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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.

Keywords

Gene Rearrangement Large Granular Lymphocyte Hematologic Neoplasm Atypical Lymphocyte Left Costal Margin 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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