MODULE 5 CASE STUDIES
Case Scenario 1: A resident called the lab about ordering a test for a post-vasectomy patient 2 weeks after the procedure was performed in the outpatient clinic. She would like to know the specimen collection recommendations and which tests are included on post-vasectomy semen analysis versus the fertility semen analysis.
1. What instructions should be given for post-vasectomy collection(s)?
2. What tests are required post-vasectomy and what tests are typically found on the fertility semen analysis?
Case Scenario 2: A semen analysis is being performed on a 36 year old male. The following results are obtained in progress:
Volume 3.0 mL pH 7.5
Liquefaction at 45 min Viscosity: 1 cm threads
Motility 55% at 50 min Motility Quality grade 3.0
Morphology 75% normal; 20% tapered head; 5% pin head
Sperm concentration and count is made from 1:20 dilution with normal Saline and 5 RBC squares on left side total 22 and on right side total 24 with Neubauer chamber.
1. What is the principle of the viscosity test and what is considered a normal result?
2. What is the sperm concentration in this sample? Show your calculation and include units.
3. What is the sperm count/ejaculate?
4. Discuss the results as shown in terms of normal or abnormal fertility.
Case Scenario 3: Synovial fluid from a 35 year old female with a positive R.A. serology test is obtained with the following results: volume 3.0 mL; pale color.
Cell count revealed 55,000/uL white cells and 15/ul red cells. The following image was seen in the cytospin differential. The neutrophils appear to have dark cytoplasmic granules inside them.
1. What test(s) would likely be requested to monitor for severity of R.A.?
2. What type of cell is seen in the image?
3. What are the cytoplasmic granules composed of?
4. If a viscosity test were performed, what would the most likely results be?
5. What is the viscosity test testing for?
Case Scenario 4: Consider the following laboratory results from a CSF collected from a 55 year old female:
Appearance: Clear/Colorless
RBC 4/uL
WBC 25/uL
Glucose 45mg/dL (plasma glucose was 75 mg/dL)
Protein 50mg/dL
Differential:
Segmented Neutrophils 77
Lymphocytes 12
Macrophages 10
Ependymal Cells 1
What do these results most likely correlate and what do you base your decision?
Case scenario 5: Four tubes of CSF are collected on a patient:
Tube #1 RBC Count = 12,300/uL
Tube #2 RBC Count = 3,000/uL
Tube #3 RBC Count = 600/uL
Tube #4 RBC Count = 200/uL
1. What would be the likely color of the supernatant for all four tubes?
2. What types of white cells would you expect to see in tube 1?
3. Does this most likely suggest traumatic puncture or intracranial hemorrhage and what do you base your decision?
Case scenario 6: A tech is assigned to perform fecal occult blood testing (FOBT) in the lab on two specimens.
1. What is the principle of the guaiac FOBT test?
2. The first specimen is visibly red and soft-formed. Other than blood, what are two other specific causes of red colored stool samples?
3. The second specimen is normal brown colored and formed but not watery. It gives a positive reading. What are two causes of false positive occult blood by the gFOBT method?
4. Describe the principle of the immunochemical iFOBT method.
5. If the two specimens have false positive occult blood by the gFOBT method, will they also likely have false positives with the iFOBT method? Explain your answer.
Case scenario 7: A 38 year-old pregnant woman has an AFP performed. Her results are 2.2 MoM at 15 weeks gestation.
1. What fetal condition is suspected?
2. If the amniotic fluid AFP is 2.5 MoM, what additional test could be performed?
3. In what situation would this test not be performed?
Case scenario 8: A 54-year-old male is admitted to the hospital with upper left abdominal quadrant pain. His history was remarkable. All cardiac tests were normal. A paracentesis was performed, with the following results:
Clear
Serum albumin: 3.0g/dL
Fluid albumin: 1.0g/dL
WBC count: 260/uL
RBC count: 59/uL
1. Calculate the SAAG.
2. Is this a transudate or exudate effusion?
3. Name 3 causes of transudates.
4. Name 3 causes of exudates.
5. Based on the site of the patient’s pain and the fluid results, what do you think could be causing his problem?
Case scenario 9: A 64-year old female with a history of breast cancer presented to the emergency room with shortness of breath and chest tightness. Her EKG showed irregular rhythms, but all other cardiac tests were normal. A chest X-ray was performed which revealed fluid in her pleural cavity. Thoracentesis was performed, and 3 liters of fluid were sent to the lab for examination. The results were as follows:
Cloudy
WBC count: 24,500/uL
RBC count: 37,250/uL
Differential: 72% lymphocytes, 28% other cells (in image below)
1. Is this a transudate or exudate? How do you know?
2. What type of cells do you think are in the image? What is the significance of these cells?
3. Based on the history and results, what do you think could be the cause of the patient’s problem?
4. What other tests could be performed to help with the diagnosis?
Case scenario 10: A 42-year-old-female visited her gynecologist complaining of vaginal dryness and soreness. A microscopic examination of vaginal secretions revealed numerous epithelial cells seen below, white blood cells, a few red blood cells, and moderate bacteria. The pH of the patient’s secretions was 6.5.
1. What are the cells depicted in the image? What other test could be performed to confirm these cells?
2. What is the patient’s most likely diagnosis?
3. What organism(s) cause this infection?
4. The pH of the specimen is 6.5. Why is this significant? What has caused the pH?