Question

Ellen P., a 35-year old white woman, had a history of systemic lupus erythematosus, diagnosed when she was in her early twenties. Her disease was generally under good control with steroid treatments. However, she was admitted to the hospital due to a recent onset of jaundice. Her liver was enlarged and tender.

Among her admission laboratory results are those shown.

    Ellen P.                                  Adult Female                           Reference Range

                                                            Reference Range                      for Absolute

                                                                                                            Values (x 10⁹IL)

WBC RBC Hb Hct MCV MCH MCHC Platelets RDW

13.5 3.63 109 .33 91 30 33 139 12

5-10 x 109/L 5-6 x 1012/L 140-180 g/L .41-.53 L/L 80-100 fL 26-34 pg 31-37% 150-400 x 109/L 11.6-14.8%

Abbreviations: RDW, red blood cell distribution within index.

Differential

Neutrophils      43                                   25-60%                                    1.10-6.05

Bands               0                                       0-10%                                    0.10-2.1

Lymphocytes    55                                   20-50%                                       1.50-4.00

Monocytes       2                                      2-11%                                         0.20-0.95

Eosinophils       0                                      0-8%                                            0-0.70

Basophils          0                                      0-2%                                            0-0.15

Morphology     50% of lymphocytes are reactive

Questions

1. Describe Ellen’s blood picture using appropriate terminology.

2. What conditions produce a blood picture like Ellen’s and which is the most likely in her case?

3. Explain the etiology (cause) of the lymphocyte appearance.

Answer 1

Answe 1. It is the blood picture of normocytic anaemia because Hb and PCV or Hct is decreased and MCV is with in normal limits with reactive lymphocytosis

2.Usually primary conditions, aplastic anaemia, myelopathies and secondary conditions like chronic renal failure , liver diseases drug induced . here it may be due to hypoactivity of bone marrow due to chronic disease   as is evidenced by little thrombocytopenia anaemia and erythropoitin deficiency due to kidney involvement and also due to drug induced haemolysis ( in liver enlargement )

3. Reactive lymhocytosis may be due to autoimmune disease like SLE which is evident in Ellens case here and also bacterial, viral and parasitic infection,vaccination, drug induced etc, malignancy.