A 71 years old male presented to the office with abdominal distention and shortness of breath. He has a history of hypertension.
On physical examination, He was afebrile, Blood pressure is 112/82 mm Hg, pulse rate is 104/minute, respiratory rate is 16 /minute, and he has severe pallor, with a significant hepatosplenomegaly.
Laboratory studies indicate a hemoglobin of 5.9 g/dl, leukocyte count of 23 × 109/L, and platelet count of 235 × 109/L. MCV of 78 fl,MCH of 30 pg, neutrophils 9.1x 10⁹/L,lymphocytes 6.0 x 10⁹/L,monocytes 1.2 x 10⁹/L, eosinophils 0.3x 10⁹/L, 1x 10⁹/L, basophils 0.2x 10⁹/L, metamyelocytes 4.2x 10⁹/L, myelocytes 1.2x 10⁹/L, and blast cells 0.8 x10⁹/L.
Reticulocytes < 1%. Peripheral blood smears showed tear drop cells, anisocytosis and poikocytosis
What is the most likely clinical diagnosis?
What would you do next to confirm your diagnosis?
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6 comments:
1) most likely Leukemia, CLL with acute transormatio as blasts are almost reaching to 30%.
2) Bone marrow biopsy, flow cytometry
1.)primary myelofibrosis/Acute leukemia/metastatic cancer(to be confirmed by bone marrow biopsy).
2.)Bone marrow biopsy.
1) Myelofibrosis.
2) Bonemarrow biopsy for confirmation.
Myelofibrosis.
Do a bone marrow biopsy for confirmation
1-The clinical diagnosis is Myelofibrosis
Based of the hematological labs,this patient has leukoerythroblastic anemia c/w Myelofibrosis and myeloid metapalsia.
2- Bone marrow biopsy is an appropriate choice to confirm the diagnosis
Remember that bone marrow biopsy is better than bone marrow aspiration.
So in the board if you left with 2 choices ,go with BM biopsy.
CML is an acceptable answer as well and to confirm the diagnosis you can check for philadelphia chromosome.
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