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A 57-year-old man presents with fatigue and dyspnea on exertion. Initial laboratory workup shows hemoglobin 1 0.5 g/dl with an MCV of 85 fl. leukocyte count 11 .2 00/ .uL. and platelet count 1 67 ,000/ .uL. No lymphadenopathy or splenomegaly was noted on physical exam. Peripheral blood smear is shown below.
What is the most common clinical presentation of LGL?
- Massive splenomegaly and lymphadenopathy
- Severe anemia requiring transfusion
- Severe neutropenia and infections
- Mental status changes secondary to hyperviscosity
- Purpuric rash secondary to thrombocytopenia
Medicine
C. Neutropenia is present in up to 85% of patients with LGL and is commonly severe with an absolute neutrophil count less than 500. Although splenomegaly is seen in 25% to 50% of cases, lymphadenopathy is not common. Severe anemia and thrombocytopenia may occur, but are not as common as leukopenia at presentation. Hyperviscosity is not a clinical feature of LGL leukemia. (Blood. 20 11;1 17(10):2764-2774)
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