Diagnostic Investigations of Haemoglobinopathies – Nursing Assignment Help

Assignment Task

Background (Patient data)
During the practical, you tested the blood samples from three different patients using citrate agarose electrophoresis of haemoglobins and sickle solubility test to assess whether they have a haemoglobinopathy and, if so, what type. The clinical details and full blood count results for each patient are shown in the table below. Please note patients were labelled as A, B, C in the electrophoresis part of Practical 1, and labelled as Y, X and Z respectively in the sickle solubility part of Practical 1.
Patient A (Y) B (X) C (Z) Reference range
Age 27 23 46 Sex Male Female Male Ethnic group Black (Zambian) White (Turkish) Black (Jamaican) Clinical detail Screened because female partner is pregnant and is a carrier of HbSRoutine antenatal screening patient. Routine preoperative screening. History of episodic generalised joint pain. Full blood count RBC 5.5 1012/L 3.5 1012/L 2.5 1012/L Male: 4.5-6.5 (1012/L)

• Female: 3.9-5.6 (1012/L)
• Hb 136 g/L 103 g/L 71 g/L Male: 135-175 (g/L)
• Female: 115-155 (g/L)
• MCV 88 fL78 fL85 fL80-95 fLMCH 32 pg25 pg29 pg27-34 pgMCHC 332 g/L 313 g/L 340 g/L 320-360 g/L
• Blood films have been done on patients A, B and C as well. A typical image of the blood film for each of these patient are shown as below (Fig.1).

1.1Background interpretation

• What do the patients’ clinical data, full blood counts and blood film results suggest? What differential diagnoses would you consider for each patient (provide 2-3 diagnoses per patient)?
• NB! Please support your statements in-text with peer-reviewed sources using the Harvard referencing style. It is NOT expected that you take the results for the electrophoresis and sickle solubility test into consideration at this stage (Max. word count: 250; 9 marks)
• Patient A
• These results suggest:
• Differential Diagnoses:
• Patient B
• These results suggest:
• Differential Diagnoses:
• Patient C
• These results suggest:
• Differential Diagnoses:

2. Methods and Results 
In the questions below, please paste your photograph for sickle solubility test and Haemoglobin electrophoresis, annotate clearly and add a figure legend to make it look like a figure from a journal article. For each investigation, please provide short description of the methods and your findings (can be part of the legend),
2.1 Sickle Solubility test
Indicate clearly the samples per each tube and provide the images before and after centrifugation
2.2 Haemoglobin electrophoresis
Indicate the lanes, which sample is loaded in each lane and the type of Hb that each band represents. Make sure you indicate which end was towards the anode, and which towards the cathode, and that the origin is clearly shown.


3. Interpretation of Results 
In this section, please discuss your findings for each of the patient in light of their background data and relevant literature. Please support your statements in-text with peer-reviewed sources. Provide most likely clinical condition/disease for each of the 4 patients with consideration of differential diagnoses in section 1.1 and results in sections 2.1 & 2.2) Please use figure 2 to help in your interpretation.For each patient suggest further clinical or laboratory investigations to confirm the most likely diagnosisCompare the 2 procedures with other common laboratory techniques applied in haemoglobinopathy investigation: Sickling test and HPLC. Discuss advantages, disadvantages and applications of each procedure.Considering Sickle solubility and Haemoglobin electrophoresis, comment on these tests abilities to determine definitively the genotype of the patient.