The Hematologist

March-April 2018, Volume 15, Issue 2

A Man With Hyperleukocytosis and Massive Splenomegaly

Kyle Parker, MD Resident Pathologist
University of Chicago Medical Center, Chicago, IL
Girish Venkataraman, MD Assistant Professor
The University of Chicago Medicine, Chicago, IL

Published on: February 20, 2018

A previously healthy 27-year-old man presented to an outside hospital with bilateral ear aches and prescribed a short course of antibiotics with a working diagnosis of bilateral otitis media. Two weeks later, he presented to an outside hospital emergency department with syncope and was transferred immediately to our hospital for further care. During admission, on physical examination the patient was noted to have palpable splenomegaly. Laboratory tests performed were notable for a white blood cell count of 103.9 × 103/μL, hemoglobin of 8.1 g/dL, and platelets of 99 × 103/μL. Abnormal circulating cells were present in significant numbers (45%, black arrow; 12%, grey arrow). However, reverse transcriptase–polymerase chain reaction for BCR-ABL detected only very low numbers of both p210 and p190 transcripts. The images shown here are of a Giemsa-stained peripheral blood smear (Figure 1 [low power] and Figure 2 [high power]), hematoxylin and eosin stained bone marrow core biopsy (Figure 3), and CD61 immunostain on core biopsy for megakaryocytes (Figure 4).

Giemsa-stained peripheral blood smear (low power)

Giemsa-stained Peripheral Blood Smear (Low Power).


Giemsa-stained peripheral blood smear (high power)

Giemsa-stained Peripheral Blood Smear (High Power).


Hematoxylin and eosin stain of the core biopsy

Hematoxylin and Eosin Stain of the Core Biopsy


CD61 immunostain on bone marrow core biopsy for megakaryocytes

CD61 Immunostain on Bone Marrow Core Biopsy for Megakaryocytes

 

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