A 65-year-old-man was found to have neutropenia in a routine physical examination. He had been in relatively good health except for occasional sinusitis and for chronic arthritis. Physical examination demonstrated a large spleen about 3 cm below the left costal margin. No hepatomegaly or lymphadenopathy was detected. Peripheral blood examination revealed a total leukocyte count of 2, 200/μl with 3% neutrophils and 88% lymphocytes (Fig. 56.1). His hematocrit was 34%, hemoglobin 11 g/dl, and platelets 110, 000/μl. A bone marrow examination showed a decrease in myeloid to erythroid (M:E) ratio (0.8:1) (Figs. 56.2 and 56.3). A differential count revealed maturation arrest at the myelocyte stage (16% myelocytes, 2% metamyelocytes, 1% bands, and 1% segmented neutrophils) and an increase in lymphocytes (37%). The patient was treated with methotrexate, cyclophosphamide and cyclosporine with gradual improvement of neutropenia and anemia.


Gene Rearrangement Large Granular Lymphocyte Hematologic Neoplasm Atypical Lymphocyte Left Costal Margin 
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