From the Guidelines
The patient's blood test results indicate a possible chronic myeloid leukemia (CML) in chronic phase (CP), given the elevated white blood cell count, hemoglobin, and hematocrit levels, although the second test shows normalization of some parameters, and the absolute lymphocyte count remains elevated, suggesting the need for further monitoring and potentially a bone marrow biopsy for definitive diagnosis, as recommended by the European LeukemiaNet (ELN) guidelines 1.
The blood test results show several abnormal values, including an elevated white blood cell count (WBC) of 11.4 x10^3/μL in the first test, which normalized to 9.6 x10^3/μL in the second test. Hemoglobin and hematocrit were both high in the first test (16.7 g/dL and 49.4% respectively) but returned to normal ranges in the second test. The mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) were slightly elevated in the first test, indicating slightly larger red blood cells with more hemoglobin content.
Key findings include:
- Elevated absolute lymphocyte count in both tests (4.6 and 3.9 x10^3/μL), which could suggest an ongoing viral infection, chronic inflammation, or certain lymphoproliferative disorders, and warrants further investigation 1.
- Presence of immature granulocytes in the first test (1%) that disappeared in the second test, which may indicate that the body was responding to an infection that has since improved.
- The patient's red blood cell count, platelet count, and other parameters are within normal limits or have normalized in the second test.
According to the ELN guidelines, a diagnosis of CML in CP is considered when there are less than 15% blasts in the blood and bone marrow, and the patient presents with splenomegaly, fatigue, weight loss, and other symptoms related to anemia and leukocytosis 1.
Given the patient's laboratory results and the ELN guidelines, a bone marrow biopsy and further testing, such as flow cytometry and molecular analysis, are necessary to confirm the diagnosis of CML and to rule out other potential causes of the patient's symptoms and abnormal laboratory results 1.
From the Research
Blood Test Results
The provided blood test results show various parameters, including:
- White Blood Cell (WBC) count: 11.4 and 9.6 x10E3/uL, which is within the normal range of 3.4-10.8 x10E3/uL 2
- Red Blood Cell (RBC) count: 5.05 and 4.28 x10E6/uL, which is within the normal range of 3.77-5.28 x10E6/uL
- Hemoglobin: 16.7 and 14.0 g/dL, with 16.7 being higher than the normal range of 11.1-15.9 g/dL
- Hematocrit: 49.4 and 41.5 %, with 49.4 being higher than the normal range of 34.0-46.6 %
- Mean Corpuscular Volume (MCV): 98 and 97 fL, with 98 being higher than the normal range of 79-97 fL
- Mean Corpuscular Hemoglobin (MCH): 33.1 and 32.7 pg, with 33.1 being higher than the normal range of 26.6-33.0 pg
- Mean Corpuscular Hemoglobin Concentration (MCHC): 33.8 and 33.7 g/dL, which is within the normal range of 31.5-35.7 g/dL
- Red Cell Distribution Width (RDW): 12.5 and 12.1 %, which is within the normal range of 11.7-15.4 %
- Platelets: 377 and 318 x10E3/uL, which is within the normal range of 150-450 x10E3/uL
- Neutrophils: 49 and 49 %, with no established normal range
- Lymphs: 40 and 41 %, with no established normal range
- Monocytes: 6 and 6 %, with no established normal range
- Eos: 3 and 3 %, with no established normal range
- Basos: 1 and 1 %, with no established normal range
Abnormal Results
The abnormal results include:
- Hemoglobin: 16.7 g/dL, which is higher than the normal range of 11.1-15.9 g/dL
- Hematocrit: 49.4 %, which is higher than the normal range of 34.0-46.6 %
- MCV: 98 fL, which is higher than the normal range of 79-97 fL
- MCH: 33.1 pg, which is higher than the normal range of 26.6-33.0 pg
- Lymphs (Absolute): 4.6 x10E3/uL, which is higher than the normal range of 0.7-3.1 x10E3/uL
- Lymphs (Absolute): 3.9 x10E3/uL, which is higher than the normal range of 0.7-3.1 x10E3/uL
Relevant Studies
The study by 2 discusses the complete blood count and its components, including the red blood cell count, hemoglobin, hematocrit, and white blood cell count and differential. This study provides information on the physiologic basis and clinical usage of the complete blood count, which can be helpful in understanding the results of the provided blood test. However, the study by 3 is not directly relevant to the provided blood test results, as it discusses the CO-binding kinetics of cytochrome a3 in isolated, detergent-solubilized cytochrome oxidase.