A 56 y.o. African-American male presents with a two-month history of decreased exercise tolerance and groin soreness. He states that he has been in good health, although he had always had "low blood", as has one of his siblings. Physical examination (PE) revealed splenomegaly and enlarged inguinal and axillary lymph nodes.
The following laboratory results were obtained:
WBC 58.8 x 103
NE 11.6%
LY 74.3%
MO 10.7%
EO 2.5%
BA 0.9%
RBC 5.19 x106
HGB 9.4 g/dl
HCT 31.3%
MCV 60.3 fl
MCH 18.0 pg
MCHC 29.9 g/dl
RDW 25.5%
PLT 425 x 103
View peripheral blood PB_smear_1, PB_smear_2, and PB_smear_3.
Questions:
1. What is suggested by the WBC data?
2. What WBC disorder is supported by the clinical, laboratory, and morphologic data?
3. What further studies may be performed to confirm this diagnosis?
4. What is suggested by the RBC data?
5. What disorder(s) can explain the RBC data?
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