March-April 2018, Volume 15, Issue 2
A Man With Hyperleukocytosis and Massive Splenomegaly
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).