A 52-Year-Old Man With Fatigue, Leukocytosis, and Moderate Splenomegaly

Koyamangalath Krishnan, MD


December 11, 2017

Physical Examination and Work-up

The physical examination reveals that his oral temperature is 98.8°F, pulse is 80 beats/min, blood pressure is 144/80 mm Hg, respiratory rate is 16 breaths/min, and oxygen saturation is 97% on room air. He is alert and oriented to person, place, and time and not in distress. Head and neck examination findings are normal. Examination reveals a palpable spleen about 7 cm below the left costal margin. The remainder of the systemic examination findings are normal.

Laboratory tests reveal a complete blood count (CBC) with a white blood cell (WBC) count of 42,000 cells/µL, hemoglobin level of 10.8 g/dL, hematocrit of 32.6%, and a platelet count of 140,000 cells/µL. The differential count reveals neutrophils at 43%, lymphocytes at 13%, monocytes at 6%, eosinophils at 6%, basophils at 12%, and bands at 20%. Chemistry panel findings are within normal limits. The lactate dehydrogenase level is 690 IU/L, the phosphorus level is 4.8 mg/dL, and the uric acid level is 8.7 mg/dL. Coagulation panel findings are within normal limits. Urine analysis findings are negative.

Peripheral smear and bone marrow findings are shown in figures 1 and 2.

Figure 1.

Figure 2.


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