Differential Diagnosis
- Single most likely diagnosis
- Chronic Lymphocytic Leukemia (CLL): The presence of smudge cells, progressive leukocytosis, and mild lymphocytosis are highly suggestive of CLL, a type of lymphoproliferative disorder. The patient's age and history of unintentional weight loss also support this diagnosis.
- Other Likely diagnoses
- Monoclonal B-cell Lymphocytosis (MBL): This condition is characterized by the presence of small clones of B cells and can be a precursor to CLL. The patient's mild lymphocytosis and smudge cells could be indicative of MBL.
- Reactive Lymphocytosis: Although less likely given the progressive nature of the leukocytosis, reactive lymphocytosis could be considered, especially if the patient has a underlying infection or inflammatory condition.
- Myeloproliferative Neoplasm (MPN): The patient's neutrophilia and progressive leukocytosis could also be indicative of an MPN, such as essential thrombocythemia or polycythemia vera.
- Do Not Miss
- Lymphoma: Although less likely given the absence of systemic symptoms such as fever and night sweats, lymphoma should be considered and ruled out due to its potential severity and impact on treatment.
- Leukemia (other types): Other types of leukemia, such as acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL), should be considered and ruled out due to their aggressive nature and potential for rapid progression.
- Rare diagnoses
- Hairy Cell Leukemia: This rare type of leukemia is characterized by the presence of hairy cells in the blood and bone marrow. Although unlikely, it should be considered in the differential diagnosis due to its distinct clinical and laboratory features.
- Large Granular Lymphocytic Leukemia: This rare type of leukemia is characterized by the presence of large granular lymphocytes in the blood and bone marrow. It is often associated with cytopenias and should be considered in the differential diagnosis.