September 16th (Thursday) - Glandular Fever

An interesting case

Specimen Results Entry HONORAMA, FLETCHER                                                     Queue  DOB  07/04/1992 Sex F Pat No 666          Source    G.P.   Received  18:23 Address   HER HOUSE                       Clinician JECKYLL              16/09/2010 Diagnosis SORE THROAT Specimen No   :  AW126536J               Selected Auth Level : S  HB     13.7   Q000  MONO   1.6    Q000                     WBC    11.1   Q000  EOS    0.0    Q000                     PLT    168    Q000  BASO   0.4    Q000                     RBC    4.87   Q000  E      5      Q000                     HCT    0.420  Q000  G      +      Q000                     MCV    85.2   Q000  ~F1   ^ATM    Q008                     MCH    28.1   Q000  ~F2   ^FR     Q008                     MCHC   33.0   Q000                                        NEUH   2.7    Q000                                        LYMPH  6.5    Q000                                        1 Auth'd   2 Unauth'd   3 Nomin'd   4 Change   5 Reject  6 Options  7 eXit> U  Disc: CLIN    Sect: HAEW          The Author

Note the reversed neutrophil/lymphocyte ratio and the appearance of atypical mononuclear cells in the blood film.

Bearing in mind the diagnosis of “sore throat” and the patient’s age, I suspected this to be a case of glandular fever. I added the test for glandular fever to the request, and my educated guess was right. And in doing this I’ve saved time in the diagnostic process.

And then I found two more almost identical cases. Is there an outbreak?  And then I remembered – schools and colleges are back in session…