Hematology Case Study

Patient History

Patient- 30-year-old man arrived at the clinic with severe stomach pain after eating. He also complained of hip pain during the last several weeks. His doctor found on physical examination that he had an enlarged spleen. A complete blood count was performed on the automated hematology analyzer

Laboratory Results:
RBC= 2.96 WBC= 230.0 Hemoglobin = 9.9 Hematocrit = 30. 2 Platelet= 105 WBC/ PLT Histogram is giving abnormal flags RBC Histogram is giving abnormal flags

What laboratory findings should be discussed?

Interpretation

WBC s are markedly increased Platelets are decreased RBC and Hemoglobin and Hematocrit are slightly decreased.

Should other tests be performed?

What?

Manual Differential Smear

Results of Manual Differential Smear:

Segmented Neutrophils= 30 Band Neutrophils = 22 Metamyelocytes= 10 Myelocytes= 7 Promyelocytes= 4 Blasts= 1 Basophils= 7 Eosinophils= 2 Lymphocytes= 17 NRBCs/100 cells= 3 RBC Morphology: 2+ aniso, 1+ polychromasia, 1+ poik

Other Manual Test Results

Hgb conc. without centrifugation- 9.9 Hgb conc. after centrifugation- 7.5 RBC count 1.94

Explanations

When WBC > 99.9 or exceeds the linearity range of WBCs Spin the Hgb and perform manual hgb Hemolysates prepared from whole blood same as, marked leukocytosis can cause turbidity and erroneous results Hemolysates should be centrifuged

Troubleshooting Notes, continued:

Correct the RBC because an extremely high WBC count can falsely elevate the RBC count. Perform manual WBC if particle interference is present on WBC or PLT histogram. Question Platelet Validity- check smear and or perform manual platelet count.

Abnormal blood specimens will produce small particle interference that results in false elevation of the platelet count.

What is the Most Likely Cause of this Situation?

Case Solution

Massive splenomegaly with marked leukocytosis and a left shift in precursor cells of the myeloid series, and basophilia is highly suggestive of chronic granuloma leukopenia (CGL).
Unlike leukemia reactions, in which the blood smear findings may be similar to that seen in CGL, the leukocyte alkaline phosphatase (LAP) score is high, while in patients with CGL it is extremely low or cannot be estimated. Chronic Granulocytic Leukemia