6BM039 summative case study (3rd attempt, 2021-22)

6BM039 summative case study (3rd attempt, 2021-22)

A 23 year old female presents to her GP with menorrhagia. She has recently moved into the area, so her GP feels it is a good idea to request some blood tests and to take her history. Her GP feels she looks slightly pale so decides to request some blood tests to determine whether she has any degree of anaemia. Her family origin is African, with her mother and father originating from Ghana. Her FBC, blood film and HPLC results are shown below, with normal ranges provided.

FBC Results:

Parameter Result Normal range

Haemoglobin 94 g/L 120 - 160 g/L

WBC 8.3 x 109/L 4.0 - 11.0 x 109/L

RBC 4.40 x 1012/L 4.20 - 5.40 x 1012/L

HCT 0.260 L/L 0.35 - 0.47 L/L

MCV 58.4 fL78 - 98 fLMCH 21.3 pg27 - 32 pgPlatelets 258 x 109/L 150 - 450 x 109/L

Neutrophils 4.69 x 109/L (57.9%) 2.0 - 7.5 x 109/L (50 - 98%)

Lymphocytes 2.73 x 109/L (33.7%) 1.5 - 4.0 x 109/L (5 - 50%)

Monocytes 0.47 x 109/L (5.4%) 0.2 - 1.0 x 109/L (2 - 10%)

Eosinophils 0.38 x 109/L (0.9%) 0.1 - 0.8 x 109/L (1 - 4%)

Basophils 0.15 x 109/L (0.5%) 0.01 - 0.2 x 109/L (0 - 2%)

RDW 20.2% 11.5 - 13.9%

Reticulocytes (abs) 115 x 109/L 50 - 100 x 109/L

Reticulocytes % 2.6% 0.2 - 2.0%

Ferritin <3 g/L 20 - 400 g/L

A blood film was prepared and is shown below.

Haemoglobin variant analysis by HPLC was ordered. The chromatogram and the results are shown below:

Parameter Result Normal range

Hb F 2.2% 0.1 - 1.0%

Hb A 2.2% 95 - 98%

Hb A2 5.1% 1.8 - 3.5%

Hb variant 84.3% 1346202291080

Your task:

Give a reasoned interpretation of the patient presentation and data above.

Suggest a differential diagnosis and any further testing that might be useful to resolve it.

Summarize the disease biology and comment on the likely prognosis and current treatment.

Support your answers with relevant academic, peer-reviewed references, cited and listed in proper Harvard style.

The submission date is 14:00 hrs on 15th June, 2023. The work must be uploaded by that deadline to the canvas portal.

As this work contributes to the final module grade you must not work together with other students in any way on this assessment. Note the warnings given about collusion and plagiarism in the module introduction.

6BM039 Clinical Haematology - coursework task and brief (LO1, LO2, LO3, LO4)

LO1 Demonstrate a critical understanding of the underlying principles of haematological systems.

LO2 Demonstrate an understanding of and the ability to critically evaluate the methods used in the diagnosis and monitoring of a range of haematological disorders.

LO3 Demonstrate practical skills and the ability to follow defined laboratory protocols whilst adhering to health and safety regulations.

LO4 Demonstrate a critical understanding of the clinically significant blood group systems and the implications of these for transfusion practice.

Case report: Data analysis and diagnosis

Your assessment task is to write a report on the given patient case study to include an appraisal of the presentation and results from any laboratory tests, a differential diagnosis and any further tests that would be needed to clarify the diagnosis, a brief summary of the disease biology, prognosis and treatment. You should support your report with citations to scientific articles published in peer-reviewed journals using the Harvard referencing system.

The marks will be allocated as follows:

Data interpretation (30 marks)

Marks will be awarded for identifying the relevant parameters in any tests carried out so far rather than woodenly commenting on each one, and for interpreting them together rather than as isolated entities. (Note that relevant parameters may include those in the normal range.)

Differential diagnosis (20 marks)

Credit will be given for logical interpretation of the information and formulation of a differential diagnosis, even where this does not necessarily arrive at the correct answer. If further tests would be likely to resolve the diagnosis these should be suggested, and an indication of how the results would be interpreted. The appropriateness of such tests should be considered expensive and timeconsuming tests should not be ordered without due consideration.

Disease biology, prognosis and treatment (30 marks)

A brief summary of the most likely disorder should be given, along with comments on the prognosis and current treatment.

References (20 marks)

Marks will be given for the suitability of supporting references and correct referencing style. Quality and appropriateness of references will be credited above quantity around 5 10 papers would be considered normal and credit will not be given for citing a surfeit of papers. Guidance on suitability of sources and correct referencing style can be found in the Biomed-Physiology Departments Guide to Referencing (available on canvas) and in the Librarys guide: https://www.wlv.ac.uk/lib/skills-forlearning/referencing/

General comments:

The total word count should be 1500, + 20%. The writing should be clear and unambiguous, using correct scientific terms and scientific writing style.

Submission and Grading of your work:

Your work will be submitted and graded on canvas electronically out of a possible 100%. A grade will be calculated using a rubric which is a table of criteria that your work should fulfil to achieve the mark stated. You must look at this closely and use these as essential criteria to structure the work. The use of these marking schemes helps to ensure the objectivity of the marking process and ensures work can be graded efficiently and on time.

Marking rubric for 6BM039 Clinical Haematology

Score/Criteria 70-100%

(21-30 /30;

14-20 / 20)

Excellent Pass 50-70%

(15-21 / 30;

10-14 / 20)

Good pass 40-50%

12-15 / 30;

8-10 / 20)

Borderline pass 20-40%

(6-12 / 30;

4-8 / 20)

Borderline fail 0-20%

(0-6 / 30; 0-4 / 20)

Fail

(1)

Data interpretation

30% Excellently written, picked out the relevant parameters or features of the diagnostic tests and interpreted them together to provide an overall description of the patients condition. Intelligent comments about unusual or conflicting features. Correct style and language used. Well written, most relevant features of the lab tests identified and correctly interpreted, minor errors or omissions, some flaws in language, grammar or style. A correct interpretation overall, but some tendency to regard parameters as distinct entities rather than to build up an overall picture. Some relevant points missed or misinterpreted. Writing quality and style satisfactory rather than good. A largely incorrect or self-contradictory interpretation, several relevant points missed or misinterpreted. Poor writing or unclear meaning. No attempt or an inadequate attempt to interpret the data. Poor writing or unclear meaning.

(2)

Differential diagnosis

20% Excellently written, one or more possible diagnoses correctly identified and suitable further tests suggested, with projected interpretations. Correct style and language used. Well written, differential diagnosis largely correct, but one or two relevant points missed. Minor flaws in language, grammar or style. Generally correct diagnosis, but the level of understanding and

interpretation is rather basic. Suggested alternative diagnoses and further tests rather weak. Adequately written so the intended meaning is clear, but the style and grammar are poor. An incorrect or inadequate initial diagnosis, alternative diagnoses not considered or incorrect. Poor or unclear writing, incorrect language or style. No attempt or an inadequate attempt to find a differential diagnosis. Poor writing or unclear meaning.

(3)

Disease biology,

prognosis

and treatment

30% A well-written summary of the disease biology of the most likely disorder with up-to-date information on prognosis and the latest treatment. Correct use of language and writing style. A well-written summary of the disease biology of the most likely disorder or a plausible disorder, some minor errors or omissions in the prognosis or treatment. Minor errors of grammar or writing style. An adequate summary of the disease biology of a plausible disorder and prognosis and treatment, but with significant errors or omissions. Some errors of grammar or writing style. An inadequate attempt to explain the disease biology of a relevant disorder, or an irrelevant disorder covered. Prognosis and treatment not covered, or inadequately covered. Poor or unclear writing. No attempt made to explain the disease biology, or the disease biology is inadequate, or of an irrelevant disorder. No attempt, or a completely incorrect attempt to explain the prognosis and treatment.

(4)

Supporting references

20% Excellent selection and use of supporting references, from peerreviewed journals and correctly cited in Harvard style. Primary papers used where appropriate. Good selection of references, mostly suitable journal articles, but sometimes general reviews of only passing relevance to the topic. Harvard style used correctly, or with minor errors. Adequate referencing, but mostly general review papers rather than relevant articles. Occasional inappropriate source. An attempt at Harvard format, but with significant errors. Sources are journal articles that dont address the topic where they are cited, or inadequate scientific sources (textbooks, websites, online book compilers such as StatPearls). Harvard format not attempted, or attempted with significant errors. No supporting references offered, or wholly inadequate sources used (e.g. online publicinformation webpages or leaflets, wikipedia, netdoctor etc.) No attempt at Harvard referencing.

6BM039 retrieval

These are some tips Ive distilled from the first submissions. You had a chance to discuss them further in the meeting, but as ever the conversation was largely one-sided. The only extra point that came out of the limited conversation is that if you find yourself having to cover a very wide topic, tackle it by way of examples rather than trying to cover everything. This is a graduate skill that has to be applied by the lecturers that teach you, and the authors of the textbooks you use.

Do not copy, paraphrase, reproduce anyone elses work and pass it off as your own. Do not work with anyone else.

Do not try to do the minimum you think is required to pass.

If youve been given feedback, use it, but try to discriminate between major and minor failings. (If you got 38%, dont think that correcting the occasional spelling error must get you another 2%.)

Make sure you read the assignment brief and follow it. If it helps, set out your answer under separate subheadings. Do not omit any sections.

You can reproduce the FBC table, blood film and figures if you like, or take them as read, but do not laboriously spell out all the cell counts and reference ranges in the text of your answer.

Do not assume the answer (because you know it but cant articulate why, or because word has got round what the answer is) and then try to force the data to fit your diagnosis. This is not how patients are diagnosed! Show how you have worked from the data given to your diagnosis (or likely diagnosis or diagnoses if you cant be certain at this stage).

Make sure you know how to interpret the immunophenotyping dot plots. Some quotes:

CD19 at only 20%.........the plot shows 96% CD33 markers.........a case with high CD33.........CD33 was the most-expressed antigen

Whats wrong with these? A few more:

low haemoglobin indicates the possibility of anaemia.....high LDH indicates infection of the nervous system

Make sure you know what to cover under e.g. differential diagnosis, disease biology.

Write a short paragraph only on prognosis.

Treatment has to be more than just chemotherapy or induction followed by consolidation. Think about what you need to cover to summarize current treatment of the disorder concisely, bearing in mind the limited word count.

Make sure your references are appropriate sources, in Harvard format, and actually apply to the text they are used to support. Dont just insert them in random places in the text. Dont use sources you have been specifically told to avoid.