Slide 1

2003 By Default!

OSCE HEMATOLOGY

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Slide 2

2003 By Default!

Station 1

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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

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2003 By Default!

Answer Station 1

Megaloblastic anemia

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Slide 4

2003 By Default!

Station 2

What ancillary tests will you do to clinch the

diagnosis? Give any two.

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Slide 5

2003 By Default!

Answers Station 2

LDH
S. Bilirubin
Vit B12 level
S. Folic Acid levels

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2003 By Default!

Station 3

What are the recommended dosages for the

treatment of Vitamin B 12 and Folic Acid deficiency

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2003 By Default!

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.

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Slide 8

2003 By Default!

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

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2003 By Default!

Answer Station 4

Giant Platelets

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Slide 10

2003 By Default!

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?

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2003 By Default!

Answers Station 5

No treatment is required. Just observation

No need for bone marrow

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2003 By Default!

Station 6

Kindly counsel the parents of this child

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2003 By Default!

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

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2003 By Default!

Station 7

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

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2003 By Default!

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

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2003 By Default!

Station 8

1. Identify the spot (Arrow)

2. Name the agents
used to stain this cell

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2003 By Default!

Answers Station 8

Myeloblast with 3 prominent nuclei

Stains- Myeloperoxidase, Non specific esterase
and Sudan black

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2003 By Default!

Station 9
A 5 yr boy c/o pallor and passing dark-colored urine. Three
days prior the patient had low-grade fever and dry cough.
Initial CBC revealed a Hemoglobin level of 4.5 g/dL, an Hct
of 14%, a WBC count of 9,100/mm3. (N76%, L14%, M8%,
E1%) and a platelet count of 372,000/mm 3. The patient had
been diagnosed with Hemoglobin H disease since 18
months of age. He had received 2 blood transfusions when
he had fever and acute anemia. Both parents are
thalassemia carriers.
Physical examination: Temp- 38.3 C, Markedly pale
Heart: Syst. ejection murmur grade II/VI at lt upper sternum
Abdomen: Splenohepatomegaly
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2003 By Default!

Station 9 (contd)

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What is the diagnosis?

What may be the trigger
for this crises?

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2003 By Default!

Answers Station 9

Hb H/Hb CS disease with hemolytic crisis

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Slide 21

2003 By Default!

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)

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2003 By Default!

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

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2003 By Default!

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.

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2003 By Default!

Questions Station 11

What is the most probable diagnosis?

Name the cutaneous marker.
What malignancies are expected in this patient?

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2003 By Default!

Answers Station 11

Fanconi anemia
Caf au lait spot
Acute leukemia

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2003 By Default!

Station 12

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Identify the spot with

arrow?
Define it

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2003 By Default!

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

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2003 By Default!

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?

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2003 By Default!

Answer Station 13

SQUID- Super-conducting Quantum Interference

Device & Provides the most accurate and bestvalidated 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.
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2003 By Default!

Station 14

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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?

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2003 By Default!

Answer Station 14

Langerhans cell Histiocytosis

Prickle layer
Birbeck granules

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2003 By Default!

Station 15

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Identify the spot in

the marrow
What is the
treatment for this?
Name two drugs

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2003 By Default!

Answer Station 15

LD Body
Amphotericin B & Sodium Stibogluconate,
Multifosein

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