This 60 year old male patient was referred by his general practitioner to a specialist because of persisting lymphadenopathy. The peripheral blood count on CELL-DYN Ruby showed thrombocytopenia and leukocytosis which was accompanied by the DFLT (LM) flag, indicating that the algorithm was unable to make a clear separation between the lymphocyte and monocyte population. Visual interpretation of the WBC scatterplots and the NWBC-LYM-MONO histogram suggested that the default threshold lines spuriously classified part of the “lymphocyte” population as monocytes. This finding was confirmed by microscopic examination, which showed mainly medium-sized pleomorphic lymphocytes with irregular nuclei. Immunological typing of the leukemic cells and lymph nodes confirmed the diagnosis of mantle cell lymphoma.
SUSPECT |
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WBC | 16.7 | 10e3/μL | NOC |
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NEU | 4.08 | 24.4 | % |
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LYM | 10.3* | 61.6* | % | VARLYM |
MONO | 2.03* | 12.2* | % |
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EOS | .201 | 1.20 | % |
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BASO | .102* | .611 | % | DFLT (LM) |
RBC | 4.23 | 10e6/μL |
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HGB | 12.5 | g/dL |
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HCT | 39.2 | % |
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MCV | 92.6 | fL |
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MCH | 29.5 | pg |
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MCHC | 31.9 | g/dL |
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RDW | 13.9 | % | ||
PLT | 98.2 | 10e3/μL |
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MPV | 12.7 | fL | ||