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A 57 -year-old male truck driver presen ts For evaluation of chest pain and dyspnea on minimal exertion. Patien t reports gradually worsening generalized Fatigue over the precedi ng 3 mon ths. Examination reveals splenomegaly. Laboratory workup shows leukocyte count of 32.000/pl. hemoglobin of 9.7 g/dl. and platelet count of 1 3LJ .0001 pl. Peripheral blood smear reveals increased number of homogeneously ap-pearing leukocytes as shown below.
What is the next most appropriate test to perform?
- Leukocyte alkaline phosphatase
- BCR-ABL translocation
- Flow cytometry
- CT chest/abdomen/pelvis
- Spleen biopsy
Medicine
B. Peripheral blood count reveals increased number of monocytes. The clinical picture of increased leukocyte count, absolute monocytosis, and splenomegaly raise concern for underlying chronic myeloid leukemia (CML) or chronic myelomonocytic leukemia (CMML). Testing for BCR-ABL translocation will differentiate between the two as CML is by definition positive while CMML is negative for BCR-ABL translocation (Leukemia. 2008;22(7):1308).
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