Diagnose This #3

Welcome back friends! Here’s hoping that you all have had an awesome week and are learning a lot from these little articles of mine.

Now, last week we presented a rather straightforward case with some tricky questions. The spot diagnosis for this patient is Tuberculosis (formerly known as consumption), caused by mycobacterium tuberculosis, and the major cause of death in HIV infected individuals. The treatments available include rifampicin, isoniazid, pyrazinamide, and ethambutol (or RIPE for those of you who enjoy a good acronym), and the type of stain used to identify M. Tuberculosis is a Ziehl-Neelsen stain. This particular stain is useful in identifying acid-fast bacillus. Again, if you have any queries please do not hesitate to contact bloodbonesandbodies.

 

So, without further ado, here is this week’s scenario:

A 38 year old man presents to you with paraesthesia in the peripheries for a duration of about 3 months, along with progressively worsening numbness. After ordering some blood work the results come back and show the following:

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A peripheral blood film shows marked macrocytosis and poikilocytosis* along with some hypersegmented neutrophils.

 

Based on these findings alone, what is your primary DDx? Are there any other conditions that can cause these findings? How would you proceed from here?

 

Tune in next time to find out!

 

*CORRECTION: poikilocytosis has been seen in this blood film, not target cells.

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The art of phlebotomy is rooted in the practice of bloodletting, a method that can be traced back to as early as 1000BC!
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