HCT of 30,4% is low and should be complemented by RBC and Hb to calculate the red cell indices. Platelets 625,000 / µl is probably reactive with corresponding morphology in the blood smear (anisocytosis, larger plts?). Or is it an artifact by fragmented red cells? Lymph: 4270/µl WBC x 12% = 512 lymph / µl is low Mono: 4270/µl WBC x 26% = 1110 monos/µl is reactive Eos: 4270/µl WBC x 14,8% = 631 eos/µl is upper normal range Neutrophils are 4270x44%=1880/µl just below normal. There seems to be an abnormal propagation of cytotoxic CD4 cells (57+38+). CD8 cells are extremely low in this case and CD4+57+ could be the repair for the normal cytotoxic T cells. Also B and NK cells must be very low (together 8% of 512 = 41/µl). CD8 are 4% = 20/µl. Obviously normal CD4s are missing. CD4+57 are normally rare even in reactive cases. The near absence of normal lymphs is hard to explain in a reactive situation. Immediate searech for lymph nodes is needed and surgical lymph node extirpation is required to exclude lymphoma (including MRT for mediastinum). Our approach: Review blood smear, do absolute counts from all blood cell populations and subpopulations, contact clinician, get patients history (how long?). Is antigen density normal, is CD2, CD5 or CD7 dim? TCR rearrangement? T-NHL can not be excluded from the data presented. Clinical FCM in its typical limitations. Regards Thomas Nebe Universitaetsklinikum Mannheim > ______________________________ Reply Separator > _________________________________ > Subject: Unusual case > Author: stetler@box-s.nih.gov at INTERNET > Date: 26/01/1999 18:49 > > > Here's a weird one: > > 43 yo white male. 30.4%HCT, 625 K/UL plateets, WBC- 4.27 K/UL with > 44.3% polys, 12% lymphocytes, 26.5% monocytes, 14.8% eosinophils and 2.4% > basophils. 96% of lymphocytes are T-cells. 92% of Lymphocytes are > CD4+,CD3+ > and 4 % CD8+,CD3+. This is the cute part- 45% are CD4+, CD57+, CD3+ > T-cells. They are mostly CD7+ (15% CD7-,CD3+), all CD2+ and CD5+ (a > slightly dim population noted). They are TCR alpha beta +, CD16-, CD38+, > and HLADR- as well as negative for B-cell antigens. How often have you > seen > CD4+CD57+ T-cells? > > Maryalice > Maryalice Stetler-Stevenson > Director Flow Cytometry Unit > Laboratory of Pathology, NCI, NIH
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