Question

A 45-year-old woman was shaking with chills and fever that began after she inhaled toxic fumes. Two days later, she noticed a rash over her back and trunk. She was admitted to the hospital suffering from generalized body soreness, coughing, malaise, and fever. Her admission laboratory findings were: WBC 5.9 X 10°/L; Hb 11.6 g/dL; PLT 30 X 10°/L and a leukocyte differential revealed neutrophils (N) segmented forms 24% and toxic; N band forms, 72%; lymphocytes, 2%; monocytes, 2%. On day 2, the patient's Hb had fallen to 7.7 g/dL and her platelets had decreased to 13.0 X 10°/L. Consequently, the patient was trans- fused with 2 units of packed red cells and several units of platelets. The patient's condition began to stabilize on the fourth day. Her Hb was 10.0 g/dL and her PLT was 120 X 10°/L. The neutro- phils no longer looked toxic and there was no evidence of phago- cytosis. However, on a follow-up leukocyte differential per- formed in the outpatient laboratory on day 24, a marked reactive lymphocytosis was noted, which persisted for 2 weeks. Her leukocyte count and differential were: WBC 14.0 X 10°/L; neutro- phils, seg. 20%; neutrophils, band 10%; lymphocytes, 60% (vari- ant); monocytes, 10%. 1. Judging from the clinical information and admission laboratory findings, what is the most likely cause of the thrombocyto- penia and the left shift of the neutrophils? 2. Considering the patient's clinical history and treatment, what is the most likely cause of the reactive lymphocytosis? 3. What is the absolute lymphocyte count on day 24? 4. What laboratory tests are needed to confirm the diagnosis?

Answer 1

Ans1:- CML

Ans 2:- it is due to compensatory hyperactivity of lymphoid precursor cells and cause lymphocytosis.

Ans 4- 1.CBC

2.Bone marrow aspiration and biopsy

3.molecular testing