From the Guidelines
The patient's complete blood count (CBC) results are mostly within normal limits, with a slightly elevated absolute monocyte count at 1.1 x10³/μL, which may indicate a chronic inflammatory process, infection, or recovery from a recent illness, and should be interpreted in the context of the patient's symptoms and clinical presentation. The patient has a normal white blood cell count, red blood cell count, hemoglobin, hematocrit, and red cell indices. The platelet count is at the upper limit of normal at 449 x10³/μL. The mean corpuscular volume (MCV) is 95 fL, which is within the normal range, suggesting that the patient does not have microcytic or macrocytic anemia 1.
The elevated monocyte count could be a sign of a underlying condition, such as a chronic inflammatory process or infection, and further evaluation may be warranted if the patient has symptoms such as fatigue, recurrent infections, or other concerning findings. However, if the patient is asymptomatic, monitoring with a repeat CBC in 1-3 months would be reasonable, as mild monocytosis is likely not clinically significant on its own 1.
Key points to consider in the patient's CBC results include:
- Normal white blood cell count: 7.4 x10³/μL
- Normal red blood cell count: 4.98 x10⁶/μL
- Normal hemoglobin: 16.0 g/dL
- Normal hematocrit: 47.2%
- Normal MCV: 95 fL
- Elevated absolute monocyte count: 1.1 x10³/μL
- Normal platelet count: 449 x10³/μL
It is essential to interpret the patient's CBC results in the context of their symptoms and clinical presentation, and to consider further evaluation if necessary, as recommended by the clinical practice guidelines for evaluation of anemia 1 and the approaches to evaluating anemia 1.
From the Research
Blood Test Results
The provided blood test results show:
- White Blood Cell (WBC) count: 7.4 x10E3/uL (within normal range)
- Red Blood Cell (RBC) count: 4.98 x10E6/uL (within normal range)
- Hemoglobin: 16.0 g/dL (within normal range)
- Hematocrit: 47.2% (within normal range)
- Mean Corpuscular Volume (MCV): 95 fL (within normal range)
- Mean Corpuscular Hemoglobin (MCH): 32.1 pg (within normal range)
- Mean Corpuscular Hemoglobin Concentration (MCHC): 33.9 g/dL (within normal range)
- Red Cell Distribution Width (RDW): 12.4% (within normal range)
- Platelet count: 449 x10E3/uL (within normal range)
- Neutrophils: 65% (no established normal range)
- Lymphocytes: 17% (no established normal range)
- Monocytes: 15% (no established normal range)
- Eosinophils: 2% (no established normal range)
- Basophils: 1% (no established normal range)
- Immature Cells: not established
- Neutrophils (Absolute): 4.8 x10E3/uL (within normal range)
- Lymphocytes (Absolute): 1.3 x10E3/uL (within normal range)
- Monocytes (Absolute): 1.1 x10E3/uL (high)
- Eosinophils (Absolute): 0.2 x10E3/uL (within normal range)
- Basophils (Absolute): 0.1 x10E3/uL (within normal range)
- Immature Granulocytes: 0% (no established normal range)
- Immature Granulocytes (Absolute): 0.0
Monocytosis
The absolute monocyte count is 1.1 x10E3/uL, which is higher than the normal range (0.1-0.9 x10E3/uL) 2, 3. Monocytosis can be a sign of various conditions, including chronic myelomonocytic leukemia (CMML) 2, 4, 3.
Chronic Myelomonocytic Leukemia (CMML)
CMML is a clonal hematopoietic stem cell disorder characterized by prominent monocytosis and an inherent risk for leukemic transformation 2, 3. The diagnosis of CMML is based on the presence of sustained peripheral blood monocytosis, bone marrow dysplasia, and cytogenetic or molecular evidence of clonality 2, 3.
Risk Stratification
The Mayo Molecular Model (MMM) is a risk model that stratifies CMML patients into four groups based on the presence of truncating ASXL1 mutations, absolute monocyte count, hemoglobin, platelet count, and the presence of circulating immature myeloid cells 2, 3. The patient's absolute monocyte count is high, which is a poor prognostic factor for overall survival 5.
Management
The management of CMML includes hypomethylating agents, such as 5-azacitidine and decitabine, and allogeneic stem cell transplant, which is the only potentially curative option 2, 3.