Case of the Month August 2009

An elderly man with lymphocytosis

Olukemi A Esan MBBS, Maurice Grant MD, Sharon L Wenger PhD.

Patient History

A 75-year-old man presents with a 3 year history of lymphocytosis. He recently developed a cutaneous lesion on his upper lip that was excised at another facility.  The patient reports that the pathology of the cutaneous lesion revealed a ‘lymphoma’.  This has yet to be confirmed.  A peripheral blood smear ordered at his most recent visit included morphologic examination, flow cytometry and fluorescent in situ hybridization (FISH).

Laboratory Results

Table 1: Complete blood count and differential

Laboratory Test

Patient Result

Reference Range

Hemoglobin

12.6 g/dl

13.1 -17.3 g/dl

Hematocrit

37.8 %

39.8 – 50.2 %

Platelet count

95 Thou/ul

140-450 Thou/ul

White blood cell count

76.9 Thou/ul

3.5 -11.0 Thou/ul

DIFFERENTIAL

 

 

Polymorphonuclear cells

7 %

40-75%

Lymphocytes

89 %

20-45%

Eosinophils

2 %

1-6%

Monocytes

2 %

4-13%

Basophils

0 %

0-1%

Nucleated red blood cells

0

0