WBC Cases

History: 8 year old male well until two weeks PTA, complained of headaches, sore throat, and night sweats with a fever of 102-103 and bone pain two days PTA.

Physical exam: pale with petechiae on lower legs; palpable lymph nodes—cervical, inguinal and femoral

Peripheral Blood:

Hb: 5.8 g/dL WBC: 7.3 × 10⁹ /L

RBC: 2.06 × 10¹² /L N seg: 3%

Hct: 17.5% N myelo: 0.7%

MCV: 83 fL L: 31.7%

MCH: 28.3 pg M: 1%

MCHC: 33.5% E: 1.3%

Platelets: 23 × 10⁹/L Plasma cells: 1.3%

Lymphoblasts and immature lymphocytes: 60%

The red cells show slight aniso- and poikilocytosis with elliptocytes and rare teardrops and helmet cells. The lymphoblasts and immature lymphocytes have variably fine chromatin pattern with nucleoli in the most immature forms. Nuclear clefts are frequent, and moderate sized vacuoles are present in the nuclei and cytoplasm of many cells. The cytoplasm is scanty and basophilic.

Bone marrow biopsy: Slighly hypercellular—M:E layer 12%; 95.8% lymphoblasts and immature lymphocytes—PAS positive

History: 68 year old male with a previous diagnosis of pernicious anemia treated with vitamin B₁₂ injections.

Cheif complaint: fatigue, dizziness and weakness—particularly of the lower extremities with easy bruising.

Physical exam: pallor, splenomegaly, ecchymoses on lower extremities.

Peripheral blood:

Hb: 8.4 g/dL WBC: 31.6 × 10⁹/L

Hct: 25% N: 2%

RBC: 2.45 × 10¹²/L L: 8%

MCV: 99 fL Hairy cells: 90%

MCH: 35 pg Platelets: 28 × 10⁹/L

MCHC: 34%

Normochromic RBC. Marked anisocytosis with many macrocytes and few microcytes. Moderate to marked poikilocytosis with elliptocytes, echinocytes, target cells, acanthocytes, fragments, and occasional spherocytes. Polychromasia is slightly increased. There is a slight rouleaux. Platelets are markedly decreased. Some are large and show poor granulation. The predominant white cells are relatively large and pleomorphic. The nucleus is round or slightly indented, with a coarse chromatin pattern and frequent large nucleoli. The cytoplasm is a grainy blue-grey color with an irregular, ragged boundary. There are numerous thread-like projections that give the cells a “hairy” appearance.

History: 77 year old female; six years PTA had L radial neck resection for adenoid cystic carcinoma of the submandibular gland; three year history of congestive heart failure—controlled by medication; two to three months PTA noticed increased tiredness, malaise, loss of appetite, dizziness, low grade fever, and night sweats.

Physical exam: mild generalized adenopathy involving the cervical, supraclavicular, axillary and inguinal regions; soft, tender, firmly attached submandibular mass, 4 × 6 cm, at the site of the neck resection scar.

Peripheral blood:

Hb: 11.6 g/dL WBC: 21.6 × 10⁹/L

Hct: 34.7% N seg: 20%

RBC: 3.69 × 10¹²/L N band: 8%

MCV: 93 fL N meta: 1%

MCH: 32.1 pg N myelo: 1%

MCHC: 34 g/dL L: 64%

M: 4%

E: 1%

B: 1%

The RBC are normochromic and normocytic. The platelets appear adequate. The majority of the lymphocytes appear mature, with a smudged chromatin pattern, a “stretched” nucleus, and a slight to moderate amount of cytoplasm. Some of the cells have a more reactive apperance, with a finer chromatin pattern, visible nucleoli, and a more abundant basophilic cytoplasm.

Bone marrow biopsy: hypercellular