg. Physical exam reveals a slightly over weight woman with blood pressure of 150/95.

    WBC    6.5 X 103   RBC    4.13  
            Percent   Abs   HGB    12.7 Stool is heme positive.
    NE     52.8     3.5   HCT     37.3  
    LY      34.3     2.2   MCV    90.4  
    MO       9.0    0.6   MCH    30.7  
    EO        3.6    0.2   MCHC  34.0  
    BA        0.3      0   RDW    12.3 Reference values?
        PLT  >1 X 106  
        MPV      7.3  
    Click the little red + in the smear above to see the slide using the virtual microscope. Describe what you see and then answer the following questions.
    •  What in the peripheral smear indicates this patient has a form of a myeloproliferative disease?
    • Are these findings specific for any one in particular?
    • What are the guidelines for essential thrombocytosis?
    • What would show the thrombocytosis is not reactive?
    • Bone marrow findings?
    • Would you expect normal platelet function tests?
    • Why heme positive stools and what other complications do you need to be ready for?

    The next patient is a man with history of prostate cancer.

    What's with this bone marrow?

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