A 19-year-old female college student went to the University Health Center with a

Question

A 19-year-old female college student went to the University Health Center with a symptoms of malaise, fatigue, sore throat, and a slight fever. A complete blood count was performed, and both RBC and WBC were within normal limits, but the hematology analyzer flagged as positive on possible abnormality on WBC morphology. A rapid strep test was performed, and the result was negative. A slide agglutination test for infectious mononucleosis was indeterminate. The result of quantitative result of CRP is indicated an increased level approximately 25 mg/dL. The student was advised to return after a few days for a repeat mononucleosis test. How does a test result of CRP help in a presumptive diagnosis of infectious mononucleosis? What would you do next if there is a flag from the hematology analyzer, and what would you expect to see on the WBC differential smear?

Explanation / Answer

CRP stands for C-reactive protein synthesized by the liver. It binds with phosphocholine present on the surface of dead/dying bacterial/viral cells. This will induce complement system. Diseased conditions like viral/bacterial infections, inflammation, injury, malignancy etc., will trigger the synthesis of CRP from liver. Hence under such physiological conditions, CRP is increased rapidly within 2 hours of infection. So measuring a CRP level acts as a basic screening test and is indicative of the presence of infectious agents.

The results from CRP is combined with the abnormality of the WBC morphology and the symptoms to conclude that it would be infectious mononucleosis.

Infectious mononucleosis is caused by Epstein Barr virus. It causes fatigue, sore throat, slight fever, swollen lymph glands and discomfort (malaise).

WBC differential smear shows bilobed neutrophil with condensed chromatin. Atypical lymphocytes will be seen. Hematological observation shows abnormally giant irregular lymphocytes with more cytoplasm (deep blue), round to ovoid nuclei.

A serological test for infectious mononucleosis will confirm the diagnosis because similar hematological results can be observed in cytomegalovirus and hepatitis infection.

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