Case 15 The presenting symptoms of a 8-year-old include weakness, lethargy, and

Question

Case 15

The presenting symptoms of a 8-year-old include weakness, lethargy, and a tender abdomen.

Manual differential counts:

WBC: 2.3                                        Band neutrophils:

RBC: 3.20                                       Segmented neutrophils: 22

Hgb: 10.0                                        Lymphocytes: 10

Hct: 30.6                                         Monocytes: 6

MCV: 95.6                                     Eosinophils:

MCH: 31.3                                     Basophils:

MCHC: 32.6                                   Metamyelocytes:

RDW: 13.9                                     Myelocytes:

PLT: 74.9                                        Promyelocytes:

                                                        Abnormal lymphoid cells: 62

1. Describe the peripheral blood findings.

2. What additional tests should be performed?

The results of the proposed additional tests were as follows:

Abdominal imaging studies: splenomegaly

Bone marrow aspirate: dry tap

Bone marrow biopsy: fried egg appearing abnormal lymphoid cells

TRAP stain: positive (as shown in the following image)

TRAP stain

3. Based on all the data provided, what condition is most likely?

4. What information is most diagnostic?

Explanation / Answer

Answer 1. Peripheral blood finding includes MCV, MCH, MCHC and RDW. These all are based on the sizes of blood cells. Mean corpuscular volume (MCV) is the average volume of red cells. Mean corpuscular hemoglobin (MCH) is the average mass of hemoglobin in one red blood cell. Mean corpuscular hemoglobin concentration (MCHC) is the average concentration of hemoglobin in the red blood cells. Red cell distribution width (RDW) is the range of red blood cells volume.

Answer 2. Additional tests include ultrasound, bone marrow aspirate, bone marrow biopsy, staining. The results of additional tests are given in the case study.

Answer 3. Based on the given data most likely condition is hairy cell leukemia.

Answer 4. The most diagnostic information from the given case study is peripheral blood count finding, which shows severely decreased numbers of blood cell counts and highly increased numbers of lymphoid cells. The splenomegaly shown in the ultrasound is also diagnostic in hairy cell leukemia.

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