Page 486 - Clinical Hematology_ Theory _ Procedures ( PDFDrive )

470 PART 6 ■ Neoplastic Disorders

CASE STUDIES (continued)
CASE STUDIES (continued)

■ Critical Thinking Group Discussion Questions ■ Critical Thinking Group Discussion Questions
1. Wh t qu ntit tive cellul r bnor lities were reve le 1. Wh t is the ost prob ble i gnosis in this c se?

by l bor tory testing?

2. Woul ny ition l tests be v lu ble?

2. Wh t o the l bor tory t suggest in this c se?

3. Why i this p tient exhibit thro bocytosis on the

3. N e other tests th t woul support i erenti l i- peripher l bloo s e r?

gnosis o PRV.

Case Study 23.3

Case Study 23.2
A 55-ye r-ol white n w s t ken by the loc l volunteer

A 64-ye r-ol white n s w his physici n bec use he bul nce service to the hospit l e ergency ep rt ent.
w s experiencing p in in the shoul ers n wrists since His chie co pl int w s severe p in in the b o en n

returning ro his winter ho e in Flori 6 weeks i rrhe or the p st 3 ys. Physic l ex in tion reve le
be ore. Physic l ex in tion reve le th t the p tient w s extensive b o in l istention, resh bloo in the stool, n

p le but otherwise in goo he lth. T e physici n sent the elev te or l te per ture, ecre se bloo pressure, n
p tient to the outp tient l bor tory or CBC n pre- r pi pulse. T e physici n itte the p tient n or ere

scribe n n lgesic or the joint isco ort. S A CBC n seru electrolyte eter in tions. An
intr venous physiologic l s line solution w s st rte er

■ Laboratory Data the bloo h been r wn or ex in tion. A ull-bo y
Te p tient’s erythrocytes n he oglobin were o er- co pute to ogr phy (C ) sc n w s sche ule or the

tely ecre se . His tot l leukocyte count w s 68 × 10 /L. next orning bec use convention l lower g strointestin l
9
T e leukocyte istribution w s s ollows: r iogr phic series w s contr in ic te owing to the resh

blee ing.
Pro yelocytes 1%

Myelocytes 8%

Met yelocytes 15% ■ Laboratory Data
Te p tient’s erythrocyte n he oglobin p r eters were
B n s 35% within nor l r nge; however, the tot l leukocyte count w s

Seg ente neutrophils 25% 63 × 10 /L. T e leukocyte i erenti l results were s ollows:
9
Ly phocytes 14%

Monocytes 2% Bl st or s 2%

Pro yelocytes 5%
So e i ture erythrocytes were note , n the nu - Myelocytes 13%
ber o pl telets w s incre se . A subsequent bone rrow Met yelocytes 20%

ex in tion reve le both gr nulocytic n eg k ryo- B n s 20%
cytic overproli er tion. Cytoche istry st ining resulte in Seg ente neutrophils 35%

the ollowing LAP scores:
Ly phocytes 4%

P tient 6 Monocytes 1%

Control 43
T e pl telet esti te ro the i erenti l s e r in ic te

slightly incre se nu ber. T e seru electrolyte v lues
in ic te st te o ehy r tion.

■ Additional Clinical Data
T e p tient’s te per ture re ine elev te uring the night

o ission. A bro -spectru ntibiotic w s e to the

intr venous in usion. T e p tient’s bloo pressure bec e

unst ble uring the night. A repe t CBC w s or ere the

next orning. At th t ti e, the leukocyte count h risen

to 118 × 10 /L with essenti lly the s e i erenti l istri-
9
bution o leukocytes. At 10 am, the l bor tory w s notif e

th t the p tient h ie n n utopsy h been requeste .

T e utopsy reve le th t the p tient h esen-
(Reprinte ro McCl tchey KD. Clinical Laboratory teric thro bosis, n cute peritonitis h subsequently

Medicine, 2n e , Phil elphi , PA: Lippincott Willi s evelope .

& Wilkins, 2002, with per ission.)