0
A LJ 3-year-old female patient is referred for evaluation of leukocytosis which has beenn present for the last 3 years. Complete blood shows leukocyte count of 1 7 .000. hemoglobin 1 LJ.3 g/dl. and platelet count 390.000/JLL. Physical exam shows no lymph- adenopathy or hepatosplenomegaly. Other than a long history of tobacco abuse. the patien t has no significant medical problems. The peripheral blood smear is shown below.
Which of the following tests would be the next appropriate step in the evaluation of this patient?
- Flow cytometry
- Bone marrow biopsy
- Stain for myeloperoxidase
- Stain for nonspecific esterase
- TCR gene rearrangement
Medicine
A. The peripheral blood smear shows large lymphocytes with clumped chromatin, some of which have bilobed nuclei, without azurophilic cytoplasmic granules. This finding, coupled with a smoking history in a female, should make one consider polyclonal lymphocytois, which has been de-scribed in such patients. Flow cytometry would be critical to determine if the expansion in white cells is monoclonal or polyclonal. Bone marrow biopsy might be indicated depending on the results of flow cytometry. Myeloperoxidase and nonspecific esterase staining may be used in the diagnosis of acute myeloid leukemia (AML) but has been supplanted by flow cytometry. TCR gene rearrangement assay is of value in the evaluation of large granular lymphocytes (LGL) leukemia, which is usually associated with neutropenia and large lymphocytes with prominent granules.
need an explanation for this answer? contact us directly to get an explanation for this answer