PROTOCOL 7

CLINICAL INTERPRETATION OF COMPLETE BLOOD COUNT

INDICES: ERYTHROCYTES, LEUKOCYTES AND PLATELETS.
Case-study 1

A 54-year-old woman is referred to a hematologist for a several month long history

of progressive headaches and erythromelalgia of the lower extremities. Physical
examination reveals mild splenomegaly and facial plethora.

CBC Data

 WBC count: 15,000/µL

 Hgb: 18.5 g/dL
 Platelet count: 500,000/µL

Other Laboratory Findings

 Erythropoietin: 3 mU/mL (4–27 mU/mL)

 PCR for V617F JAK2 mutation: POSITIVE

Comment:

Case-study 2

A 35-year-old woman presents to her primary physician with a several month history
of slowly progressive fatigue.
CBC Data:

• WBC count: 7900/µL

• Hgb: 9.3 g/dL
• MCV: 62
• RDW: 19%
• Platelet count: 399,000/µL

A peripheral blood smear (A, Wright stain, ×1000); the Wright-Giemsa-stained

Bone marrow aspirate (B, ×600).

Comment:

Case-study 3

A 40-year-old man presents with a new onset of a diarrheal illness. He presented to

a local physician and was noted on physical examination to have an enlarged spleen.

CBC Data

• WBC count: 143,900/µL

• Hgb: 11.9 g/dL
• Platelet count: 589,000/µL
• ANC: 122,300/µL

The peripheral blood smear reveals a marked leukocytosis with neutrophilia, a few
myelocytes and promyelocytes, rare blasts, and a basophilia (4300/μL).

The bone marrow (BM) aspiration and biopsy reveal a markedly hypercellular BM
(99% cellular) with small megakaryocytic forms and a markedly increased
Myeloid:Erythroid ratio of 29:1.

Comment:

Case-study 4

A 22-year-old college student presents with a recent history of sore throat, fever, and
palpable cervical lymphadenopathy and splenomegaly.

CBC Data

 WBC count: 63,600/µL

 Hgb: 9.9 g/dL
 Platelet count: 256,000/µL
 ALC: 45,300/µL

Review of the peripheral blood smear reveals a marked increase in atypical

lymphocytes. Flow cytometric analysis of the peripheral blood reveals 78% of cells
within the lymphocyte region. Cells within the lymphocyte region are composed of
87% T cells (CD4:CD8 ratio is 0.7) with a normal immunophenotype, 8% polyclonal
B cells, and 5% natural killer (NK) cells. The patient subsequently had a positive
monospot test for heterophile antibody.
Comment:
 Case-study 5

A generally healthy 54-year-old man with a history of osteoarthritis and

gastroesophageal reflux disease is found to have thrombocytopenia (platelets
15,000/µL) on routine blood work. He has no personal history of bleeding disorder
and demonstrates no sequelae of thrombocytopenia on physical examination. Other
CBC parameters are within normal limits. A PB smear review is requested.

CBC Data

 WBC count: 8,500/µL

 Hgb: 14.3 g/dL
 Platelet count: 15,000/µL

Microscopic examination of the PB smear demonstrated numerous large clumps of

platelets with the overall number of platelets appearing normal, and was otherwise
unremarkable.
Comment:

Case-study 6

A 68-year-old woman with a history of chronic leukocytosis was referred for a

second opinion. She has no significant past medical history. She has smoked a pack
of cigarettes weekly for the past 30 years. She initially presented with a mild
neutrophilic leukocytosis, which has been slowly progressive throughout the past 17
years (WBC 13.3-32.7 × 109/L; absolute neutrophil count 26.5 × 109/L at the time
of referral). The hemoglobin and platelet count are normal. She has remained
asymptomatic during this period and does not have palpable lymphadenopathy or
hepatosplenomegaly on examination. A peripheral blood smear is shown below.
Comment:

Case-history 7

An 18-year-old woman with distal pancreatectomy and splenectomy for benign

pancreatic pseudopapillary tumor two weeks earlier presents to the emergency
department with a temperature of 103°F (39.4°C), leukocytosis with bandemia,
tachycardia, and urinalysis results consistent with infection. White blood cell count
= 57,100 per mm3 (57.1 × 109per L), hemoglobin = 12.6 g per dL (126 g per L),
platelet count = 832,000 per mm3 (832 × 109 per L). White blood cell differential:
75.4% segmented cells, 19.3% bands.
Comment:

Case-study 8

A 39-year-old female was referred for CBC testing by her family physician. CBC
demonstrated slight leukocytosis with absolute neutrophilia, eosinophilia and
basophilia. The CBC also demonstrated a normocytic, normochromic anemia. The
family physician had noted pallor and splenomegaly.

Platelet Parameter Results:

Platelet count (× 103 /µL) – 713 (normal range 150-400)
MPV (fL) – 10 (normal range 8-12)
PDW (fL) – 13 (normal range 9-15)
IPF (%) – 5 (normal range 0.5-7)
Platelet Morphology – No abnormalities noted
Platelet histogram for case study 8.
The dotted line represents a normal histogram. The solid line represents the patient
histogram.
Comment:

Case-study 9
A 55-year-old male was referred by an orthopaedic specialist for a CBC.
Platelet Parameter Results:
Platelet count (× 103 /µL) – 19 (normal range 150-400)
MPV (fL) – 14 (normal range 8-12)
PDW (fL) – 16 (normal range 9-15)
IPF (%) – 12 (normal range 0.5-7)
Platelet Morphology – Few giant platelets noted
Platelet histogram for case study 9.
The dotted line represents a normal histogram. The solid line represents the patient
histogram.
Comment:

Case-study 10
A 38-year-old female was referred for a CBC by her internal medicine physician.

Platelet Parameter Results:

Platelet count (× 103 /µL) – 116 (normal range 150-400)
MPV (fL) – 9 (normal range 8-12)
PDW (fL) – 11 (normal range 9-15)
IPF (%) – 3 (normal range 0.5-7)
Platelet Morphology –

Platelet histogram for case study 10.

The dotted line represents a normal histogram. The solid line represents the patient
histogram.
Comment: