Case 12 The presenting symptoms of a 68-year-old include increasing malaise, wei

Question

Case 12

The presenting symptoms of a 68-year-old include increasing malaise, weight loss, and distended abdomen.

Manual differential counts:

WBC: 28.3                                      Band neutrophils: 16

RBC: 3.20                                       Segmented neutrophils: 40

Hgb: 10.0                                        Lymphocytes: 12

Hct: 30.2                                         Monocytes:

MCV: 94.3                                     Eosinophils:

MCH: 31.2                                     Basophils: 6

MCHC: 33.1                                   Metamyelocytes: 11

RDW: 22.9                                     Myelocytes: 9

PLT: 660.9                                      Promyelocytes: 4

                                                        Blasts: 2

                                                        NRBCs/WBCs: 25/100

Giant and abnormal PLTs:

1. Describe the peripheral blood findings.

2. What additional tests should be performed?

Additional test performed would be bone marrow biopsy and stain

The results of the proposed additional test were as follows:

Abdominal imaging studies: hepatosplenomegaly

Bone marrow aspirate: dry tap

Bone marrow biopsy: megakaryocytic hypercellularity with increased fibrosis

Silver stain: positive for connective tissue protein fibers

Trichrome stain: positive for connective tissue protein fibers

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

4. What test results are most helpful in establishing the diagnosis?

5. What automated CBC values might be spurious in this condition

Explanation / Answer

Answer-1-this is a case of increased wbc in the peripheral smear.more immature cells are spilled in the blood.this condition is called leukemia.

Answer-2-bone marrow biopsy is the gold standard test to look out for leukemia, along with peripheral blood film.flow cytometry will also aid in diagnosis.

Answer-3-according to the finding this is a case of essential thrombocythemia in which bone marrow is fibrosed and platelet count is abnormal.

Answer-4-giant and abnormal platelets with increased platelet count hints towards abnormalities of platelets.it is associated with jak-2kinase mutation,which affects bone marrow and causes it's fibrosis.hence resulting in the dry tap.extramedullary haematopoiesis occurs resulting in hepatosplenomegaly.

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