Here’s an interesting case which came up on a
Facebook group I follow. Given the above result:
1, How would you proceed?
2, What do you think is causing these
abnormal results?
3, What could the diagnosis be?
The obvious first step is to get a repeat sample;
it looks disastrous. But apparently these results were repeatable.
So… the massive white cell count is probably
CLL. I’d check a blood film looking for appropriate morphology and also looking
to check that massive MCV. It turned out that the red cells didn’t look
macrocytic.
The chap posing the question said “With
such a high lymphocyte count and low RBC count, the small lymphs are counted in
the RBC graph, and you would see a dimorphic population, and hence an
erroneously elevated MCV.
After consulting with our hematology
supervisor, we subsequently reported MCV, RBC and RDW as unavailable until this
patient's RBCs and WBCs went back to reasonable numbers.”
Personally I’m intrigued as to what
analyser mixes up red cells and lymphocytes. I’ve never noticed this before and
I’ve regularly dealt with white cell counts over 200.
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