hematology case study

8/3/2019 Hematology Case Study

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Hematology Case Study


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Patient History

Patient- 30-year-old man arrived at theclinic with severe stomach pain aftereating. He also complained of hip pain

during the last several weeks. His doctorfound on physical examination that he hadan enlarged spleen.

A complete blood count was performed on

the automated hematology analyzer


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Laboratory Results:

RBC= 2.96

WBC= 230.0

Hemoglobin = 9.9

Hematocrit = 30. 2

Platelet= 105

WBC/ PLT Histogram is giving abnormal

flagsRBC Histogram is giving abnormal flags


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What laboratory findings should be

discussed?


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Interpretation

WBC s are markedly increased

Platelets are decreased

RBC and Hemoglobin and Hematocritare slightly decreased.


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Should other tests be

performed?

What?


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Manual Differential Smear


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Results of Manual Differential Smear:

Segmented Neutrophils= 30

Band Neutrophils = 22

Metamyelocytes= 10

Myelocytes= 7

Promyelocytes= 4

Blasts= 1

Basophils= 7

Eosinophils= 2

Lymphocytes= 17

NRBCs/100 cells= 3

RBC Morphology: 2+ aniso, 1+ polychromasia,1+ poik


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Other Manual Test Results

Hgb conc. without centrifugation- 9.9

Hgb conc. after centrifugation- 7.5

RBC count 1.94


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Explanations


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When WBC > 99.9 or exceeds the linearityrange of WBCs

Spin the Hgb and perform manual hgb Hemolysates prepared from whole blood

same as, marked leukocytosis can cause

turbidity and erroneous results

Hemolysates should be centrifuged


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Troubleshooting Notes, continued:

Correct the RBC because an extremely high WBCcount can falsely elevate the RBC count.

Perform manual WBC if particle interference is

present on WBC or PLT histogram.

Question Platelet Validity- check smear and orperform manual platelet count.

Abnormal blood specimens will produce smallparticle interference that results in false elevationof the platelet count.


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What is the Most Likely Cause of

this Situation?


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Case Solution

Massive splenomegaly with marked leukocytosisand a left shift in precursor cells of the myeloidseries, and basophilia is highly suggestive of

chronic granuloma leukopenia (CGL).

Unlike leukemia reactions, in which the bloodsmear findings may be similar to that seen inCGL, the leukocyte alkaline phosphatase (LAP)score is high, while in patients with CGL it isextremely low or cannot be estimated.

Chronic Granulocytic Leukemia

hematology case study

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