Need help with case, please.

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LRingers

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What do you think about this case?
Patient is 40 yo WM s/p divorce 1 month. Exercises 1/wk. No PMHx/PSgHx. ROS -. Patient CBC: WBC 3.5, Hg 14, Hct 42, Platelet 200. diff: Neuto 37%, Lympho 54%, Mono 6 %, Eos 1.9 %, Baso 0.4%. Absol Neutro 1.3, Absol Lympho 1.9, Abs Mono/eos/baso wnl. Chem-8 wnl. Patient thinks he has cancer vs. etc. but reports feeling well/ asymptomatic. Need help with differential and treatment.
 
LRingers said:
What do you think about this case?
Patient is 40 yo WM s/p divorce 1 month. Exercises 1/wk. No PMHx/PSgHx. ROS -. Patient CBC: WBC 3.5, Hg 14, Hct 42, Platelet 200. diff: Neuto 37%, Lympho 54%, Mono 6 %, Eos 1.9 %, Baso 0.4%. Absol Neutro 1.3, Absol Lympho 1.9, Abs Mono/eos/baso wnl. Chem-8 wnl. Patient thinks he has cancer vs. etc. but reports feeling well/ asymptomatic. Need help with differential and treatment.


I'd get a peripheral smear to look for blasts and an LDH, alk phos, also trend his white count.
 
What is his cheif complaint? Divorce? Why does he think that he has cancer?

Also, how about a physical exam?

CLL is often insidious and discovered on routine check-ups, but the absolute lymphocyte count is usually over 5000.

Gotta think about lymphocytic leukemia. Other causes could be tb, viral infections...., but any acute stress can cause lymphocytosis, and so can recovery from a bacterial infection.
 
What about alky-hol? EtOH use can cause pretty significant (but usually reversible) bone marrow toxicity. If the dude just got divorced, he may have upped his baseline blood alcohol concentration.
 
Sorry--treatment would involve reducing the offending agent. Alcohol-induced bone marrow suppression is reversable, as far as I understand. But I'm with the above--a physical would be coo.

DS
 
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