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

Click here to see the whole slide image.

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.

Related Posts

• Slide of the Week: CNS Mass, December 12th, 2011
• Slide of the Week: Severe Uterine Hemorrhage, November 28th, 2011
• Slide of the Week: Pancreatic Mass, November 14th, 2011
• Slide of the Week: Young Female with Breast Mass, October 31st, 2011
• Slide of the Week: Li-Fraumeni Syndrome, October 17th, 2011
• Slide of the Week: Hereditary Multiple Exostosis, October 3rd, 2011
• Slide of the Week Answers: Stomach Mass, September 19th, 2011
• Slide of the Week: Stomach Mass, September 19th, 2011
• Slide of the Week: Medullary Thyroid Cancer, September 5th, 2011
• Slide of the Week: Mammary Gland Biopsy, August 22th, 2011

Related posts:

1. Slide of the Week: Increased WBC, April 14, 2011
2. Slide of the Week: Clear Cell Carcinoma, Kidney, May 3, 2011
3. Slide of the Week: Lobular Breast Carcinoma, March 9, 2011
4. Slide of the Week: Squamous Cell Carcinoma of the Lung, June 20th, 2011
5. Slide of the Week: Carcinoid in the Lung, July 25th, 2011