Slide of the Week: Elevated WBC Following Hemorrhage and Subsequent Infection, August 8th, 2011

A 63 year old male was hospitalized following a massive hemorrhage secondary to a motor vehicle accident and subsequent infection of a surgical site.  Three weeks post-admittance his WBC demonstrated a marked elevation (40,000/mm3).  Subsequent laboratory tests showed a very high leukocyte alkaline phosphatase score, whereas the PCR for the BCR/ABL fusion gene was negative.

Elevated WBC Following Hemorrhage and Subsequent Infection

 

Elevated WBC Following Hemorrhage and Subsequent Infection: x100 zoom

 

What is your most likely diagnosis?

  1. CML
  2. AML
  3. Leukemoid reaction

 

 

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Click here for the comparative pathology.

Scroll below for answers.


 

 

 

 

 

 

 

 

 

Answer: 3, Leukemoid reaction.


 

Comment:

A marked increase in total WBC and myeloid elements in the peripheral blood can be found in settings other than leukemia, including infections and post-hemorrhage.  Testing for the presence of the Ph chromosome and BCR-ABL gene product help to rule out a diagnosis of CML, as would a more invasive bone marrow examination.  Also to be noted on this leukemoid reaction smear is the relatively large number of more mature neutrophils than would be expected in leukemia, which tends to exhibit more immature forms.

 

Reference:

Melo JV, Hughes TP, Apperley JF. Chronic myeloid leukemia. Hematology Am Soc Hematol Educ Program. 2003:132-52. Review. PubMed PMID: 14633780.

 

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