blood smear

[MudPhud20XX]

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So what do you guys think? It's one of the WBC disorders.....

 

[Missorleans]

Spherocytes? if its a WBC disorder might be due to globulins, like AIHA, can be due to a leukemia, don't remember which.

 

[MudPhud20XX]

Spherocytes? if its a WBC disorder might be due to globulins, like AIHA, can be due to a leukemia, don't remember which.

here is the clinical vignette that goes along with this figure. When I read the question, I just couldn't see any correlation with the image of the blood smear. What do you think?

A 60-year-old man has had fever and productive cough for a week. Streptococcus pneumoniae is cultured from his sputum. Additional laboratory studies shown Hgb 10 g/dL, Hct 30%, platelet count 110,000/µL, and WBC count 4300/µL. His total protein is 11 g/dL and albumin 5 g/dL. His serum electrophoretic pattern is shown in the image. Which of the following cells is most likely to be greatly increased in number in his bone marrow?

 

[Transposony]

Looks like CLL.
I also see polychromasia, spherocyte/elliptocyte.

 

[thehundredthone]

here is the clinical vignette that goes along with this figure. When I read the question, I just couldn't see any correlation with the image of the blood smear. What do you think?

A 60-year-old man has had fever and productive cough for a week. Streptococcus pneumoniae is cultured from his sputum. Additional laboratory studies shown Hgb 10 g/dL, Hct 30%, platelet count 110,000/µL, and WBC count 4300/µL. His total protein is 11 g/dL and albumin 5 g/dL. His serum electrophoretic pattern is shown in the image. Which of the following cells is most likely to be greatly increased in number in his bone marrow?

Are you sure this is the question because you're talking about someone with a low WBC count for infection, increased protein and an electrophoresis report shown in the image and then showing us an image of a peripheral smear.

CLL would have a higher WBC count and also hypo(gamma)globulinemia.

 

[Transposony]

His serum electrophoretic pattern is shown in the image.

 

[Robotman]

Increased erythrocytic precursors because spherocytes would be caught in spleen due to decreased lability. Also hct is low so the bone marrow would try to pump up the hct via ERP.

But where are the neutrophils too?

 

[cruCiATE]

Spherocytes arise do to two things only, either Hereditary (ankryn and spectrin i.e. Cytoskeleton disorder) or by autoimmune hemolytic anemia.
It can be CLL do to the fact the there is either low immunoglobulins by neoplastic B-cell or if they do make Igs they will be against our own RBCs, causing a autoimmune hemolytic anemia (spherocytes on smear). It would have been nice to see some smuge cells on the Smear which are good indicators for CLL or SLL or some Cluster Differentiation markers on the vignette (ie CD20 or CD5).

 

[Transposony]

It is not possible to make a diagnosis solely based on peripheral smear and even for a hematology fellow it's difficult.
That's why associated info like age etc in history are essential to make a "most likely" diagnosis.

 

[DeeJay2728]

So is it SLL?