A 76-year-old man presented with weakness and dyspnea for a week. The patient had been treated for plasma cell myeloma for the past three years. Laboratory examination revealed anemia, thrombocytopenia, and leukocytosis. The total leukocyte count was 13, 500/μl with 74% lymphocytes by automatic cell count. However, manual examination revealed that many of the “lymphocytes” were immature plasma cells. Further examination showed that his β2-microglobulin was 2.8 mg/l and lactate dehydrogenase 411 mg/dl. His immunoglobulin study demonstrated decreases in all immunoglobulins as compared with the levels six months ago. The morphology of the tumor cells in the peripheral blood and bone marrow is depicted in Figs. 36.1, 36.2 and 36.3.


Plasma Cell Total Leukocyte Count Hematologic Neoplasm Automatic Cell Count Plasma Cell Leukemia 
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