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Case 30

Hematopathology Case

Clinical Information

 

A 63-year-old male had a history of spontaneous rupture of spleen approximately one year ago. He denied night sweats, weight loss, fever or lymphadenopathy. Rest of review of systems was negative otherwise.

CBC with differential

 

BLOOD     11/19     10/22     06/26     03/08     02/09           Reference

           2007      2007      2007      2007      2007

          07:11     16:02     07:48     14:10     06:45     Units    Ranges

-------------------------------------------------------------------------------

WBC       13.3 H    13.5 H    13.6 H    12.0 H    14.9 H    K/uL   4 to 11

RBC       4.98      4.83      5.20      4.89      5.13      M/uL    4 to 6

HGB       15.3      15.1      16.0      14.1      14.3      g/dL   12.5 to 17

HCT       45.6      44.3      45.2      42.2      43.6         %   37 to 50

MCV       91.6      91.7      86.9      86.3      85.0        fL   80 to 98

MCH       30.7      31.3      30.8      28.8      27.9        pg   27 to 33

MCHC      33.6      34.1      35.4      33.4      32.8      g/dL   32 to 36

RDW       14.1      14.5      14.7      17.7 H    16.9 H       %   11.5 to 15

PLT        204       230       282       266       278      K/uL   150 to 450

MPV       12.0      12.0      12.8 H                          fL   8.3 to 12.4

MPV                                     11.9 H    13.0 H      fL   6.5 to 10

NEUTR %   38.8 L    41.2 L    46.8                42.6 L       %   43 to 76

GRAN %                                                         %   43 to 76

LYMPH%    47.5 H    46.8 H    38.7                42.9         %   16 to 45

MONO%      9.6       8.5       9.3                10.9         %   5 to 14

EOSIN%     3.6       3.0       4.8                 3.4         %    0 to 5

BASO %     0.5       0.5       0.4                 0.2         %    0 to 1

NEUTR #    5.2       5.6       6.4                 6.3      K/uL   1.7 to 7

GRAN #                                                      K/uL   2 to 11.6

LYMPH #    6.3 H     6.3 H     5.3 H               6.4 H    K/uL   1 to 3.5

MONO #     1.3 H     1.1       1.3 H               1.6 H    K/uL   .2 to 1.1

EOSIN #    0.5 H     0.4       0.7 H               0.5 H    K/uL   0 to .4

BASO #     0.1       0.1       0.1                 0.0      K/uL   0 to .1

FLOW CYTOMETRY OF PERIPHERY BLOOD

 

               Total events analyzed=           A gate Bright CD45 positive

               50560                            events = 14092 (35% of total

                                                events analyzed)

                CD45+/CD14-                               99%

                CD19+/CD3-                                 4%

                CD3+/CD19-                                86%

                CD19+/CD20+                                3%

                CD19+/CD38+                                2%

                CD19+/CD10+                               <2%

                CD5+/CD19+                                <2%

                CD5+/CD19-                                86%

                CD19+/CD23+                                2%

                CD19+/FMC7+                                4%

                CD26+                                     19%

                CD2+/CD7+                                 74%

                CD3+/CD5+                                 83%

                CD3+/CD4+                                 49%

                CD3+/CD8+                                 36%

                CD16+                                     12%

                CD3-/CD56+                                10%

                            Gated on CD19+ cells 

                CD19+/sIg/Kappa+                          59%

                CD19+/sIg/Lambda+                         42%

     

PERIPHERAL BLOOD SMEAR

 

A count of the peripheral blood revealed that 52% of the lymphocytes had a morphology of the following:

 

 

Wright-Giemsa, 100

Wright-Giemsa, 100

 

 

Wright-Giemsa, 100

Wright-Giemsa, 100

 

 

Wright-Giemsa, 100

Wright-Giemsa, 100

 

 

Wright-Giemsa, 100

Wright-Giemsa, 100

 

 

 

Wright-Giemsa, 100

 

 

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Source: Department of Pathology, Creighton University Medical Center, Omaha, NE