Case Scenario :
- 59 years old male patient presented with fever for 1 week duration.
- H/O Pain abdomen off & on for 5 days duration.
- H/O Head ache (+)
- No H/O vomiting & loose stools
- Known case of DM type 2, not on proper treatment.
- On examination he was conscious, oriented, febrile.
Investigations
- Blood sugar : 376mgs%
- Blood urea : 42 mgs%
- Serum creatinine : 2.0 mgs%
- Total count : 19,300 cells/cumm
- Hb : 13.3 gms%
- Acetone: negative
CLINICAL DIAGNOSIS :
Long standing T2 DM , Urinary tract infection , Chronic pancreatitis , Ischemic heart disease.
He was admitted in our hospital and was treated with iv antibiotics, IVF, Insulin & symptomatic treatment.
[After stabilization on his 2ND admission day]
- Blood sugar : 248mgs%
- Blood urea : 38 mgs%
- Serum creatinine : 1.7 mgs%
- Total count : 17,500 cells/cumm ( No immature cells)
- Hb : 12.8 gms%
- Acetone: negative
[Patient discharged 5th admission day with following reports]
- Blood sugar : 178mgs%
- Blood urea : 30 mgs%
- Serum creatinine : 1.2mgs%
- Total count : 18,000 cells/cumm (No immature cells)
- Hb : 12.6 gms%
- No H/O Pain abdomen & fever.
[Patient reviewed after 15 days with following reports]
- Blood urea : 32 mgs%
- Serum creatinine : 1.0 mgs%
- Total count : 19,200 cells/cumm (No immature cells)
- Hb : 12.2 gms%
- Patient feels better.
[Patient reviewed after 1 month with following report]
- Blood urea : 34 mgs%
- Serum creatinine : 1.1 mgs%
- Total count : 20,400cells/cumm (No immature cells)
- Hb : 12.4 gms%
His total count increased without any specific symptom patient refer to higher center for bone marrow study.
Bone Marrow Study :
Complete Hemograms :
- AEC (absolute eosinophil count): 200 cells/cumm
- ANC (absolute neutrophil count): 2600 cells/cumm
- HB: 12.1 gms%
- TOTAL WBC COUNT : 25,500 cells/cumm
Differential count :
- Neutrophils: 10 %
- Lymphocytes: 86%
- Monocyte : 3%
- Eosinophils :1%
- Basophils : 0 %
- Platelet count: 23,400cells/cumm.
- PCV : 35%
- Total RBC count : 4.1millions/cumm
- MCV : 86fl
- MCH : 29 Pg
- MCHC : 34 g/dl
- ESR : 38 mm/hr
- Reticulocyte : 1.3 %
Flow Cytometry:
CLPD panel:
Specimen Studied : Peripheral Blood Sample
Method : Immunophenotyping
Impression :
- The scatter parameters and antigen expression and antigen expression profile studied in correlation with morphological findings are consistent with B cell lymphoproliferative disease , suggestive of #CHRONIC LYMPOCYTIC LEUKEMIA#.
Patient refer to medical oncologist for further management.
