An
82-year-old man presented with mild leucocytosis. On examination he had an 8cm
spleen below the left intercostal margin and no palpable lymphadenopathy.
Hb 82 g/l
Wbc 63
Plt 75
Lymph 35
“Try
and identify the cells our patient has in his blood film”.
Well…
what a silly question. Bearing in mind there’s six neutrophils it can only be
option 2… or is it option 3? Are a couple of those neutrophils immature?
The
software said option 3. I suppose it is a UK thing that we lump band forms in
with mature neutrophils and only count as separate when metamyelocytes?
Butu what
a wasted opportunity – we might have had the option to learn something about
those lymphoma cells. And the red cells – a tad hypochromic and microcytic?
I suppose
this illustrates the difficulty of coming up with a simple yes or no question
in morphology, doesn’t it?
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