Case 30

Hematopathology Case
 

CLINICAL INFORMATION

 

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

CBC WITH DIFFERENTIATION

 

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 have 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

 

     
 

Click here for diagnosis and case discussion.

 

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

Photo: Zenggang Pan

Discussion: Zenggang Pan