The Journal of the American Osteopathic Association, 2020/04, 120(4):286. doi: 10.7556/jaoa.2020.046, type of study: ,ci,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

Free full text   (https://www.degruyter.com/document/doi/10.7556/jaoa.2020.046/html)

Keywords:

chronic lymphocytic leukemia [1]
Wright-Giemsa stain [1]
clinical images [12]

Abstract:

An 87-year-old man with a history of paroxysmal atrial fibrillation, hypertension, and chronic kidney disease presented to the emergency department with confusion, weakness, and shortness of breath with nonproductive cough. Laboratory studies revealed a white blood cell count of 41,300 × 109/L, an absolute lymphocyte count of 23,500 × 109/L, a hemoglobin level of 9.8 g/dL, a platelet count of 280,000 × 109/L, and a creatinine level of 1.16 mg/dL. On physical examination, the patient had no hepatosplenomegaly, lymphadenopathy, bruising, or bleeding. An evaluation for infection or autoimmune conditions was unrevealing. A peripheral blood smear revealed smudge cells (image A) and small round lymphocytes with coarsely clumped chromatin (image B) characteristic of chronic lymphocytic leukemia (CLL; Wright-Giemsa stain).