Question

A 65-year-old man is admitted to the hospital for a knee replacement. On physical examination, cervical lymphadenopathy was noted. The following are pre-surgical CBC values:

                       Manual differential:
WBC       48.3               Band neutrophils   3
RBC       4.50               Seg neutrophils   15
Hgb       13.9               Lymphs       75
Hct       42.1               Monos           5
MCV        93.5               Eos           2
MCH       30.8               Basos
MCHC       33.0               Metamyelocytes
RDW       13.9               Myelocytes
PLT   160.9               Promyelocytes

                          

The bone marrow aspirate shown below is hypercellular with a predominance of small mature lymphocytes.

8 8 0,000

  
1.   Describe the peripheral blood results and smear findings. (5 pts)

2.   Based on all the data provided, what condition is most likely? (5 pts)
  

3.   What information is most diagnostic? (5 pts)

4.   Calculate the absolute lymphocyte count for this patient. (5 pts)
  

5.    What is the key characteristic blood smear finding and why does it occur in this disease? (5 pts)

6.   What is the course of treatment for this disease? (5 pts)

Answer 1

ANSWER

1. Peripheral blood result and smear findings.

            * Peripheral blood test of this patient shows presence immature neutrophils

              such as metamyelocytes,myelocytes,promyelocytes.

            * It shows elevated lymphocyte count.

            * Presence of band and segmented neutrophils.

            * Normal erythrocyte and platelet count.

            * Bone marrow aspirate shows hypercellular and small mature lymphocytes.

2. Based on lab investigation (shows presence of immature neutrophils and

    elevated lymphocytes) and physical examination (cervical lymphadenopathy)

    and bone marrow report patient has chronic lymphocytic leukemia (CLL).

3. More diagnostic information is bone marrow biopsy which shows hypercellular and

    small mature lymphocytes and presence of immature neutrophils.

4. Absolute lymphocyte count.

          Formula = WBC * Lymphocyte percentage

                      WBC = 48.3

         Lymphocyte = 75% (0.75)

           Absolute lymphocyte count = 48.3 * 0.75

                                 = 36.2

5. Key characterstics of blood smaer findings and rationale.

                           * Presence of promyelocytes,myelocytes,metamyelocytes which

                              are immature neutrophils present in the blood due to granulocytosis

                              occur in chronic lymphocytic leukemia.

                            * presence of band and seg neutrophils which are premature neutrophils

                               and its presence shows that bone marrow signaled to release more WBC

                              or increase production of WBC is known as left shift commonly occur in

                              CLL.

6. Treatment for Chronic lymphocytic leukemia.

                          * Chemotherapy.

                                      * Use of chemotherapeutic agents to kill the abnormal growing cells and arrest

                                         overgrowth of cells.

                                      * Chemotherapeutic agents fludarabine and cyclophosphamide are given in

                                         combination with monoclonal antibody rituximab.

                           * Radiation therapy.

                                      * Localised low dose radiation therapy to treat enlarged lymphnodes to reduce

                                        symptoms of disease.

                           * Bood transfusion.

                                     * Use of blood products or components to replace deficiencies in the blood

                                        stream.

                           * Stem cell transplantation.

                                     * If the chemotherapeutic and radiation treatment are not controlling the disease

                                        transplantation of stem cells into the bone marrow of patient to treat the condition.