The Hematologist

May-June 2018, Volume 15, Issue 3

A Real Nose-Pincher

Yi Li, MD, MSc Clinical Fellow in Hematopathology
Brigham and Women's Hospital, Boston, MA
Annette S. Kim, MD, PhD Associate Professor of Pathology
Harvard Medical School; Brigham and Women's Hospital, Boston, MA

Published on: April 23, 2018

A 68-year-old man with a history of polycystic kidney disease presented five months postcadaveric renal transplantation with new-onset neutropenia and anemia, as well as a rising creatinine (2.59 mg/dL the prior week) with no other significant symptoms. A concurrent complete blood count showed the following:

White blood cell count 2.25 K/μL (absolute neutrophil count 0.71 K/μL)
Hemoglobin 7.9 g/dL
Hematocrit 24.9%
Mean corpuscular volume 86.2 fL
Platelet count 160 K/μL.

A 95-gene next-generation sequencing myeloid panel identified no pathogenic variants or copy number alterations. Metaphase cytogenetics revealed a normal karyotype. Two images from the peripheral blood smear and one image of the bone marrow biopsy are shown in Figures 1 and 2.

Peripheral blood smear
Peripheral blood smear
Bone marrow biopsy



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