Question

A 69-year-old woman is in the hospital undergoing treatment for recently diagnosed breast cancer.

WBC          1.0               Band neutrophils      5

RBC       2.90               Seg neutrophils    15

Hgb          9.0                Lymphs       80

Hct       27.1               Monos          

MCV        93.4               Eos

MCH       31.3               Basos

MCHC       33.2               Metamyelocytes

RDW       12.9               Myelocytes

PLT      5.9               Promyelocytes

1.   Describe the peripheral blood findings.

2.   What additional tests should be performed?  

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

  

4.   What is the expected condition of the bone marrow?

5.   What information is most diagnostic?

6.   Comment on the lymphocytosis.

Answer 1

1)

• The normal values of WBC - 4 x10-3 /mcl , RBC - 5.7 x10-3/mcl , HGB - (9 -16 g/dl), Hct - 38 -52% , MCV - 40 -60 fl , MCH - 15 -20pg , MCHC - 32 -36 g/dL , Platelets - 160 -420 /mcl , Seg neutrophils - 51 -72%.
• From the above data WBC , RBC, Hct, platelets , seg neutrophils are low.
• Lymphs and MCH values are high.
• More notably platelets are very low and lymphs are very high.

2)

• The low values of WBC, RBC and HCT indicates that there is a presence of bone marrow disorder.
• Low platelet count and high lymph count indicates that there is an infection .
• Additional tests for bone marrow like examination of bone marrow tissue biopsy for cancer or any infection .
• Screening for any parasites that causes infection .

3)

• The lady might be affected with myeloid displastic syndromes, which leads to recurring infections and high bleeding (low platelet) and blood cell count .

4)

• Bone marrow disorders are to be expected .
• Leukemia - as the lymph cells are high.

5)

Platelets are very low and lymphs are very high

6)

Lymphhocytosis - it is condition present when there is a severe infection resulting in over production of lymph cells. It may also lead to leukemia.